Shen JJ, Washington EL, Shen JJ, Bell R; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 986.
Governors State University, Health Administration, One University Parkway, University Park, IL 60466 Tel. (708) 534-3144 Fax 708.534.8041
RESEARCH OBJECTIVE: Little has been done analyzing emergency department (ED) utilization patterns over time for affective psychosis. This study analyzes changes in ED admissions as a proportion of total admissions for affective psychosis assessing the association with social and environmental factors including ethnicity, insurance status and unemployment. STUDY DESIGN: During the period studied, trends of hospital admissions through the ED as a percentage of total hospital admissions were examined with consideration of ethnicity, insurance status and unemployment rates. American Hospital Association data and Area Resource File were merged with the NIS to detect associations between physician to population ratios for primary care physicians (general practice, internal medicine, family medicine, and pediatrics) and/or psychiatrists with ED admissions. POPULATION STUDIED: 73,745 patients with affective psychosis were studied in 1995, 85,840 in 1997, 83,105 in 1999, 91,551 in 2000, and 95,260 in 2001, all identified from the National Inpatient Sample (NIS). PRINCIPAL FINDINGS: For 1995, 1997, and 1999 the percentages of patients admitted through the ED were 41.5%, 41.2%, and 39.1%, respectively. The percentage increased sizably to 44.7% in 2001. The anticipated relationship with the September 11th tragedy was not observed (no clustering of ED admissions after September 11th). No association between the physician to population ratios and ED admissions was revealed. However, a potential relationship between higher unemployment rates and higher ED admissions was demonstrated. African Americans were the only minority who had a consistently higher risk of ED admissions when compared to whites although the magnitude of this disparity declined (risk ratios (RR), 1.22 in 1995, 1.17 in 1997, 1.19 in 1999 and 1.13 in 2001). While the magnitude of the disparity between Medicaid patients as compared to the privately insured declined (RR, 1.15 in 1995, 1.21 in 1997, 1.19 in 1999 and 1.00 in 2001), the magnitude of the disparity between the uninsured and privately insured persisted with little change (RR, 1.23 in 1995, 1.21 in 1997, 1.25 in 1999 and 1.21 in 2001). CONCLUSIONS: Vulnerable populations have a higher risk of ED admissions for affective psychosis. A higher risk among African Americans may potentially indicate limitations in access to care and social stressors contributing to vulnerability. Limited access to care for uninsured and Medicaid patients is a likely contributor to excess ED utilization in these populations. Further research is indicated to conclusively determine the nature and extent of the relationship between ED admissions affective psychosis and unemployment rates. Additional research to assess more sensitive indicators to access to care including availability of transportation and appointment availability is needed to further evaluate the extent to which barriers to access may contribute to excess ED utilization for affective psychosis. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Public policy should promote accessibility to routine ambulatory behavioral health services for vulnerable populations to decrease excess ED utilization in these populations. Policy makers should also consider access to employment and economic opportunity as key factors for improving public health and enhancing the appropriateness of health care resource utilization.
Publication Types:
Keywords:
- Affective Disorders, Psychotic
- African Americans
- Child
- Delivery of Health Care
- Ethnic Groups
- European Continental Ancestry Group
- Health Services
- Health Services Needs and Demand
- Hospital Departments
- Hospital Units
- Hospitalization
- Humans
- Insurance Coverage
- Medicaid
- Medically Uninsured
- Minority Groups
- Physicians
- Vulnerable Populations
- economics
- hsrmtgs
UI: 103624020
From Meeting Abstracts