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

项目总结/摘要 八分之一的急诊（艾德）就诊涉及行为健康危机、心理健康状况和 物质使用障碍是可预防艾德使用的主要原因。然而，艾德往往是一个不适当的 行为健康危机的无效设置。行为健康提供者的不足导致 个人寻求照顾的艾德，即使当替代护理设置可能更适合，以满足他们的 需求行为健康危机护理（BHCC）是一种潜在的替代行为健康的挑战 艾德利用率。心理健康治疗机构可以采用一系列BHCC服务。药物滥用 和心理健康服务管理局（SAMHSA）建议全面的BHCC作为最佳实践， 包括以下六项服务：紧急精神病上门服务，危机干预小组，现场危机 稳定、移动的危机稳定、自杀预防和同伴支持服务。尽管呼吁实施 我之前的研究发现，只有6%的心理健康治疗 工厂目前提供全面的BHCC。重要的是，目前还不清楚环境因素，如 社区需求和可用资源可能会影响采用BHCC服务的决定。此外，它是 目前尚不清楚BHCC是否真的会降低行为健康艾德的利用率。因此，这一目标 研究旨在评估BHCC采用的驱动因素以及BHCC在减少可避免的 艾德利用率。目的1，评估与BHCC采用相关的市场因素，检验心理假设， 健康治疗设施将更有可能采用综合BHCC 1）更慷慨（资源丰富） 环境; 2）较少动态（不稳定）的环境;以及3）较少复杂（错综复杂）的环境。这一目标 将BHCC服务的新数据集与县级环境因素数据相结合。目标2，评估 BHCC服务和行为健康艾德访问之间的关联，检验了BHCC采用 将与行为健康艾德访视减少相关，但与身体健康艾德访视无关。这一目标将 利用倾向评分匹配面板来检查与BHCC采用相关的艾德利用率的变化。 这项拟议中的研究意义重大，因为它严格衡量了一个有前途的、具有成本效益的模式的影响 提供行为健康服务。这项研究是创新的，因为它扩展了BHCC的证据基础 通过使用多种数据来源和先进的方法学途径，而且这 需要进行研究，为政策决策提供信息，以加快BHCC的采用，并改善服务不足的人群的获得 社区.最后，通过检查与替代模式相关的采用/实施和结果， 护理慢性病和社会经济不利的个人，这项研究有效地针对 以下是AHRQ确定的高度优先研究领域：1）提高卫生服务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来提供护理; 2）收集数据， 技术，以提高医疗保健质量和病人的结果，并提供一个360度的病人的看法。

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.