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)
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?
Rates are used to measure how
often something happens and 1426
allows for comparisons among 1000
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.
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. . .
Adults with either a mental health or
4000 substance abuse diagnosis used the
3910 emergency room two times more often.
Adults with both mental health and
2000 substance abuse diagnoses used the
1680 1730 emergency room four times more often,
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
Most emergency room visits are for 100.0%
medical conditions or injuries, not 80.0%
behavioral health issues. 76.4
Adults with either a mental health or 40.0%
substance abuse diagnosis were twice as
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
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?
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