title: Factors associated with emergency department useamong veteran psychiatric patients.
abstract: Frequent utilization of emergency department (ED) services contributes substantially to the cost of healthcare nationally and is often driven by psychiatric factors. Using national-level data from the Veterans Health Administration (VHA), the present study examined patient-level factors associated with ED use among veteran psychiatric patients. Veterans who had at least one ED visit with a psychiatric diagnosis in fiscal years 2011-2012 (n = 226,122) were identified in VHA administrative records. Andersen's behavioral model of healthcare utilization was used to identify need, enabling, and predisposing factors associated with frequency of ED use (primary outcome) in multivariate regression models. Greater ED use was primarily linked with need (psychotic, anxiety, personality, substance use, and bipolar disorders) and enabling (detoxification-related service utilization and homelessness) factors. Chronic medical conditions, receipt of an opioid prescription, and predisposing factors (e.g., younger age) were also linked to greater ED use; however, the effect sizes for these factors were markedly lower than those of most psychiatric and psychosocial factors. The findings suggest that intensive case management programs aimed reducing frequent ED use among psychiatric patients may require greater emphasis on homelessness and other psychosocial deficits that are common among these patients, and future research should explore cost-effective approaches to implementing these programs.
authors.affiliation: HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA. Daniel.Blonigen@va.gov.|Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA. Daniel.Blonigen@va.gov.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blonigen
authors.affiliation: Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA.
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Macia
authors.affiliation: HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Bi
authors.affiliation: HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.|Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
authors.forename: Paola
authors.initials: P
authors.lastname: Suarez
authors.affiliation: HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
authors.forename: Luisa
authors.initials: L
authors.lastname: Manfredi
authors.affiliation: HSR&D Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.|Health Economics Resource Center, Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Emergency department; High utilizers; Psychiatric; Service utilization; Veterans