Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: The consequences of increasing medical complexity

Abstract

Objective Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity. Methods Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes. Results Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions. Conclusion Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones.

A Model of Enhanced Primary Care for Patients with Severe Mental Illness

“…Lastly, those with SMI face a fragmented behavioral and physical health system that makes accessing adequate primary care difficult, rendering them less likely to receive needed preventive care and manage their comorbid physical illnesses [19][20]. As a result, these patients are often compelled to use the health care system in inefficient ways, with increased use of emergency departments and inpatient hospitalization [21].…”

Factors associated with chronic frequent emergency department utilization in a population with diabetes living in metropolitan areas: a population-based retrospective cohort study

“…Patients living with diabetes are known to be high health care users [ 25 , 26 ]. In a study conducted on patients with cardiovascular risk factors (including diabetes), about 5% used near 50% of all ED visits made by that population [ 10 ].…”

Impact of Peer Support on Acute Care Visits and Hospitalizations for Individuals With Diabetes and Depressive Symptoms: A Cluster-Randomized Controlled Trial

“…A majority of these dollars are spent on AC visits, hospitalizations, and diabetes-related complications rather than prevention and selfmanagement education and support (4). Utilization rates and costs are often higher for those with comorbid mental health disorders, including depression (6,7). Peer support and coaching can be an important bridge from clinic to community that could be used as a strategy for population health management, particularly for high-risk individuals (8), but few data report on the impact of peer support on health services utilization for people living with diabetes.…”