title: Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: the consequences of increasing medical complexity.
abstract: OBJECTIVE
  Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity.
  
  
  METHODS
  Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes.
  
  
  RESULTS
  Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions.
  
  
  CONCLUSIONS
  Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones.
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA; Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta, GA, USA. Electronic address: rshim@msm.edu.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Shim
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA.
authors.forename: Shun
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Center for Mental Health and Aging, The University of Alabama, Tuscaloosa, AL, USA; Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
authors.forename: Giyeon
authors.initials: G
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Morehouse School of Medicine, USA.
authors.forename: Adesoji
authors.initials: A
authors.lastname: Oderinde
authors.affiliation: Department of Psychiatry, University of Missouri School of Medicine, USA.
authors.forename: Sosunmolu
authors.initials: S
authors.lastname: Shoyinka
authors.affiliation: National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA; Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Rust
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012559:Schizophrenia / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D014481:United States; D055815:Young Adult
keywords: Diabetes; Emergency department utilization; Medicaid; Schizophrenia