title: Predictors of frequent emergency department use among patients with psychiatric illness.
abstract: OBJECTIVE
  To identify the patient characteristics associated with frequent emergency department (ED) use and develop a tool to predict risk for returning in the next month.
  
  
  METHODS
  Prospective cohort study of 863 adults with psychiatric illness presenting to one of four general hospital EDs. ED visits and relevant clinical information in the year before and one month after the index visit were abstracted.
  
  
  RESULTS
  One hundred sixty-seven of the patients (19%) were considered frequent users. Characteristics associated with frequent user status were homelessness, cocaine-positive toxicology screen, Medicare insurance, a personality disorder and hepatobiliary disease (all P<.05). Patients scoring in the highest risk category had nearly five times the odds of returning to the ED in the month subsequent to the index visit.
  
  
  CONCLUSIONS
  Psychiatric patients with frequent ED use are a heterogeneous group, but there are specific target conditions which, if confirmed, may facilitate reduced ED use and be replaced by more appropriate treatment.
authors.affiliation: Partners Psychiatry and Mental Health, Division of Health Services Research, Boston, MA 02115; Harvard Medical School, Boston, MA 02115; Brigham Women's Hospital, Boston, MA 02115. Electronic address: grace.chang2@va.gov.
authors.forename: Grace
authors.initials: G
authors.lastname: Chang
authors.affiliation: Partners Psychiatry and Mental Health, Division of Health Services Research, Boston, MA 02115; Harvard Medical School, Boston, MA 02115; Massachusetts General Hospital, Boston, MA 02114. Electronic address: weissan@upstate.edu.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Weiss
authors.affiliation: Partners Psychiatry and Mental Health, Division of Health Services Research, Boston, MA 02115; Harvard Medical School, Boston, MA 02115; Brigham Women's Hospital, Boston, MA 02115. Electronic address: eorav@partners.org.
authors.forename: Endel John
authors.initials: EJ
authors.lastname: Orav
authors.affiliation: Partners Psychiatry and Mental Health, Division of Health Services Research, Boston, MA 02115; Harvard Medical School, Boston, MA 02115; McLean Hospital, Belmont, MA 02478. Electronic address: srauch@partners.org.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Rauch
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies
keywords: Emergency department; Mental disorder; Prediction; Utilization