Background:

Although many studies have described patients who frequently utilize emergency department and psychiatry services, little is known of the population frequently admitted to inpatient medicine services. This study characterized the frequently hospitalized group in terms of demographics, length of stay, costs, comorbidities, 1‐year mortality, and reason for hospitalization.

Methods:

During a 6‐month period (January 21, 2009, through July 20, 2009), we selected all adult patients who had >4 admissions to inpatient medicine services at a large academic hospital. Scheduled admissions (largely for chemotherapy) were excluded. We identified a total of 64 such patients. Data were collected on sex, age, race, marital status, insurance status, utilization of outpatient resources, comorbidities from the Charlson comorbidity index, coexistence of mental health disorders, chronic pain syndromes/narcotic dependence, reason for hospitalization, length of stay, and cost (the latter 2 both for index hospitalization and cumulative for 6 months). Descriptive statistics were used to determine characteristics and trends within the group.

Results:

The population was 78% white, 17% black, and 36% married. All patients were insured; 61% had Medicaid/Medicare. On average, patients were admitted 6 times for 29 days total (5 days/hospitalization) at a cost of $203,000 ($28,900 per hospitalization) over the 6‐month period. During this time frame, these 64 patients utilized a total of 405 hospitalizations and 1850 hospital days at a cost in excess of $13 million. On average, they utilized outpatient visits 10 times in 6 months. The most common comorbidities were renal disease (39%), diabetes mellitus (34%), chronic pulmonary disease (30%), coronary artery disease (28%), malignancy (28%), congestive heart failure (23%), immunosuppression (20%), and cerebrovascular accident/transient ischemic attack (16%). Even more common than medical comorbidities were coexisting mental health disorders (63%) and chronic pain/narcotic dependence (61%). Aside from the most frequent reason for hospitalization (atypical chest pain), reasons for hospitalization were quite varied. Thirty‐four percent of patients died within 1 year of the study period.

Conclusions:

Frequently hospitalized patients who utilize an enormous amount of hospital resources have a wide variety of comorbidities and reasons for hospitalization. All patients were insured, and the majority of patients maintained outpatient follow‐up visits in the interim between hospitalizations, indicating better than average access to medical care. There was a strong association between frequently hospitalized patients and underlying mental health disorders as well as chronic pain. Frequent hospitalizations were a predictor of 1‐year mortality.

Disclosures:

J. G. Dastidar ‐ none; M. Jiang ‐ none; S. J. Bernstein ‐ none