171547 Reducing ER utilization for frequent users

Monday, October 27, 2008

Karen Swanson, PhD, ScM , Office of Planning, Data Quality and Analysis, Los Angeles County Department of Health Services, Los Angeles, CA
Jose Salazar, DrPH , Director Program Development, Tarzana Treatment Center, Reseda, CA
Background/Aim: In studies worldwide, the most frequent users of hospital ERs tend to be patients with mental health disorders, substance abuse disorders, and/or are homeless. Because they are mostly uninsured, they seek health care at this costly and often inappropriate level. Project Improving Access to Care's (PIAC) aim is to reduce frequent users' high ER utilization through having case managers (CMs) link them to appropriate community-based care including primary care, mental health care, substance abuse treatment, legal aid, and temporary housing.

Design: A quasi-experimental nonequivalent control group design.

Intervention: An electronic flag appears on the CMs' computers when a patient makes a fifth (or more) ER visit in the past year. If these patients are uninsured or have Medi-Cal, and present with mental illness, substance abuse, and/or homelessness, CMs do intake interviews, needs assessments, and then refer them to community-based organizations for care.

Analysis: An analysis of this ongoing intervention was performed (N=89) comparing ER utilization six months before and after project enrollment. The control group was 49 non-PIAC randomly selected sex-matched patients with similar utilization. The mean number of ER visits for the PIAC group in this six-month period decreased by 3.2, whereas the control group's mean number of ER visits decreased by 1.7; p=0.08.

Conclusion: Case management used to link frequent users of a public hospital ER to community-based care decreased ER utilization almost two-fold, compared to a control group. A larger sample size at the end of the project may improve the statistical significance of the findings.

Learning Objectives:
1. List three patient risk factors for ER frequent use. 2. Be able to describe how technology can be utilized in identifying ER patients who are frequent users. 3. Identify successful components of an intervetion that reduces ER frequent use.

Keywords: Emergency Department/Room, Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I do not have any financial ties with a commercial interest in th past 12 months, nor am I presenting any CEs for this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Mental Health Section Posters IV
See more of: Mental Health