We examined clinical and geospatial factors associated with frequent emergency department (ED) use and identified neighborhood ED "hotspots" over a two-year period (2014–16). Emergency department patients were classified into three categories: (1) infrequent users (<3 ED visits); (2) semi-frequent users (3 or more visits in a year); and (3) persistent users (3 or more visits in both years). Persistent users were more likely to be female, aged 45–64, and have insurance compared with infrequent and semi-frequent users. Thirty percent of persistent users had both a mental and chronic health condition. Persistent and semi-frequent users were no more likely than infrequent users to use the ED for non-emergent conditions, but were more likely to use the ED for primary care treatable and preventable conditions. Emergency department hotspots were located closer to federally qualified health centers, closer to the main ED, had higher rates of mental health and other chronic conditions.


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pp. 471-490
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