Skip to main content

Advertisement

SpringerLink
Log in

Association of Follow-Up After an Emergency Department Visit for Mental Illness with Utilization Based Outcomes

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Follow-up within 30 days of an emergency department (ED) visit for mental illness is a new and widely-used quality measure. However, no empirical evidence validates associations between follow-up and subsequent utilization based outcomes. Using Massachusetts all payer claims data, we identified insured individuals with an ED visit for mental illness. Multivariate regression analysis estimated associations between follow-up within 30 days after an ED visit for mental illness with costs, hospitalizations, and additional ED visits in 180 days following the index visit. 63,814 index ED visits were included (56.5% female, mean [SD] age 38.0 [12.1] years, 48% Medicaid covered). 31% of index ED principal diagnoses were for major depressive disorder, 3% schizophrenia, 5% bipolar disorder, 34% anxiety disorder, 0.6% post-traumatic stress disorder, 8% other psychoses, and 19% other mental illness diagnoses. Only 33% of patients had a follow-up visit for mental illness within 30 days. Adjusted regression analyses show timely follow-up is associated with increased costs in the 180 days after (average marginal effect = $1622; 95% confidence interval [CI] 1459, 1786), an increased probability of inpatient hospitalization (2.7 percentage points; 95% CI 0.021, 0.032), and a small reduction in the probability of at least one additional ED visit (− 1.7 percentage points; 95% CI − 0.026 to 0.009). Overall follow-up rates are low; follow-up within 30 days of an ED visit for mental illness is associated with increased costs and increased probability of hospitalization in the follow-up period. It is not known whether increased rates of utilization improve patient outcomes, potentially by receiving appropriate more intensive care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Beadles, C., Ellis, A., Lichstein, J., et al. (2015). First outpatient follow-up after psychiatric hospitalization: Does one size fit all? Psychiatric Services, 66(4), 364–372.

    PubMed  Google Scholar 

  • Belotti, F., Deb, P., Manning, W. G., & Norton, E. C. (2015). twopm: Two-part models. Stata Journal, 15(1), 3–20.

    Google Scholar 

  • Berkowitz, S. A., Parashuram, S., Rowan, K., et al. (2018). Association of a care coordination model with health care costs and utilization: The Johns Hopkins community health partnership (J-CHiP). JAMA Network Open, 1(7), e184273.

    PubMed  PubMed Central  Google Scholar 

  • Bruffaerts, R., Sabbe, M., & Demyttenaere, K. (2005a). Predicting community tenure in patients with recurrent utilization of a psychiatric emergency service. General Hospital Psychiatry, 27(4), 269–274.

    PubMed  Google Scholar 

  • Bruffaerts, R., Sabbe, M., & Demyttenaere, K. (2005b). Predicting aftercare in psychiatric emergencies. Social Psychiatry and Psychiatric Epidemiology, 40(10), 829–834.

    PubMed  Google Scholar 

  • Browne, J., Penn, D. L., Meyer-Kalos, P. S., et al. (2017). Psychological well-being and mental health recovery in the NIMH RAISE early treatment program. Schizophrenia Research, 185, 167–172.

    PubMed  Google Scholar 

  • Busch, S. H., Golberstein, E., Goldman, H. H., Loveridge, C., Drake, R. E., & Meara, E. (2019). Effects of ACA expansion of dependent coverage on hospital-based care of young adults with early psychosis. Psychiatric Services. https://doi.org/10.1176/appi.ps.201800492.

    Article  PubMed  Google Scholar 

  • Center for Health Information and Analysis. (2013). All-payer claims database introduction. 2013. www.mass.gov/chia/apcd. Accessed 5 October 2013.

  • Creed, J. O., Cyr, J. M., Owino, H., et al. (2018). Acute crisis care for patients with mental health crises: Initial assessment of an innovative prehospital alternative destination program in North Carolina. Prehospital Emergency Care, 22(5), 555–564.

    PubMed  Google Scholar 

  • Croake, S., Brown, J. D., Miller, D., et al. (2017). Follow-up care after emergency department visits for mental and substance use disorders among medicaid beneficiaries. Psychiatric Services, 68(6), 566–572.

    PubMed  Google Scholar 

  • Dobsha, S., Delucchoi, K., & Young, M. (1999). Adherence with referrals for outpatient follow-up from a VA psychiatric emergency room. Community Mental Health Journal, 35, 451–458.

    Google Scholar 

  • Druss, B. G., Miller, C. L., Pincus, H. A., & Shih, S. (2004). The volume–quality relationship of mental health care: Does practice make perfect? The American Journal of Psychiatry, 161(12), 2282–2286.

    PubMed  Google Scholar 

  • Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36(1), 8–27.

    CAS  PubMed  Google Scholar 

  • Ericson, K., Geissler, K., & Lubin, B. (2019). The impact of partial-year enrollment on the accuracy of risk-adjustment systems: A framework and evidence. American Journal of Health Economics, 4(4), 454–478.

    Google Scholar 

  • Farid, M. (2019). Tail people: The extremely under and overcompensated in individual health insurance markets. Paper presented at: 8th Conference of the American Society of Health Economists, 2019, Washington, DC.

  • Geissler, K. H. (2020). Differences in referral patterns for rural primary care physicians from 2005 to 2016. Health Services Research, 55(1), 94–102.

    PubMed  Google Scholar 

  • Geissler, K. H., & Zeber, J. E. (2020). Primary care physician referral patterns for behavioral health diagnoses. Psychiatric Services, 71(4), 389–392.

    PubMed  Google Scholar 

  • Geissler, K. H., Lubin, B., & Ericson, K. M. M. (2020). The role of organizational affiliations in physician patient-sharing relationships. Medical Care Research and Review: MCRR, 77(2), 165–175.

    PubMed  Google Scholar 

  • Golberstein, E., Busch, S. H., Zaha, R., Greenfield, S. F., Beardslee, W. R., & Meara, E. (2015). Effect of the Affordable Care Act’s young adult insurance expansions on hospital-based mental health care. The American Journal of Psychiatry, 172(2), 182–189.

    PubMed  Google Scholar 

  • Herbstman, B. J., & Pincus, H. A. (2009). Measuring mental healthcare quality in the United States: A review of initiatives. Current Opinion in Psychiatry, 22(6), 623–630.

    PubMed  Google Scholar 

  • Hermann, R. C., & Palmer, R. H. (2002). Common ground: A framework for selecting core quality measures for mental health and substance abuse care. Psychiatric Services, 53(3), 281–287.

    PubMed  Google Scholar 

  • Insel, T. R. (2008). Assessing the economic costs of serious mental illness. The American Journal of Psychiatry, 165(6), 663–665.

    PubMed  Google Scholar 

  • Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. Washington (DC): The National Academies Press.

    Google Scholar 

  • Johnston, A. N., Spencer, M., Wallis, M., et al. (2019). Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review. Emergency Medicine Australasia, 31(5), 715–729.

    PubMed  Google Scholar 

  • Kanwal, F., Asch, S. M., Kramer, J. R., Cao, Y., Asrani, S., & El-Serag, H. B. (2016). Early outpatient follow-up and 30-day outcomes in patients hospitalized with cirrhosis. Hepatology, 64(2), 569–581.

    PubMed  Google Scholar 

  • Kane, J. M., Robinson, D. G., Schooler, N. R., et al. (2016). Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. The American Journal of Psychiatry, 173(4), 362–372.

    PubMed  Google Scholar 

  • Klinkenberg, W. D., & Calsyn, R. J. (1997). The moderating effects of race on return visits to the psychiatric emergency room. Psychiatric Services, 48(7), 942–945.

    CAS  PubMed  Google Scholar 

  • Klinkenberg, W. D., & Calsyn, R. J. (1999). Predictors of receiving aftercare 1, 3, and 18 months after a psychiatric emergency room visit. Psychiatric Quarterly, 70(1), 39–51.

    CAS  PubMed  Google Scholar 

  • Lee, K. K., Yang, J., Hernandez, A. F., Steimle, A. E., & Go, A. S. (2016). Post-discharge follow-up characteristics associated with 30-day readmission after heart failure hospitalization. Medical Care, 54(4), 365–372.

    CAS  PubMed  PubMed Central  Google Scholar 

  • McCullumsmith, C., Clark, B., Blair, C., Cropsey, K., & Shelton, R. (2015). Rapid follow-up for patients after psychiatric crisis. Community Mental Health Journal, 51(2), 139–144.

    PubMed  Google Scholar 

  • National Quality Forum. (2018). Follow-up after emergency department visit for mental illness or alcohol and other drug abuse or dependence; STEWARD: National Committee for Quality Assurance. http://www.qualityforum.org. Accessed November 20, 2018.

  • Nossel, I., Wall, M. M., Scodes, J., et al. (2018). Results of a coordinated specialty care program for early psychosis and predictors of outcomes. Psychiatric Services, 69(8), 863–870.

    PubMed  Google Scholar 

  • Nouraei, S. A., Hudovsky, A., Frampton, A. E., et al. (2015). A study of clinical coding accuracy in surgery: Implications for the use of administrative big data for outcomes management. Annals of Surgery, 261(6), 1096–1107.

    CAS  PubMed  Google Scholar 

  • Olfson, M., Marcus, S. C., Wan, G. J., & Geissler, E. C. (2004). National trends in the outpatient treatment of anxiety disorders. The Journal of Clinical Psychiatry, 65(9), 1166–1173.

    PubMed  Google Scholar 

  • Olfson, M., Marcus, S. C., & Bridge, J. A. (2012). Emergency treatment of deliberate self-harm. Archives of General Psychiatry, 69(1), 80–88.

    PubMed  Google Scholar 

  • Owens, P., Mutter, R., & Stocks, C. (2010). Mental health and substance abuse-related emergency department visits among adults, 2007. Rockville, MD: U.S. Agency for Healthcare Research and Quality.

    Google Scholar 

  • Pincus, H. A., Page, A. E., Druss, B., Appelbaum, P. S., Gottlieb, G., & England, M. J. (2007). Can psychiatry cross the quality chasm? Improving the quality of health care for mental and substance use conditions. The American Journal of Psychiatry, 164(5), 712–719.

    PubMed  Google Scholar 

  • Pincus, H. A., Spaeth-Rublee, B., & Watkins, K. E. (2011). Analysis & commentary: The case for measuring quality in mental health and substance abuse care. Health Affairs, 30(4), 730–736.

    PubMed  Google Scholar 

  • Sacarny, A. (2018). Adoption and learning across hospitals: The case of a revenue-generating practice. Journal of Health Economics, 60, 142–164.

    PubMed  Google Scholar 

  • Sajatovic, M., Blow, F. C., & Ignacio, R. V. (2006). Psychiatric comorbidity in older adults with bipolar disorder. International Journal of Geriatric Psychiatry, 21(6), 582–587.

    PubMed  Google Scholar 

  • Schneider, E. C., Zaslavsky, A. M., Landon, B. E., Lied, T. R., Sheingold, S., & Cleary, P. D. (2001). National quality monitoring of Medicare health plans: The relationship between enrollees’ reports and the quality of clinical care. Medical Care, 39(12), 1313–1325.

    CAS  PubMed  Google Scholar 

  • Schneider, E. C., Zaslavsky, A. M., & Epstein, A. M. (2002). Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA: The Journal of the American Medical Association, 287(10), 1288–1294.

    PubMed  Google Scholar 

  • Schneider, E. C., Zaslavsky, A. M., & Epstein, A. M. (2005). Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiaries. The American Journal of Medicine, 118(12), 1392–1400.

    PubMed  Google Scholar 

  • Sharma, G., Kuo, Y. F., Freeman, J. L., Zhang, D. D., & Goodwin, J. S. (2010). Outpatient follow-up visit and 30-day emergency department visit and readmission in patients hospitalized for chronic obstructive pulmonary disease. Archives of Internal Medicine, 170(18), 1664–1670.

    PubMed  PubMed Central  Google Scholar 

  • Shrestha, A., Bergquist, S., Montz, E., & Rose, S. (2018). Mental health risk adjustment with clinical categories and machine learning. Health Services Research, 53(Suppl 1), 3189–3206.

    PubMed  Google Scholar 

  • Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., & Ayanian, J. Z. (2005). Trends in the quality of care and racial disparities in Medicare managed care. New England Journal of Medicine, 353(7), 692–700.

    CAS  PubMed  Google Scholar 

  • Trivedi, A. N., Swaminathan, S., & Mor, V. (2008). Insurance parity and the use of outpatient mental health care following a psychiatric hospitalization. JAMA: The Journal of the American Medical Association, 300(24), 2879–2885.

    CAS  PubMed  Google Scholar 

  • Turner, S. B., & Stanton, M. P. (2015). Psychiatric case management in the emergency department. Professional Case Management, 20(5), 217–227. (quiz 228-219).

    PubMed  Google Scholar 

  • Vinson, D. R., Ballard, D. W., Huang, J., et al. (2015). Timing of discharge follow-up for acute pulmonary embolism: Retrospective cohort study. Western Journal of Emergency Medicine, 16(1), 55–61.

    PubMed Central  PubMed  Google Scholar 

  • Vijayaraghavan, M., Messer, K., Xu, Z., Sarkin, A., & Gilmer, T. P. (2015). Psychiatric readmissions in a community-based sample of patients with mental disorders. Psychiatric Services, 66(5), 551–554.

    PubMed  Google Scholar 

  • Weiss, A., Barrett, M., Heslin, K., & Stocks, C. (2016). Trends in emergency department visits involving mental and substance use disorders, 2006–2013. Rockville, MD: U.S. Agency for Healthcare Research and Quality.

    Google Scholar 

Download references

Funding

This work is funded by a research grant from the National Institute for Health Care Management (NIHCM). The content is solely the responsibility of the authors and does not necessarily represent the views of NIHCM. The funder had no role in the design and conduct of the study; collection, management, analysis, of the data; or in the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 715 N Pleasant St, 337 Arnold House, Amherst, MA, 01003, USA

    Kimberley H. Geissler, Michael I. Cooper & John E. Zeber

Authors
  1. Kimberley H. Geissler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael I. Cooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John E. Zeber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberley H. Geissler.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 45 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Geissler, K.H., Cooper, M.I. & Zeber, J.E. Association of Follow-Up After an Emergency Department Visit for Mental Illness with Utilization Based Outcomes. Adm Policy Ment Health 48, 718–728 (2021). https://doi.org/10.1007/s10488-020-01106-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-020-01106-2

Keywords

Search

Navigation