Identifying Social Need Trends Among Emergency Department Super-Users: A Latent Class Analysis.

Abstract

Introduction

Frequent emergency department (ED) users, particularly those with high rates of use, often experience complex social determinants of health (SDOH) that contribute to their repeated visits and may lead to adverse health outcomes. Our objective in this study was to characterize the needs most commonly affecting this population, which may support the creation of tailored interventions with a higher chance of success.Methods

This was a retrospective analysis of patients evaluated by an ED social medicine team in a large urban academic ED from May 2021-December 2023. Patients were identified either via frequent ED use (patients with the 10 highest number of visits each month) or referred by ED staff. We assigned 11 categories of medical, mental health, and social needs through chart review and team documentation. The primary outcome was the identification of distinct need-based subgroups among patients with high ED use, using latent class analysis of documented social, mental health, and medical needs.Results

Of the 181 patients, representing approximately 0.4% of the ED patient population, 149 (82.3%) were frequent ED users, with a median of 14 ED visits annually (IQR 8-21), while the rest were referred by ED staff (median 2 visits (1-4.25). The majority were non-Hispanic Black (159, 87.8%) and publicly insured (163, 90.0%). The most common needs were related to housing instability (116, 64.1%) and limited access to outpatient care (112, 61.9%). Latent class analysis revealed four distinct subgroups, all of which included limited access to outpatient care: 1) primarily limited access to outpatient care (40, 22.1%); 2) housing instability and other basic needs (27, 14.9%); 3) housing instability, psychotic disorders, other basic needs, and inability to live independently (23, 12.7%); and 4) housing instability, substance use, and psychotic disorders (91, 50.3%).Conclusion

This analysis identified four distinct need-based subgroups of frequent ED users, suggesting the need for tailored, multifaceted interventions. Housing instability, psychiatric illness, substance use, and outpatient care access were prevalent across groups, underscoring the importance of including resources for these basic needs in any programs developed for this population. Findings support prioritizing coordinated care models, particularly those that incorporate housing, behavioral health, substance use resources, and navigation support, for this vulnerable population.

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BibTeX RIS

BibTeX

@article{kumaravel2026identifying,
  title = {{Identifying Social Need Trends Among Emergency Department Super-Users: A Latent Class Analysis.}},
  author = {Shwath Kumaravel and Emily Parker and Eleanor Friedman and Kimberly A Stanford},
  journal = {The western journal of emergency medicine},
  year = {2026},
  month = jul,
  doi = {10.5811/westjem.58307},
  url = {https://europepmc.org/article/MED/42900946},
  note = {CC BY},
}

RIS

TY  - JOUR
TI  - Identifying Social Need Trends Among Emergency Department Super-Users: A Latent Class Analysis.
AU  - Shwath Kumaravel
AU  - Emily Parker
AU  - Eleanor Friedman
AU  - Kimberly A Stanford
PY  - 2026
DA  - 2026/07/28
JO  - The western journal of emergency medicine
DO  - 10.5811/westjem.58307
UR  - https://europepmc.org/article/MED/42900946
AB  - Introduction  Frequent emergency department (ED) users, particularly those with high rates of use, often experience complex social determinants of health (SDOH) that contribute to their repeated visits and may lead to adverse health outcomes. Our objective in this study was to characterize the needs most commonly affecting this population, which may support the creation of tailored interventions with a higher chance of success.Methods  This was a retrospective analysis of patients evaluated by an ED social medicine team in a large urban academic ED from May 2021-December 2023. Patients were identified either via frequent ED use (patients with the 10 highest number of visits each month) or referred by ED staff. We assigned 11 categories of medical, mental health, and social needs through chart review and team documentation. The primary outcome was the identification of distinct need-based subgroups among patients with high ED use, using latent class analysis of documented social, mental health, and medical needs.Results  Of the 181 patients, representing approximately 0.4% of the ED patient population, 149 (82.3%) were frequent ED users, with a median of 14 ED visits annually (IQR 8-21), while the rest were referred by ED staff (median 2 visits (1-4.25). The majority were non-Hispanic Black (159, 87.8%) and publicly insured (163, 90.0%). The most common needs were related to housing instability (116, 64.1%) and limited access to outpatient care (112, 61.9%). Latent class analysis revealed four distinct subgroups, all of which included limited access to outpatient care: 1) primarily limited access to outpatient care (40, 22.1%); 2) housing instability and other basic needs (27, 14.9%); 3) housing instability, psychotic disorders, other basic needs, and inability to live independently (23, 12.7%); and 4) housing instability, substance use, and psychotic disorders (91, 50.3%).Conclusion  This analysis identified four distinct need-based subgroups of frequent ED users, suggesting the need for tailored, multifaceted interventions. Housing instability, psychiatric illness, substance use, and outpatient care access were prevalent across groups, underscoring the importance of including resources for these basic needs in any programs developed for this population. Findings support prioritizing coordinated care models, particularly those that incorporate housing, behavioral health, substance use resources, and navigation support, for this vulnerable population.
SN  - 1936-900X
SN  - 1936-9018
ER  -

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