Complex Patients Have More Emergency Visits: Don't Punish the Systems That Serve Them
AuthorsMick, Eric O.
Alcusky, Matthew J.
Eanet, Frances E.
Allison, Jeroan J.
Kiefe, Catarina I.
Ash, Arlene S.
UMass Chan AffiliationsGraduate School of Biomedical Sciences
Department of Population and Quantitative Health Sciences
Document TypeJournal Article
Keywordsemergency department utilization
social determinants of health
Health Services Administration
Health Services Research
Mental and Social Health
Substance Abuse and Addiction
MetadataShow full item record
AbstractIMPORTANCE: Better patient management can reduce emergency department (ED) use. Performance measures should reward plans for reducing utilization by predictably high-use patients, rather than rewarding plans that shun them. OBJECTIVE: The objective of this study was to develop a quality measure for ED use for people diagnosed with serious mental illness or substance use disorder, accounting for both medical and social determinants of health (SDH) risks. DESIGN: Regression modeling to predict ED use rates using diagnosis-based and SDH-augmented models, to compare accuracy overall and for vulnerable populations. SETTING: MassHealth, Massachusetts' Medicaid and Children's Health Insurance Program. PARTICIPANTS: MassHealth members ages 18-64, continuously enrolled for the calendar year 2016, with a diagnosis of serious mental illness or substance use disorder. EXPOSURES: Diagnosis-based model predictors are diagnoses from medical encounters, age, and sex. Additional SDH predictors describe housing problems, behavioral health issues, disability, and neighborhood-level stress. MAIN OUTCOME AND MEASURES: We predicted ED use rates: (1) using age/sex and distinguishing between single or dual diagnoses; (2) adding summarized medical risk (DxCG); and (3) further adding social risk (SDH). RESULTS: Among 144,981 study subjects, 57% were women, 25% dually diagnosed, 67% White/non-Hispanic, 18% unstably housed, and 37% disabled. Utilization was higher by 77% for those dually diagnosed, 50% for members with housing problems, and 18% for members living in the highest-stress neighborhoods. SDH modeling predicted best for these high-use populations and was most accurate for plans with complex patients. CONCLUSION: To set appropriate benchmarks for comparing health plans, quality measures for ED visits should be adjusted for both medical and social risks.
Mick EO, Alcusky MJ, Li NC, Eanet FE, Allison JJ, Kiefe CI, Ash AS. Complex Patients Have More Emergency Visits: Don't Punish the Systems That Serve Them. Med Care. 2021 Jan 28. doi: 10.1097/MLR.0000000000001515. Epub ahead of print. PMID: 33528234. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/46923
Showing items related by title, author, creator and subject.
Policy Brief: Addressing Social Determinants of Health through Community Health Workers: A Call to ActionLondon, Katharine; Damio, Grace; Ferrazo, Meredith; Perez-Escamalla, Rafael; Wiggins, Noelle (2018-01-30)This technical report was compiled by the Hispanic Health Council in partnership with Southwestern AHEC and a panel of Community Health Worker Policy Research Experts which included our Katharine London from the Center for Health Law and Economics. The report offers a number of policy recommendations for community health workers for communities that might benefit from community-based services. The report offers recommendations on; payment of community health workers; community health worker caseloads; community health worker recruitment; community health worker training; reflective and trauma-informed mentoring and supportive supervision of community health workers; integration of community health workers into care teams; documenting the effect of community heal worker services on social determination of health. The Hispanic Health Council believes a service design that effectively supports community health workers would incorporate the seven areas of policy recommendation included in this report.
A Public Health Framework for the State Mental Health Authority: A Call for Action by Massachusetts Consumers and Family MembersDelman, Jonathan (2006-01-01)During the Spring of 2006, Consumer Quality Initiatives (CQI) conducted 20 focus groups across the state, 12 with adults with mental illness, 3 with parents of youth with serious emotional disorder, 2 with youth with SED, 1 with family members of adult consumers, and 2 with youth in transition. Supported by a contract with Massachusetts Department of Mental Health (DMH), the goal was to assist DMH in framing the criteria for its upcoming reprocurement. Our findings reveal a frustration with an approach to health care delivery that focuses primarily on the provision of psychiatric care (egs, medication, therapy, hospitalization). We reviewed the focus group reports to identify the most significant themes, which clustered within eight broad categories.
Making the Case for Sustainable Funding for Community Health Worker Services: Talking to Payers and ProvidersLondon, Katharine (2018-01-27)In this presentation, Katharine London of the Center for Health Law and Economics makes her case for offering sustainable funding for community health worker services. Research has shown community health workers can have a distinct impact on health systems, helping them improve population health and contain costs, while also promoting health equity and community engagement. This presentation was designed to assist CHWs and other advocates in engaging with policymakers and payers to support CHW sustainability and develop a financial plan for their CHW work. It was presented as part of a CHW Sustainability event held at the Families USA’s annual conference, Health Action 2018: Staying Strong for America’s Families, in Washington, DC. See Katharine London's blog post on payment delivery methods for community health workers here.