Predictors of Return Visits Among Insured Emergency Department Mental Health and Substance Abuse Patients, 2005-2013

Introduction: Our goal was to describe the pattern and identify risk factors of early-return ED visits orinpatient admissions following an index mental health and substance abuse (MHSA)-related ED visit in theUnited States.Methods: We performed a retrospective cohort study using Optum Labs Data Warehouse, a nationallyrepresentative database containing administrative claims data on privately insured and MedicareAdvantage enrollees. Authors identified patients presenting to an ED with a primary diagnosis of MHSAbetween 2005 and 2013 who were discharged home. Study inclusion required continuous insuranceenrollment for the 12 months preceding and the 31 days following the index ED visit. During the studyperiod we included only the first ED visit for each patient.Results: A total of 49,672 (14.2%) had a return visit to the ED or had a hospitalization within 30 daysfollowing discharge. Mean time to the next ED visit or inpatient admission was 11.7 days. An increasedage (age 65+ vs. age <18 years; OR 1.65, 95% CI [1.57 to 1.74]), chronic medical comorbidities (Hwangcomorbidity 5+ vs 0; OR 1.31, 95% CI [1.27 to 1.35]), prior ED and inpatient utilization (4+ visits vs 0 visits;OR 5.59, 95% CI [5.41 to 5.78]) were associated with return visits within 30 days following discharge.Conclusion: In an analysis of nearly 350,000 ED visits for MHSA, 14.2 % of patients returned to the ED orhospital within 30 days. This study identified a number of factors associated with return visits for acute care.[West J Emerg Med. 2017;18(5)884-893.