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RESEARCH WEEKLY: Shared Data Systems to Help Frequent Emergency Department Users
with Mental Illness

Serious mental illness is a major contributor to emergency department crowding,
as we highlighted in our latest evidence brief, Delayed and Deteriorating [[link removed]].
In addition, frequent emergency department users, often a target of policymakers
and hospital systems due to the high healthcare costs associated with their service
utilization, often have mental health concerns that are unaddressed.
However, few research studies examining this population of "superutilizers" have
comprehensively examined both medical service use, such as hospitals and emergency
departments, in combination with other social services such as homeless shelters
or outpatient mental healthcare. As we wrote in A Crisis in Search of Data [[link removed]],
"the inability to share, combine and analyze data is an issue with significant public
policy implications. Without a complete picture of the impact on the component systems,
policymakers do not have the information they need to analyze the net impact of
SMI [severe mental illness] on high utilization between systems." Integrated data
systems that monitors and links individual's data over time are needed in order
to understand how to improve outcomes and reduce costs.
The San Francisco Department of Public Health implemented such data systems in 2007
to monitor vulnerable populations of people with complex needs. The data system
has information on medical service use as well as social services such as homeless
shelter use, housing, and jail health services.
A research article published in this month's Health Affairs journal employed this
data system in San Francisco to examine service utilization of frequent emergency
department users. The authors found that 67% of the superfrequent users, people
with 18 or more emergency department visits in one year, had at least one mental
health visit during the year of study and an average of more than two psychiatric
hospitalizations. Only 22% of the nonfrequent users had any mental health treatment.
The authors also found that individuals with a psychotic disorder were more than
twice as likely to be a frequent emergency department user and individuals who
had a history of legal conservatorship had 2.5 higher odds of being a frequent emergency
department user.
Care coordination across service systems is needed for this population, evidenced
by the significant use of services in a variety of different settings, the authors
argue.
"To achieve a future state in which whole-person care can be delivered, policy makers
should prioritize improvements in data sharing across sectors and, as a first step,
the development and expansion of integrated health and social data systems," the
authors write. Policy makers can look to the integrated data system in San Francisco
as an example to how these data systems can be implemented and inform policy decisions
to improve outcomes.
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References:

* Kanzaria, H. K. (2019, November). Frequent emergency department users: Focusing
solely on medical utilization misses the whole person. [[link removed]]
Health Affairs.
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Elizabeth Sinclair Hancq
Director of Research
Treatment Advocacy Center
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Research Weekly is a summary published as a public service of the Treatment Advocacy
Center and does not necessarily reflect the findings or positions of the organization
or its staff. Full access to research summarized may require a fee or paid subscription
to the publications.
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The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical
companies.
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