A recent article in HealthLeaders about usage for emergency departments, as well as research we've done recently at Truven Health Analytics, highlight a number of issues around health care utilization. The article touches on the diversity of problems represented by repeat emergency room users, but the role of mental illness may be underrepresented in the figures. Emergency room records focus on acute treatment – for example, trauma, respiratory, or cardiac issues – and may ignore underlying factors that contribute to the acute condition.
In a sample from our MarketScan® database of commercially insured patients with ER visits in 2011, 45% of the patients with an ER visit had at least one more ER visit in 6 months of less. Overall, 13% of the ER visits were associated with patients having a diagnosis of psychosis some time during the year; but patients with a diagnosis of psychoses made up 29% of those patients having 5 or more ER visits within 6 months.
I happened to look at Medicaid ER visits with an eye toward understanding whether mental health might play a role here too, and found that this pattern holds true and also there seems to be a gender-based utilization difference. Fifty-six percent of Medicaid ER visits in the sample were female; but ‘frequent flyers’ - patients with 5 or more visits to an ER in 6 months - who also have a diagnosis of psychoses, are 73% female.
If we consider some percentage of trips to the ER as being a failure to effectively treat and manage psychoses, then this indicates female psychoses patients appear to be associated with a higher number of acute failure episodes.
Director of Market Analytics