Who Becomes a High Utilizer? A Case-Control Study of Older Adults in the USA

Frequently hospitalized patients represent a high-cost population at risk of poor outcomes. These high-utilizers represent only 1.6% of admitted patients, but they account for 8% of admissions and 7% of direct costs.1,2 While prior studies have identified risk factors for 30-day readmissions,3 little is known about risk factors associated with patients who accrue multiple admissions over a longer period of time. Prior studies using cross-sectional analyses have also neglected to identify upstream risk factors for becoming a high-utilizer.3,4 Proactively identifying patients years before entering a cycle of frequent hospitalizations may allow for early intervention to prevent hospitalizations and improve outcomes. We sought to identify distinguishing comorbid conditions, functional limitations, and social risk factors that differentiate patients, who had 5 or more hospitalizations over a 2-year period, years before they became high-utilizers.