Predictors of frequent emergency department use among patients with psychiatric illness

Chang, Grace; Weiss, Anthony P.; Orav, E. John; Rauch, Scott L.

doi:10.1016/j.genhosppsych.2014.09.010

Cited by 48 publications

(43 citation statements)

References 32 publications

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“…Some studies attempted to use validated questionnaires for material needs. Most studies were cross‐sectional surveys, five were retrospective cohort studies, and three used prospective cohorts . Several studies described their methods as “case‐control” or “prospective” but were in fact cross‐sectional.…”

Section: Resultsmentioning

confidence: 99%

“…While the majority of local studies reported figures between 2.5 and 6%, homelessness rates were significantly higher in studies among high‐risk alcohol and drug users (22.8%), patients with psychiatric diagnoses in Arizona (22.3%), and patients at a public hospital ED near a homeless shelter in New York City (13.8%) . Several studies found an association between homelessness status and health services use (e.g., frequent ED use, hospital readmissions) …”

Section: Resultsmentioning

confidence: 99%

“…Studies varied considerably with respect to how they gathered material needs data. Twelve studies extracted material needs data from the medical chart or from a database, five of which used NHAMCS data . The remaining studies used self‐administered questionnaires or in‐person interviews.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Material Needs of Emergency Department Patients: A Systematic Review

Malecha

Williams

Kunzler

et al. 2018

Academic Emergency Medicine

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Material Needs of Emergency Department Patients: A Systematic Review

Malecha

Williams

Kunzler

et al. 2018

Academic Emergency Medicine

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“…The comprehensiveness of our dataset is especially important given previous work that showed that FEDUs visited different EDs within a region to a greater extent than non-FEDUs. 6 …”

mentioning

confidence: 99%

A Comprehensive View of Frequent Emergency Department Users Based on Data from a Regional HIE

Saef¹,

Carr²,

Bush³

et al. 2016

Southern Medical Journal

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Objectives A small but significant number of patients make frequent emergency department (ED) visits to multiple EDs within a region. We have a unique health information exchange (HIE) that includes every ED encounter in all hospital systems in our region. Using our HIE we were able to characterize all frequent ED users in our region, regardless of hospital visited or payer class. The objective of our study was to use data from an HIE to characterize patients in a region who are frequent ED users (FEDUs). Methods We constructed a database from a cohort of adult patients (18 years old or older) with information in a regional HIE for a 1-year period beginning March 2012.A Patients were defined as FEDUs (those who made four or more visits during the study period) and non-FEDUs (those who made fewer than four ED visits during the study period). Predictor variables included age, race, sex, payer class, county of residence, and International Classification of Diseases, Ninth Revision (ICD-9) codes. Bivariate (χ2) and multivariate (logistic regression) analyses were performed to determine associations between predictor variables and the outcome of being an FEDU. Results The database contained 127,672 patients, 12,293 (9.6%) of whom were FEDUs. Logistic regression showed the following patient characteristics to be significantly associated with the outcome of being an FEDU: age 35 to 44 years; African American race; Medicaid, Medicare, and dual-pay payer class; and ICD-9 codes 630 to 679 (complications of pregnancy, childbirth, and puerperium), 780 to 799 (ill-defined conditions), 280 to 289 (diseases of the blood), 290–319 (mental disorders), 680 to 709 (diseases of the skin and subcutaneous tissue), 710 to 739 (musculoskeletal and connective tissueB disease), 460 to 519 (respiratory disease), and 520 to 579 (digestive disease). No significant differences were noted between men and women. Conclusions Data from an HIE can be used to describe all of the patients within a region who are FEDUs, regardless of the hospital system they visited. This information can be used to focus care coordination efforts and link appropriate patients to a medical home. Future studies can be designed to learn the reasons why patients become FEDUs, and interventions can be developed to address deficiencies in health care that result in frequent ED visits.

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“…Although frequent ED users represent a heterogeneous population with diverse health needs [2], studies across jurisdictions have noted several commonalities, including high rates of acute and chronic medical conditions, mental illness and addictions [3, 4], homelessness [5, 6] and perceived unmet mental health needs [7, 8], when compared to non-frequent ED users. According to a systematic review, presenting complaints are likewise varied among frequent ED users and include worsening of existing chronic conditions, pain, substance or mental health related challenges and a variety of different complaints upon each visit [2].…”

Section: Introductionmentioning

confidence: 99%

The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial

et al. 2017

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Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. The Coordinated Access to Care from Hospital EDs (CATCH-ED) study examined the effectiveness of a brief case management intervention in reducing ED use and improving health outcomes among frequent ED users with mental health or addiction challenges in a large urban centre. Adults (≥18 years of age) who had five or more ED visits in the past 12-months, with at least one visit for mental health or addictions problems were randomized to either brief case management (N = 83) or usual care (N = 83) and followed for 12 months. The primary outcome of effectiveness was the frequency of ED visits during 12 months after study enrolment. Secondary outcomes included days in hospital, mental health and addiction symptom severity and health-related quality of life, measured by the SF-12. Compared to usual care, CATCH-ED participants saw a 14% reduction in frequency of ED visits during the 12-month post-randomization period [rate ratio (RR) = 0.86, 95% CI 0.64–1.15)], however, this finding did not reach statistical significance. There were also no statistically significant differences between the groups at 12 months in the number of days spent in hospital (RR = 1.16, 95% CI 0.59–2.29), physical (1.50, 95% CI -2.15–5.15) or mental (-3.97, 95% CI -8.13–0.19) component scores of the SF-12, severity of psychiatric symptoms (-0.41, 95% CI -2.30–1.49), alcohol (0.053 95% -0.017–0.12) or drug (-0.0027, 95% CI -0.0028–0.023) use. Compared to usual care, a brief case management intervention did not result in significantly reduced ED use or improved health outcomes among frequent ED users with mental health or addictions challenges in a large urban centre in Canada. Future studies need to evaluate the availability and accessibility of community-based resources for individuals with frequent ED use.

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Predictors of frequent emergency department use among patients with psychiatric illness

Cited by 48 publications

References 32 publications

Material Needs of Emergency Department Patients: A Systematic Review

Material Needs of Emergency Department Patients: A Systematic Review

A Comprehensive View of Frequent Emergency Department Users Based on Data from a Regional HIE

The effect of brief case management on emergency department use of frequent users in mental health: Findings of a randomized controlled trial

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