Factors Associated With Emergency Department Use by Patients With and Without Mental Health Diagnoses

Matthew J Niedzwiecki,Pranav J Sharma,Renee Y Hsia,Hemal K Kanzaria,Shannon Mcconville

doi:10.1001/jamanetworkopen.2018.3528

Abstract

An association between frequent use of the emergency department (ED) and mental health diagnoses is frequently documented in the literature, but little has been done to more thoroughly understand why mental illness is associated with increased ED use. To determine which factors were associated with higher ED use in the near future among patients with and without mental health diagnoses. A retrospective case-control study of all patients presenting to the ED in California in 2013 using past ED data to predict future ED use. Data from January 1, 2012, through December 31, 2014, from California's Office of Statewide Health Planning and Development were analyzed. Factors associated with higher ED use in the year following an index visit for patients with vs without a mental health diagnosis. Among the 3 446 338 individuals in the study (accounting for 7 678 706 ED visits), 44.6% (1 537 067) were male; 31.6% (1 089 043) were between the ages of 18 and 30 years, 40.3% (1 338 874) were between the ages of 31 and 50 years, and 28.1% (968 421) were between the ages of 51 and 64 years. The mean (SD) number of ED visits per patient per year was 1.69 (2.56), and 29.1% of patients (1 002 884) had at least 1 mental health diagnosis. Previous hospitalization and high rates of lagged ED visits were associated with higher future ED use. The severity of the mental health diagnosis (mild, moderate, or severe) was associated with increased ED visits (incidence rate ratio [IRR], 1.029; 95% CI, 1.02-1.04 for mild; IRR, 1.121; 95% CI, 1.11-1.13 for moderate; and IRR, 1.226; 95% CI, 1.22-1.24 for severe). Little evidence was found for interaction effects between mental health diagnoses and other diagnoses in predicting increased future ED use. Certain classes of mental health diagnoses were associated with higher ED use. The presence of a mental illness diagnosis did not appear to interact with other patient-level factors in a way that meaningfully altered associations with future ED use.

Highlights

The rate of visits to US emergency departments (EDs) continues to rise, and EDs increasingly treat medically underserved patients.[1]
The severity of the mental health diagnosis was associated with increased ED visits
The presence of a mental illness diagnosis did not appear to interact with other patient-level factors in a way that meaningfully altered associations with future ED use

Summary

Introduction

The rate of visits to US emergency departments (EDs) continues to rise, and EDs increasingly treat medically underserved patients.[1] Because EDs are a high-cost care setting, policymakers have concentrated on ways to reduce potentially avoidable utilization.[2,3] One area of focus has been on better understanding the profile of frequent ED users, as they account for a disproportionate percentage of ED visits and expenditures. 4% to 8% (15.7 million) of frequent ED users account for 18% to 30% of total ED visits.[4,5,6].

Methods

Results

Discussion

Conclusion