Correlates of Emergency Department Use by Individuals With Bipolar Disorder Enrolled in a Collaborative Care Implementation Study

Abstract

Objectives The study assessed correlates of emergency department use among individuals with bipolar disorder receiving a collaborative care program. Methods Community-based clinics from two states implemented the evidence-based Life Goals-Collaborative Care Model (LG-CC), which included self-management sessions and care management contacts. Logistic regression analysis was used to determine participant factors associated with 12-month emergency department use after LG-CC implementation. Results Among 219 participants with non-missing baseline and 12-month data, 24.2% (n=53) reported at least one emergency department visit. Participants with homelessness history (OR=3.76; 95% CI=1.39–10.2; p=.01) or 5 or more care management contacts (OR=2.62; 95% CI=.1.00–6.95; p=.05) had higher probability of emergency department visit, adjusting for demographic and clinical factors including physical health and hospitalization history. Conclusions Individuals with bipolar disorder and history of homelessness were more likely to use the emergency department despite enrollment in a Collaborative Care program, suggesting a greater need for more intensive care coordination.

Changing Patterns of Mental Health Care Use: The Role of Integrated Mental Health Services in Veteran Affairs Primary Care

“…Lack of change in acute care use contrasts a previous study that found an association between increased contact with care management and increased ED visits. 24 Furthermore, our study found that higher clinic PC-MHI engagement had a small, nonsignificant reduction in total cost of care, in some contrast with other studies demonstrating modest additional costs but overall cost effectiveness of collaborative care in other settings. 25,26 To fully understand the financial burden of these services and whether they can be deemed as high value care, however, requires a more comprehensive cost-analysis that includes program implementation and operation costs.…”