Reducing the number of emergency department visits and costs associated with anxiety: a randomized controlled study.
OBJECTIVE
To demonstrate the economic effects of an intervention for members discharged from the emergency department (ED) with anxiety diagnoses.


METHODS
Randomized controlled study.


METHODS
Adults with commercial, Medicare, or Medicaid insurance coverage enrolled in a health maintenance organization and discharged from an ED with anxiety diagnoses were randomly assigned to receive usual care (n = 300) or a stepped-care intervention (n = 307). Psychiatric ED and outpatient visit utilization and cost data identified by claims were collected for 6 months following the initial ED visit.


RESULTS
Members assigned to receive the intervention demonstrated significantly fewer ED visits and lower associated facility costs in the 6 months following discharge compared with those assigned to usual care. No significant differences in psychiatric outpatient visit costs were observed. Members receiving usual care made 117 visits to the ED for a psychiatric condition during the follow-up period, for a mean of 0.39 visits per member and a mean facility cost of 118.15 dollars per member, while members receiving case management services made 79 visits to the ED for a psychiatric condition during the follow-up period, for a mean of 0.26 visits per member and a mean facility cost of 70.63 dollars per member. The intervention resulted in a savings of 7.92 dollars in ED costs per member per month for all psychiatric diagnoses during the 6-month study period.


CONCLUSIONS
The case management-based intervention effectively reduced psychiatric ED recidivism and costs for members discharged from the ED with an anxiety diagnosis, without significantly affecting psychiatric outpatient visit costs.
Kolbasovsky
Andrew
A
HIP Health Plan of New York, New York, NY 10041, USA. akolbasovsky@hipusa.com
Reich
Leonard
L
Futterman
Robert
R
Meyerkopf
Neil
N
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D019090:Case Management / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000191:economics; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States