title: Correlates of Emergency Department Use by Individuals With Bipolar Disorder Enrolled in a Collaborative Care Implementation Study.
abstract: The study assessed correlates of emergency department use among participants in a collaborative care program for bipolar disorder.
  
  
  
  Community-based clinics from two states implemented Life Goals-Collaborative Care (LG-CC), an evidence-based model that includes self-management sessions and care management contacts. Logistic regression determined participant factors associated with emergency department use between six and 12 months after LG-CC implementation.
  
  
  
  Of 219 participants with baseline and 12-month data, 24% reported at least one emergency department visit. Participants with a recent homelessness history (odds ratio [OR]=3.76, p=.01) or five or more care management contacts (OR=2.62, p=.05) had a higher probability of visiting an emergency department, after the analyses were adjusted for demographic and clinical factors, including physical health score and hospitalization history.
  
  
  
  Participants in a collaborative care program who had a history of homelessness were more likely to use the emergency department, suggesting a greater need for more intensive care coordination.
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Jeanette
authors.initials: J
authors.lastname: Waxmonsky
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Lilia
authors.initials: L
authors.lastname: Verchinina
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Daniel
authors.initials: D
authors.lastname: Eisenberg
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Julia T
authors.initials: JT
authors.lastname: Kyle
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Nord
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Rementer
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Thomas
authors.affiliation: Dr. Waxmonsky is with the Department of Family Medicine and Dr. Thomas is with the Department of Psychiatry, University of Colorado School of Medicine, Aurora. Dr. Waxmonsky is also with the Office of Healthcare Transformation, Jefferson Center for Mental Health, Wheat Ridge, Colorado. Dr. Thomas is also with Colorado Access, Denver, where Ms. Rementer is affiliated. Dr. Verchinina, Dr. Kim, Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are with the Center for Clinical Management Research, Ann Arbor U.S. Department of Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan. Dr. Kim is also with the Center for Statistical Consultation and Research, University of Michigan, Ann Arbor. Mr. Lai, Ms. Kyle, Ms. Nord, Dr. Goodrich, and Dr. Kilbourne are also with the Department of Psychiatry, University of Michigan Medical School, Ann Arbor. Dr. Eisenberg is with the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston. Send correspondence to Dr. Kilbourne (e-mail: amykilbo@umich.edu ).
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000628:therapy*; D003153:Community Health Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000073278:Self-Management / Q000706:statistics & numerical data*