TitlePsychiatric-related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services.
Publication TypeJournal Article
Year of Publication2019
AuthorsSingh, P, Chakravarthy, B, Yoon, J, Snowden, L, Bruckner, TA
JournalAcad Emerg Med
Date Published06/2019
ISSN1553-2712
Abstract
 

OBJECTIVES: Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)-which provide regional, low-cost primary care-correspond with fewer repeat psychiatric-related ED visits (PREDVs).

METHODS: We obtained repeated cross-sectional time-series data for 7.8 million PREDVs from the State Emergency Department Database for four populous U.S. states (California, Florida, North Carolina, and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate-level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual-level confounders, county health system and sociodemographic attributes, year fixed effects, and county fixed effects.

RESULTS: The risk of a repeat PREDV decreased with a county-level increase in mental health patients seen at CHCs (incidence rate ratio = 0.986, 95% confidence interval = 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicated 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses found that revisits decline for relatively mild/moderate illnesses (e.g., mood, anxiety disorders) but not for severe illnesses (e.g., schizophrenia/psychoses).

CONCLUSION: An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses.

DOI10.1111/acem.13812
Alternate JournalAcad Emerg Med
PubMed ID31162887
Grant List1R21MH110815-01A1 / / National Institutes of Mental Health /