Changes in emergency department utilization associated with behavioral health crisis care adoption

与行为健康危机护理采用相关的急诊科利用率的变化

• 批准号: 10773819
• 负责人: Ashlyn Brooke Burns
• 金额: $ 4.32万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10773819
• 关键词: Changes; emergency; department; utilization; associated

PROJECT SUMMARY/ABSTRACT With 1 in 8 emergency department (ED) visits involving a behavioral health crisis, mental health conditions and substance use disorders are a leading cause of preventable ED utilization. Yet, the ED is often an inappropriate and ineffective setting for behavioral health crises. Inadequate access to behavioral health providers leads individuals to seek care in the ED, even when alternate care settings may be more appropriate to meet their needs. Behavioral health crisis care (BHCC) is a potential alternative to the challenges of behavioral health ED utilization. Mental health treatment facilities may adopt a range of BHCC services. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends comprehensive BHCC as a best practice, including the following six services: emergency psychiatric walk-ins, crisis intervention teams, onsite crisis stabilization, mobile crisis stabilization, suicide prevention, and peer support services. Despite calls to implement these evidence-based services, my previous work has found that only 6 percent of mental health treatment facilities currently offer comprehensive BHCC. Importantly, it is unclear how environmental factors such as community needs and available resources may influence the decision to adopt BHCC services. Additionally, it is unclear whether access to BHCC actually reduces behavioral health ED utilization. Thus, the objective of this study is to assess the drivers of BHCC adoption and the potential effectiveness of BHCC at reducing avoidable ED utilization. Aim 1, assess market factors associated with BHCC adoption, tests the hypotheses that mental health treatment facilities will be more likely to adopt comprehensive BHCC in 1) more munificent (resource rich) environments; 2) less dynamic (unstable) environments; and 3) less complex (intricate) environments. This aim merges a novel dataset on BHCC services with county-level data on environmental factors. Aim 2, assess the association between BHCC services and behavioral health ED visits, tests the hypothesis that BHCC adoption will be associated with a decrease in behavioral health ED visits, but not physical health ED visits. This aim will utilize a propensity score matched panel to examine changes in ED utilization associated with BHCC adoption. The proposed study is significant because it rigorously measures the impact of a promising, cost-effective model for behavioral health service delivery. This study is innovative because it extends the evidence-base for BHCC services through the use of multiple data sources and advanced methodological approaches. Furthermore, this study is needed to inform policy decisions to expedite BHCC adoption and improve access to underserved communities. Finally, by examining adoption/implementation and outcomes associated with an alternative model of care for individuals with chronic conditions and socioeconomic disadvantage, this study effectively targets the following high priority research area as defined by AHRQ: 1) Increase accessibility and affordability of health care by examining innovative market approaches to care delivery and financing; and 2) Harness data and technology to improve health care quality and patient outcomes and to provide a 360-degree view of the patient.

项目摘要/摘要 八分之一的急诊科(ED)就诊涉及行为健康危机、精神健康状况和 物质使用障碍是可预防的ED使用的主要原因。然而，教育署往往是一个不合适的人 以及行为健康危机的无效设置。接触行为健康提供者的机会不足导致 个人到急诊室寻求护理，即使替代护理环境可能更适合满足他们的 需要。行为健康危机护理是行为健康挑战的潜在替代方案 ED利用率。心理健康治疗机构可以采用一系列的BCC服务。物质滥用 和精神卫生服务管理局(SAMHSA)建议将全面的BHCC作为最佳实践， 包括以下六项服务：精神科急诊、危机干预小组、现场危机 稳定、流动危机稳定、预防自杀和同伴支持服务。尽管有人呼吁实施 这些循证服务，我以前的工作发现，只有6%的心理健康治疗 设施目前提供全面的BCC。重要的是，目前还不清楚环境因素是如何 社区需求和可用资源可能会影响采用BCC服务的决定。此外，它是 目前尚不清楚接触BHCC是否真的减少了行为健康ED的使用。因此，这一行动的目标是 这项研究旨在评估BHCC被采用的驱动因素以及BHCC在减少可避免的 ED利用率。目标1，评估与BHCC采用相关的市场因素，测试心理上 卫生治疗机构将更有可能在1)更慷慨(资源丰富)的情况下采用全面的BCC 环境；2)不太动态(不稳定)的环境；以及3)不太复杂(复杂)的环境。这一目标 合并了一个关于BCC服务的新数据集和关于环境因素的县级数据。目标2，评估 BHCC服务与行为健康ED访问之间的关联，验证了BCC采用 将与行为健康急诊室就诊的减少有关，但与身体健康急诊室就诊的减少无关。这一目标将 利用倾向得分匹配的小组来检查与采用BHCC相关的ED利用的变化。 这项拟议的研究意义重大，因为它严格衡量了一种前景看好、成本效益高的模式的影响。 提供行为健康服务。这项研究具有创新性，因为它扩展了肝癌的证据基础 通过使用多种数据源和先进的方法提供服务。此外，这一点 需要进行研究，为政策决策提供信息，以加快BCC的采用并改善获得服务不足的机会 社区。最后，通过审查采用/实施和与替代模式相关的结果 对于患有慢性病和社会经济劣势的个人的护理，这项研究有效地针对 以下是AHRQ定义的高度优先的研究领域：1)增加卫生保健的可及性和可负担性 通过审查提供护理和筹资的创新市场办法提供护理；和2)利用数据和 改善医疗保健质量和患者结局的技术，并提供患者的360度视角。