TY - JOUR
KW - Databases, Factual
KW - Emergency Service, Hospital/statistics & numerical data
KW - Female
KW - Health Services Accessibility
KW - Health Services Misuse/trends
KW - Housing
KW - Humans
KW - Male
KW - Medicaid
KW - Middle Aged
KW - San Francisco
KW - United States
KW - Access and use
KW - behavioral health care
KW - Drug Use
KW - emergency departments
KW - Frequent users
KW - Health Policy
KW - Health services
KW - Integrated health services
KW - Medicaid patients
KW - Mental Health
AU - Hemal K. Kanzaria
AU - Matthew Niedzwiecki
AU - Caroline L. Cawley
AU - Carol Chapman
AU - Sarah H. Sabbagh
AU - Emily Riggs
AU - Alice Hm Chen
AU - Maria X. Martinez
AU - Maria C. Raven
A1 - 
AB - Frequent emergency department (ED) users often have complex behavioral health and social needs. However, policy makers often focus on this population's medical system use without examining its use of behavioral health and social services systems. To illuminate the wide-ranging needs of frequent ED users, we compared medical, mental health, substance use, and social services use among nonelderly nonfrequent, frequent, and superfrequent ED users in San Francisco County, California. We linked administrative data for fiscal years 2013-15 for beneficiaries of the county's Medicaid managed care plan to a county-level integrated data system. Compared to nonfrequent users, frequent users were disproportionately female, white or African American/black, and homeless. They had more comorbidities and annual outpatient mental health visits (11.93 versus 4.16), psychiatric admissions (0.73 versus 0.07), and sobering center visits (0.17 versus <0.01), as well as disproportionate use of housing and jail health services. Our findings point to the need for shared knowledge across domains, at the patient and population levels. Integrated data can serve as a systems improvement tool and help identify patients who might benefit from coordinated care management. To deliver whole-person care, policy makers should prioritize improvements in data sharing and the development of integrated medical, behavioral, and social care systems.
AD - Hemal K. Kanzaria ( Hemal. Kanzaria@ucsf. edu ) is an associate professor in the Department of Emergency Medicine and an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies, both at the University of California San Francisco (UCSF).; Matthew Niedzwiecki is a health researcher at Mathematica Policy Research in Oakland, California.; Caroline L. Cawley is a research associate in the Department of Emergency Medicine, UCSF.; Carol Chapman is a program analyst in the San Francisco Department of Public Health, in California.; Sarah H. Sabbagh is a health policy research associate in the Department of Emergency Medicine, UCSF.; Emily Riggs is supervisor of business intelligence analytics, San Francisco Health Plan, in California.; Alice Hm Chen is deputy director and chief medical officer, San Francisco Health Network, San Francisco Department of Public Health.; Maria X. Martinez is director of Whole Person Care in the San Francisco Department of Public Health.; Maria C. Raven is an associate professor in the Department of Emergency Medicine and an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies, UCSF.
BT - Health affairs (Project Hope)
C5 - Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
CP - 11
CY - United States
DO - 10.1377/hlthaff.2019.00082
IS - 11
JF - Health affairs (Project Hope)
LA - eng
M1 - Journal Article
N2 - Frequent emergency department (ED) users often have complex behavioral health and social needs. However, policy makers often focus on this population's medical system use without examining its use of behavioral health and social services systems. To illuminate the wide-ranging needs of frequent ED users, we compared medical, mental health, substance use, and social services use among nonelderly nonfrequent, frequent, and superfrequent ED users in San Francisco County, California. We linked administrative data for fiscal years 2013-15 for beneficiaries of the county's Medicaid managed care plan to a county-level integrated data system. Compared to nonfrequent users, frequent users were disproportionately female, white or African American/black, and homeless. They had more comorbidities and annual outpatient mental health visits (11.93 versus 4.16), psychiatric admissions (0.73 versus 0.07), and sobering center visits (0.17 versus <0.01), as well as disproportionate use of housing and jail health services. Our findings point to the need for shared knowledge across domains, at the patient and population levels. Integrated data can serve as a systems improvement tool and help identify patients who might benefit from coordinated care management. To deliver whole-person care, policy makers should prioritize improvements in data sharing and the development of integrated medical, behavioral, and social care systems.
PP - United States
PY - 2019
SN - 1544-5208; 0278-2715
SP - 1866
EP - 1875
EP - 
T1 - Frequent Emergency Department Users: Focusing Solely On Medical Utilization Misses The Whole Person
T2 - Health affairs (Project Hope)
TI - Frequent Emergency Department Users: Focusing Solely On Medical Utilization Misses The Whole Person
U1 - Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
U2 - 31682499
U3 - 10.1377/hlthaff.2019.00082
VL - 38
VO - 1544-5208; 0278-2715
Y1 - 2019
Y2 - Nov
ER -