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					                                         QI Data Snapshot
                                                              Office of Quality Improvement Services


October 2009                                                                                      Volume 1, Issue 4

       Populations Studied                Emergency Room Use by Adults with Mental
    Adults age 19 to 64 years              Health and Substance Abuse Disorders
    On Medicaid (MaineCare) for         This snapshot looks at adults with mental health and substance abuse
     11 out of 12 months                 disorders who receive Medicaid services in Maine and South Carolina.
    Service users were all adults       The study compares emergency room use in four study groups over a
     who received Medicaid services      year.
     between July 1, 2006 and June
     30, 2007                                                   Four Groups Studied

                                         1. No mental health or substance abuse diagnosis           (No MH/SA Dx)
          Study Methods
                                         2. Mental health with no substance abuse diagnosis (MH Dx)
    Adults were placed in one of
                                         3. Substance abuse with no mental health diagnosis (SA Dx)
     four groups (listed to the right)
     based on diagnoses                  4. Mental health and substance abuse diagnoses             (MH & SA Dx)

    Emergency room diagnoses are                                          Results
     based on the primary diagnoses
     given at the emergency room
     visit                                           Overall Emergency Room Use in Maine and South Carolina:
                                                                Visits per 1000 Adult Service Users
           A Closer Look                    2000
      What do the rates mean?
                                            1500
    Rates are used to measure how
     often something happens and                                1426
     allows for comparisons among           1000
     different groups
                                                                                                   827
    Emergency room rates are                  500
     based on the number of
     emergency room visits per                   0
     every 1,000 adult service users                        Maine Adults                  South Carolina Adults
    Maine’s emergency room rate is
     1426 visits per 1,000 adult               Emergency room use for Maine’s study group was nearly two
     service users, while South                 times higher than in South Carolina.
     Carolina’s rate is 827
    On average, each adult in Maine       Maine and South Carolina volunteered to share Medicaid
     used the emergency room 1.4           claims data and be involved in this two-state study. The study
     times yearly. Adults in South         was funded by a grant from the National Association of State
     Carolina used the emergency           Mental Health Program Directors Research Institute (NRI)
     room less than once a year.
                                                                                                                      1
            All Maine and South Carolina Emergency Room                      Compared to adults with no mental health
             Visits per 1000 Adult Service Users per Year                    or substance abuse diagnosis. . .
 5000
                                                                                  Adults with either a mental health or
 4000                                                                              substance abuse diagnosis used the
                                                           3910                    emergency room two times more often.
 3000
                                                                  3011
                                                                                  Adults with both mental health and
 2000                                                                              substance abuse diagnoses used the
                           1680            1730                                    emergency room four times more often,
 1000                                             1394
             880 615
                                  1123                                             and they were more than six times as
      0                                                                            likely to have four or more emergency
            No MH/SA Dx       MH Dx          SA Dx          MH & SA Dx             room visits in a year.
                           Maine      South Carolina



 Compared to adults with no mental health
 or substance abuse diagnosis. . .                                                       Reason for Emergency Room Visit
                                                                                                     by Group
         Most emergency room visits are for                             100.0%
          medical conditions or injuries, not                             80.0%
          behavioral health issues.                                                                     76.4
                                                                                                               73.1
                                                                                                                             78.5
                                                                          60.0%
                                                                                                                      61.1
         Adults with either a mental health or                           40.0%
          substance abuse diagnosis were twice as
                                                                          20.0%
          likely to use the emergency room for                                    17.8 21.4 17.2 21.5                               5.8 5.1 20.3
          medical issues.                                                  0.0%
                                                                                       Injuries         Medical Diagnosis           Mental Health &
         Adults with both mental health and                                                                                        Substance Abuse

          substance abuse diagnoses used the                                      MH Group         SA Group            MH & SA         No MH/SA
          emergency room at least four times more
          often.



                                                         Questions to Consider. . .
1. What accounts for Maine’s rate of emergency room use?
2. Why do adults with mental health or substance abuse disorders have increased use of emergency
   rooms for medical issues?
3. How can community services be changed to better provide medical care to adults with mental health
   or substance abuse issues?



                                         Contact Info
                                    Tel: (207) 287-4296
                                   TTY: 1-800-606-0215
                                   Visit OQIS Website
                          http://www.maine.gov/dhhs/QI/home.html



                          Caring..Responsive..Well-Managed..We are DHHS.
                                                                                                                                                      2

				
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