Emergency Department Utilization Among Kansas Medicaid Aged, Blind, and Disabled Beneficiaries with Severe Mental Illness: the Context and Extent of Ambulatory Care Sensitive Visits

Abstract

This research examines severe mental illness (SMI) and avoidable emergency department (ED) utilization among Kansas Medicaid beneficiaries. We compared SMI and non-SMI subgroups in relation to ED rates and proportion of avoidable or ambulatory care sensitive (ACS) visits over time. We also evaluated the distribution of visits over the course of a year as well as the effect of SMI on ED and ACS ED visits. Finally, we compared clinical reasons behind ACS visits for the SMI and non-SMI subgroups. Paper one evaluated ED utilization and ACS ED use from a longitudinal perspective for the SMI and non-SMI subgroups. ED visit rates for the SMI group were approximately two times higher than the non-SMI group, year over year. Rates for the non-SMI group peaked in 2010, while they peaked for the SMI group in 2011. The proportion of visits considered ACS by the NYU ED algorithm were higher each year for the non-SMI group in comparison to the SMI group. However, for both subgroups, ACS visit rates slightly declined from 2007-2012. Although rates are not rising, they are still concerning at current levels. The second study suggests that, although beneficiaries with SMI use the ED more than individuals without SMI, they do not use it more for ACS visits. SMI significantly increased the likelihood of an ED visit but it did not do so for an ACS ED visit. There was also a significant positive association between primary care utilization and ED use as well as ACS ED use. SMI beneficiaries are appropriate targets for policies aimed at reducing ED utilization but not ACS ED use. Finally, we found that the clinical reasons for ACS visits between SMI and non-SMI beneficiaries are mostly consistent based on ICD9 diagnosis codes. ACS visits are also highly concentrated among these ICD9 codes. Common conditions for ACS categories regardless of SMI status include asthma, upper respiratory conditions, abdominal issues, and diabetes. A strategy focused on targeting individuals by chronic condition in order to reduce ACS visits may be more successful than one zeroing in on SMI status.