Abstract
IntroductionFrequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs.MethodsThis retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder.ResultsIn the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92–4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27–1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20–3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94–3.25]) were also more likely to be frequent users compared with those with private insurance coverage.ConclusionPatients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.
Highlights
Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide
Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, adjusted rate ratios (aRR) [4.02], 95% confidence interval [CI] [3.92-4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27-1.43]) were more likely to be frequent users
Those covered by Medicare or the state’s Medicaid program Medi-Cal were more likely to be frequent users compared with those with private insurance coverage
Summary
Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. Understanding unique features of this population could lead to better care and lower healthcare costs. Mental illness is widespread and has high medical and socioeconomic costs.[1,2,3,4,5] Emergency department (ED) visits for mental healthcare are growing in the United States (U.S.).[6,7] Many patients continue to face significant barriers to consistent mental healthcare.[2,8,9,10,11] ED visits increase when mental health services are unavailable or uncoordinated.[12,13,14] Nationally, frequent ED users for all diagnoses account for 3–8% of all ED patients and 21–28% of all ED visits.[15,16,17] High ED utilization is often seen as a marker of unmet healthcare needs as well as an opportunity to decrease healthcare costs and improve resource utilization.[15,18,19] Yet prior research on frequent ED users found
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