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. 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, "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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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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