Objective:

This quality improvement initiative aimed to implement High Utilizer Plans (HUPs) to reduce emergency department (ED) visits, inpatient admissions, and healthcare costs for patients frequently presenting with migraines and other primary headache disorders.

Background:

Migraines contribute significantly to ED visits and hospital admissions, straining healthcare systems. Patients with recurrent visits often receive inconsistent treatment, leading to variable outcomes, unnecessary imaging, longer stays, and higher costs. U.S. healthcare spending on migraine-related ED visits is approximately $700 million annually, with inpatient admissions adding $375 million. HUPs were designed to standardize care, improve treatment outcomes, and optimize resource use in collaboration with outpatient providers.

Design/Methods:

A retrospective review identified patients with at least one inpatient admission or two or more ED visits for migraines between July 2021 and June 2022. Ten high-utilization patients were selected. Personalized HUPs were developed based on prior treatment outcomes and integrated into the hospital’s electronic health record (EPIC) for use during inpatient and ED visits allowing for ease of access for clinicians when opening patient chart. Outcome measures included ED visits and inpatient admissions, tracked from FY22 to March 2024.

Results:

During the first four months of HUP implementation, ED visits and admissions were reduced by 50%. However, ED visits increased by 240% and admissions by 600% over the following five months. Overall, ED visits decreased by 29%, and admissions by 36% compared to FY23. HUPs reduced an average of 1.2 ED visits and 0.5 inpatient admissions per patient, saving $920.94 per ED visit and $2,432.69 per admission.

Conclusions:

Initial data suggest that HUPs can reduce ED visits and inpatient admissions. With continued data collection and long-term follow-up, these plans may play a pivotal role in decreasing migraine-related healthcare utilization.