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Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services
Author(s) -
Singh Parvati,
Chakravarthy Bharath,
Yoon Jangho,
Snowden Lonnie,
Bruckner Tim A.
Publication year - 2019
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13812
Subject(s) - medicine , mental health , emergency department , confidence interval , depression (economics) , psychiatry , anxiety , rate ratio , confounding , mental illness , demography , pathology , sociology , economics , macroeconomics
Objectives Repeat visits (revisits) to emergency departments ( ED s) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers ( CHC s)—which provide regional, low‐cost primary care—correspond with fewer repeat psychiatric‐related ED visits ( PREDV s). Methods We obtained repeated cross‐sectional time‐series data for 7.8 million PREDV s 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 CHC s 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 CHC s (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 PREDV s 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 CHC s corresponds with a modest decline in repeat PREDV s. This decline concentrates among those with less severe mental illnesses.