Journal article
Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis
The western journal of emergency medicine, Vol.22(5), pp.1086-1094
09/01/2021
DOI: 10.5811/westjem.2021.6.52276
PMCID: PMC8463043
PMID: 34546884
Abstract
Introduction: Mental health and substance use disorder (MHSUD) patients in the emergency department (ED) have been facing increasing lengths of stay due to a shortage of inpatient beds. Previous research indicates mobile crisis outreach (MCO) reduces long ED stays for MHSUD patients. Our objective was to assess the impact of MCO contact on future ED utilization.
Methods: We conducted a retrospective chart review of patients presenting to a large Midwest university ED with an MHSUD chief complaint from 2015-2018. We defined the exposure as those who had MCO contact and any MHSUD-related ED visit within 30 days of MCO contact. The MCO patients were 2:1 propensity score-matched by demographic data and comorbidities matched to patients with no MCO contact. Outcomes were all-cause and psychiatric-specific reasons for return to the ED within one year of the index ED visit. We report descriptive statistics and odds ratios (OR) to describe the difference between the two groups, and hazard ratios (HR) to estimate the risk of return ED visit.
Results: The final sample included 106 MCO and 196 non-MCO patients. The MCO patients were more likely to be homeless (OR 14.8; 95% confidence interval [CI],1.87, 117), less likely to have adequate family or social support (OR 0.51; 95% CI, 0.31, 0.84), and less likely to have a hospital bed requested for them in the index visit by ED providers (OR 0.50; 95% CI, 0.29, 0.88). For those who returned to the ED, the median time for all-cause return to the ED was 28 days (interquartile range [IQR]: 6-93 days) for the MCO patients and 88 days (IQR: 20-164 days) for non-MCO patients. The risk of all-cause return to the ED was greater among MCO patients (67%) compared to non-MCO patients (49%) (adjusted HR: 1.66; 95% CI, 1.22, 2.27).
Conclusion: The MCO patients had less family and social support; however, they were less likely to require hospitalization for each visit, likely due to MCO involvement. Patients with MCO contact presented to the ED more frequently than non-MCO patients, which implies a strong linkage between the ED and MCO in our community. An effective referral to community service from the ED and MCO and collaboration could be the next step to improve healthcare utilization.
Details
- Title: Subtitle
- Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis
- Creators
- J. Priyanka Vakkalanka - Roy J. and Lucille A. Carver College of MedicineRyan A. Neuhaus - Roy J. and Lucille A. Carver College of MedicineKarisa K. Harland - Roy J. and Lucille A. Carver College of MedicineLance Clemsen - Roy J. and Lucille A. Carver College of MedicineElaine Himadi - Roy J. and Lucille A. Carver College of MedicineSangil Lee - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- The western journal of emergency medicine, Vol.22(5), pp.1086-1094
- DOI
- 10.5811/westjem.2021.6.52276
- PMID
- 34546884
- PMCID
- PMC8463043
- NLM abbreviation
- West J Emerg Med
- ISSN
- 1936-900X
- eISSN
- 1936-9018
- Publisher
- Westjem
- Number of pages
- 10
- Grant note
- Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA R49CE002108-05 / University of Iowa Injury Prevention Research Center T35HL007485 / University of Iowa Carver College of Medicine Summer Research Fellowship Grant (National Institutes of Health) U54TR001356 / University of Iowa Institute for Clinical and Translational Science (NIH/CTSA)
- Language
- English
- Date published
- 09/01/2021
- Academic Unit
- Epidemiology; Emergency Medicine; Injury Prevention Research Center; Law Faculty
- Record Identifier
- 9984297151302771
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