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Abstract Trends of Hospital Utilization among High-Utilizers of Inpatient Services in an Urban, Safety-Net Hospital Introduction: Although high-utilizers of healthcare services represent only a small portion of hospital population they account for huge healthcare cost in the United States. Hence, there is a need to understand the patterns of hospital utilization among high-utilizers in order to develop intervention to reduce overall hospital cost. Aim: To determine inpatient hospital utilization pattern among high-utilizers in Grady Hospital, Atlanta. Methods: Trend analysis was done to understand the pattern of health care utilization among high-utilizer (n=510) patients (HUPs) from 2011 to 2014. Multivariate logistic regression analysis was performed to determine the association between selected socio-demographic characteristics and HUPs. Results: Almost all HUPs were non-Hispanic Blacks (82.6%) with average mean age of 58. Significant proportion were employed with no health coverage. Approximately 27% of the 510 participants were HUPs at the end of 2012. At the end of 2013, the proportion of patients who became HUPs and NHUPs were 37% and 39% respectively. By 2014, 37% of patients who were HUP in 2013 remained HUP in 2014. Conclusion: The pattern of hospital utilization among high utilizers is unstable and unpredictable, and may be driven by race. Our study shows that reducing heath care cost may require developing predictive models to reduce hospital over-utilization usage among at risk group.