Super Utilizer Research Paper

BACKGROUND: Super-utilizers are individuals with disproportionately high inpatient and emergency department (ED) use, and mostly have multiple chronic conditions and use multiple concurrent medications. They place a substantial burden on the U.S. healthcare system and have become the focus of policy initiatives aimed at reducing their disproportionate inpatient and ED use. Medication management is critical for these patients since nonadherence to essential chronic medications is associated with poor health outcomes, and higher health care utilization and costs.

OBJECTIVES: This dissertation employs a three empirical research papers approach to study the following aims: (1) the prevalence and patterns of medication nonadherence to essential chronic medications in Medicare super-utilizers with chronic conditions, and to identify the factors associated with medication nonadherence, with special emphasis on factors including mental illness and use of opioid medications, (2) examine associations between medication nonadherence, and inpatient and ED use, and to evaluate other risk factors associated with health care utilization in Medicare super-utilizers with chronic conditions, and (3) examine the impact of the SafeMed Program, a care transitions program with a focus on medication management, on medication use and adherence among publicly insured super-utilizers with chronic conditions.
In the multivariate analysis examining predictors of medication nonadherence, we found that compared with patients who did not use any opioid medication in the previous period, patients using >4 opioid medications had higher odds of medication nonadherence. Other risk factors for nonadherence included age 1 physician office visits in the previous