Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis.
Mobile Crisis Outreach and Emergency Department Utilization: A Propensity Score-matched Analysis.
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DOI：
10.5811/westjem.2021.6.52276
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发表时间：
2021-09-02
期刊：
影响因子：
--
通讯作者：
Lee S
中科院分区：
文献类型：
--
作者：
Vakkalanka JP;Neuhaus RA;Harland KK;Clemsen L;Himadi E;Lee S
精神健康和物质使用障碍（MHSUD）患者在急诊科（艾德）一直面临着不断增长的住院时间，由于住院床位短缺。先前的研究表明，移动的危机外展（MCO）减少了MHSUD患者的长期艾德住院时间。我们的目的是评估MCO接触对未来艾德使用的影响。我们对2015年至2018年在一所大型中西部大学艾德就诊的MHSUD主诉患者进行了回顾性病历审查。我们将暴露定义为MCO接触者和MCO接触后30天内任何MHSUD相关艾德访视。MCO患者的倾向评分与人口统计学数据匹配为2：1，合并症与无MCO接触的患者匹配。结局是在索引艾德访视后一年内返回艾德的全因和精神病特异性原因。我们报告描述性统计和比值比（OR）来描述两组之间的差异，风险比（HR）来估计再次艾德访视的风险。最终样本包括106例MCO和196例非MCO患者。MCO患者更有可能无家可归（OR 14.8; 95%置信区间[CI]，1.87，117），不太可能获得足够的家庭或社会支持（OR 0.51; 95% CI，0.31，0.84），并且在首次访视时艾德提供者要求为其提供医院床位的可能性较小（OR 0.50; 95% CI，0.29，0.88）。对于返回艾德的患者，MCO患者全因返回艾德的中位时间为28天（四分位距[IQR]：6-93天），非MCO患者为88天（IQR：20-164天）。与非MCO患者（49%）相比，MCO患者（67%）的全因返回艾德的风险更高（校正HR：1.66; 95% CI，1.22，2.27）。MCO患者的家庭和社会支持较少;然而，他们每次访视需要住院的可能性较小，可能是由于MCO参与。与非MCO患者相比，MCO接触患者更频繁地到艾德就诊，这意味着我们社区中的艾德与MCO之间存在很强的联系。从艾德和MCO有效转介到社区服务和合作可能是提高医疗保健利用率的下一步。
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. 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. 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). 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.
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影响因子：
3.8
作者：
Fendrich, Michael;Ives, Melissa;Plant, Robert
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