Introduction High ED utilization is a known strain on the healthcare system as ED visits are being used as a substitute for limited outpatient services which usually address chronic conditions and their comorbidities. Prior studies have found homelessness,1 degree of financial insecurity,2 and severity of mental health diagnosis3 to be associated with frequent emergency department visits. A subset of those with severe mental illness are individuals with SSD (schizophrenia spectrum disorders). Schizophrenia is often correlated with other medical and psychiatric comorbidities; a combination that significantly affects health and wellbeing. This study investigates sociodemographic factors associated with high ED utilization (defined as five or more ED visits per year) by individuals with schizophrenia at Boston Medical Center: an urban safety net hospital in the Northeast. Methods We extracted data from the electronic health record of all encounters (i.e. billed visits or hospitalizations) made by adults with a SSD at Boston Medical Center (BMC) in Boston, Massachusetts and defined SSD as a chart history of at least one International Classification Of Disease Code 10th edition (ICD-10) primary diagnosis code of F20,F25,F28, F29 which resulted in a sample of 7,960 individuals. Patients with a history of neurocognitive disorder without an F20 or F25 diagnosis (n=263) were eliminated from the sample. The final cohort was restricted to patients with ED visits between January 1st 2016 and June 30th 2016, resulting in a final sample of 5,502 individuals. Results The mean age of the study population is 50.30 (sd=16.53). The study population was composed of 39% females, 60% males, 49.35% non-Hispanic black, 26.53 % non-Hispanic white, 16.49% Hispanic, 2.38% Asian and 0.4% Native Americans. 85.64% were English-speaking and the second most spoken language was Spanish. Almost all individuals (96.39%) had public insurance. Of those individuals who were at risk of housing instability, 72.9% had a history of being in a shelter or currently living in a shelter. 11.54% of individuals had 5 or more ED visits within a year. Around 8% of patients had an intellectual disability, 4% were pregnant, 39% had a co-occuring substance use disorder, and around 94% had a comorbid medical disorder. Females had 0.83 times the odds of having 5 or more ED visits within a year compared to males. English speaking patients had around 1.84 times the odds of having 5 or more ED visits within a year as compared to non-English speaking patients. There was a significant relationship between race and number of ED visits with Χ2 =33.80, p <0.001. We will explore these associations further using a zero inflated poisson regression controlling for substance use and serious physical comorbidity. Conclusion In conclusion, research regarding the factors influencing likelihood of high ED use for individuals with SSD is highly necessary to provide better quality of care and alleviate the burden in Emergency Departments. Upcoming research should aim to explore inequalities related to specific demographic factors, in addition to medical and psychiatric conditions.
Learning Objectives:
highlight the burden of high ED use in individuals with schizophrenia spectrum disorders (SSD)
assess demographics of individuals with SSD and high ED visits to explore factors correlated with frequent ED use
assess prevalence of substance use disorders and medical disorders that may be correlated with high ED use in individuals with SSD
