目的:确定行为健康危机护理服务的可用性是否与急诊科(ED)利用率的变化有关。
方法:我们使用了医疗成本和利用项目国家ED数据库中ED利用的纵向面板数据(2016-2021年),以及使用药物滥用和精神卫生服务管理局精神卫生治疗机构国家目录的信息编制的危机护理服务新数据集。亚利桑那州共有1002个独特的邮政编码,佛罗里达,肯塔基,马里兰,和威斯康星被纳入我们的分析。
方法:为了评估危机护理可用性对ED利用率的影响,我们使用了一个线性回归模型,该模型具有邮政编码和年份固定效应以及标准误差,用于在邮政编码级别进行聚类。与心理相关的ED利用,行为,和神经发育(MBD)障碍是我们的主要结果。我们还检查了与妊娠相关的ED利用率作为非等效因变量,以评估效果估计中的残留偏差。
方法:我们从国家目录中提取了由心理健康治疗机构(n=14,726个机构年)提供的危机护理服务的数据。通过将医疗成本和利用项目中定义的临床分类软件应用于每次ED遇到的主要ICD-10-CM诊断代码来评估MBD相关的ED利用(n=101,360,483)。所有数据都汇总到邮政编码级别(n=6012zip-years)。
结果:2016年至2021年与MBD相关的ED访问的总体比率为每100,000人口1610年访问。步入式危机稳定服务与MBD相关的ED利用率降低相关(系数=-0.028,p=0.009),但与妊娠相关ED利用率的变化无显著相关.
结论:步入式危机稳定服务与MBD相关ED利用率降低相关。希望减少与MBD相关的ED利用率的决策者应考虑增加对这种有前途的替代模型的访问。
OBJECTIVE: To determine whether availability of behavioral health crisis care services is associated with changes in emergency department (ED) utilization.
METHODS: We used longitudinal panel data (2016-2021) on ED utilization from the Healthcare Cost and Utilization Project\'s State ED Databases and a novel dataset on crisis care services compiled using information from the Substance Abuse and Mental Health Services Administration\'s National Directories of Mental Health Treatment Facilities. A total of 1002 unique zip codes from Arizona, Florida, Kentucky, Maryland, and Wisconsin were included in our analyses.
METHODS: To estimate the effect of crisis care availability on ED utilization, we used a linear regression model with zip code and year fixed effects and standard errors accounting for clustering at the zip code-level. ED utilization related to mental, behavioral, and neurodevelopmental (MBD) disorders served as our primary outcome. We also examined pregnancy-related ED utilization as a nonequivalent dependent variable to assess residual bias in effect estimates.
METHODS: We extracted data on crisis care services offered by mental health treatment facilities (n = 14,726 facility-years) from the National Directories. MBD-related ED utilization was assessed by applying the Clinical Classification Software Refined from the Healthcare Cost and Utilization Project to the primary ICD-10-CM diagnosis code on each ED encounter (n = 101,360,483). All data were aggregated to the zip code-level (n = 6012 zip-years).
RESULTS: The overall rate of MBD-related ED visits between 2016 and 2021 was 1610 annual visits per 100,000 population. Walk-in crisis stabilization services were associated with reduced MBD-related ED utilization (coefficient = -0.028, p = 0.009), but were not significantly associated with changes in pregnancy-related ED utilization.
CONCLUSIONS: Walk-in crisis stabilization services were associated with reductions in MBD-related ED utilization. Decision-makers looking to reduce MBD-related ED utilization should consider increasing access to this promising alternative model.