Preventing Emergency Department Re-Admissions with an Integrated Care Approach

Adults with mental illness experience greater morbidity and mortality, in large part due to elevated incidence and prevalence of chronic health conditions such as obesity, diabetes, hypertension and hyperlipidemia. One in eight emergency department visits and one in four hospital stays involves a person with a mental health or substance use disorder[1]. Within a behavioral health setting of a public hospital system in South Florida, 41% of consumers accessed the EDs on 2,084 occasions. Most of these visits were classified as Level 1 or Level 2 ED visits, which could have been treated in a primary care setting. The current program focuses on providing integrated primary and ancillary health services to individuals within an outpatient behavioral health setting as a way to reduce emergency department over-utilization among individuals with co-occurring physical and behavioral health issues.

Within the integrated Mind-Body Wellness Clinic, clients considered high utilizers of the Emergency Department showed significant reductions of their ED use over time. Electronic Health Record data indicated that, for clients enrolled longer than 14 months, ED visits in the recent 3 months and total visits since program intake were lower compared to their counterparts. Although clients enrolled for longer have more of an opportunity to have an ED visit, the average number of visits for these clients is fewer, indicating that enrollment in the MBW Clinic may prevent ED use, even among high utilizers. Additionally, 75.7% of clients on the high utilizer list are uninsured, slightly more than for the whole sample (64.1%).

Electronic Health Record data (e.g. ED visits, diagnoses) and process data will be discussed to showcase how integrated care teams can mitigate higher levels of care when they are unneeded. Preliminary results indicate that Integrated care not only contributes to more positive health and behavioral health outcomes, but that it also saves money reducing utilization of the emergency department as a setting for care among individuals with elevated health risks.

[1] Parks, J, Svendsen, D. Singer, P. & Foti, M. E. (2006). Morbidity and Mortality in People with Serious Mental Illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. Retrieved from http://theempowermentcenter.net/Articles/Technical%20Report%20on%20Morbidity%20and%20Mortaility%20-%20Final%2011-06.pdf