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Factors associated with emergency department useamong veteran psychiatric patients

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Abstract

Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011–2012 (n = 226,122) were identified in VHA administrative records. Andersen’s behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models. Greater ED use was primarily linked with need (psychotic, anxiety, personality, substance use, and bipolar disorders) and enabling (detoxification-related service utilization and homelessness) factors. Chronic medical conditions, receipt of an opioid prescription, and predisposing factors (e.g., younger age) were also linked to greater ED use; however, the effect sizes for these factors were markedly lower than those of most psychiatric and psychosocial factors. The findings suggest that intensive case management programs aimed reducing frequent ED use among psychiatric patients may require greater emphasis on homelessness and other psychosocial deficits that are common among these patients, and future research should explore cost-effective approaches to implementing these programs.

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Authors and Affiliations

  1. HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA

    Daniel M. Blonigen, Xiaoyu Bi, Paola Suarez, Luisa Manfredi & Todd H. Wagner

  2. Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA

    Daniel M. Blonigen & Kathryn S. Macia

  3. Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA

    Paola Suarez

  4. Health Economics Resource Center, Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA

    Todd H. Wagner

Authors
  1. Daniel M. Blonigen
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  2. Kathryn S. Macia
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  3. Xiaoyu Bi
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  4. Paola Suarez
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  5. Luisa Manfredi
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  6. Todd H. Wagner
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Correspondence to Daniel M. Blonigen.

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Funding

This work was supported by the Department of Veterans Affairs (VA), Health Services Research & Development (HSR&D) (PPO 13–121: PI: Dr. Blonigen). Dr. Blonigen was also supported by a Career Development Award (CDA-2-008-10S) from VA Clinical Science Research & Development. Dr. Bi was supported by the VA Office of Academic Affiliations (TPP 62–500), and the VA Health Services Research and Development (HSR&D) Service in conjunction with a VA HSR&D Advanced Fellowship Program (TPP 97–006).

Disclosures

The views expressed are the authors’ and do not necessarily reflect those of the Veterans Health Administration. The authors report no conflicts of interest.

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Blonigen, D.M., Macia, K.S., Bi, X. et al. Factors associated with emergency department useamong veteran psychiatric patients. Psychiatr Q 88, 721–732 (2017). https://doi.org/10.1007/s11126-017-9490-2

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  • DOI: https://doi.org/10.1007/s11126-017-9490-2

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