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. 2017 Aug;18(5):884-893.
doi: 10.5811/westjem.2017.6.33850. Epub 2017 Jul 17.

Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005-2013

Sangil Lee  1 , Jeph Herrin  2   3 , William V Bobo  4 , Ryan Johnson  5 , Lindsey R Sangaralingham  5 , Ronna L Campbell  6
Affiliations

Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005-2013

Sangil Lee et al. West J Emerg Med. 2017 Aug.

Abstract

Introduction: Our goal was to describe the pattern and identify risk factors of early-return ED visits or inpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in the United States.

Methods: We performed a retrospective cohort study using Optum Labs Data Warehouse, a nationally representative database containing administrative claims data on privately insured and Medicare Advantage enrollees. Authors identified patients presenting to an ED with a primary diagnosis of MHSA between 2005 and 2013 who were discharged home. Study inclusion required continuous insurance enrollment for the 12 months preceding and the 31 days following the index ED visit. During the study period we included only the first ED visit for each patient.

Results: A total of 49,672 (14.2%) had a return visit to the ED or had a hospitalization within 30 days following discharge. Mean time to the next ED visit or inpatient admission was 11.7 days. An increased age (age 65+ vs. age <18 years; OR 1.65, 95% CI [1.57 to 1.74]), chronic medical comorbidities (Hwang comorbidity 5+ vs 0; OR 1.31, 95% CI [1.27 to 1.35]), prior ED and inpatient utilization (4+ visits vs 0 visits; OR 5.59, 95% CI [5.41 to 5.78]) were associated with return visits within 30 days following discharge.

Conclusion: In an analysis of nearly 350,000 ED visits for MHSA, 14.2 % of patients returned to the ED or hospital within 30 days. This study identified a number of factors associated with return visits for acute care.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This publication was made possible by funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery. The finding was presented at the American College of Emergency Physicians Scientific Assembly in Boston, MA in 2015.

Figures

Figure
Figure
Flow chart of selection process. ED, emergency department. N=Total number of patients.
See this image and copyright information in PMC

References

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