--- title: "Serious mental illness and regional ER use. | Sutter Health" description: "Findings indicate heterogeneity in regional utilization patterns among frequent ED utilizers, with mental illness increasing the likelihood of multi-ED use." url: "https://www.sutterhealth.org/research/publications/serious-mental-illness-and-regional-er-use-1055312801" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Serious mental illness and regional ER use. # Serious mental illness and health-related factors associated with regional emergency department utilization. Azar KMJ, Petersen JP, Shen Z, Nasrallah C, Pesa J, LaMori J, & Pressman A. _Popul Health Manag. doi: 10.1089/pop.2019.0161. \[Epub ahead of print\]_ 2019-12-09 ## Abstract Frequent emergency department (ED) utilization is an indicator of unmet health and social needs, especially among patients with mental and physical health problems. The authors aimed to characterize frequent ED utilizers and drivers of multiple ED use, including presence of serious mental illness (SMI), across 2 large health care systems in Northern California. Using electronic health records and a data-sharing platform, a cross-sectional analysis was conducted of patients aged 18+ years with ≥10 ED visits in 2016. Logistic regression was used to determine factors associated with multiple ED use versus single ED use. Among the 8036 patients who met inclusion criteria, the mean age was 55.9 years (95% CI = 55.5-56.4), 53% were female, 54% were non-Hispanic white, and 38% had any SMI. Overall, 51% of patients were single ED utilizers. Patients ages ≥65 years were less likely to use multiple EDs compared to younger patients (ages 18-23) (OR = 0.3, 95% CI = 0.2-0.4). African Americans exhibited more than 3 times the likelihood of multi-ED use compared to non-Hispanic whites (OR = 3.8, 95% CI = 3.3-4.3). A diagnosis of any SMI (OR = 2.3 \[95% CI: 2.1-2.6\]), major depressive disorder (OR = 1.3, 95% CI = 1.1-1.4), schizophrenia (OR = 2.1, 95% CI = 1.6-2.6), or suicidal attempts/ideation (OR = 2.7, 95% CI = 2.1-3.6) was significantly associated with increased likelihood of multi-ED use. Findings indicate heterogeneity in regional utilization patterns among frequent ED utilizers, with mental illness increasing the likelihood of multi-ED use. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/31816257) ![Kristen M J Azar, RN, MSN, MPH](https://dyn.mktgcdn.com/p/rFmyR1kiX8JzE5-XNwup0gVC1GRaVTlH7oSDlG0Tr5A/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Kristen M J Azar, RN, MSN, MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985) ## Research topics - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Mental Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Mental+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit.](https://www.sutterhealth.org/research/publications/digital-info-sharing-pt-privacy-families-icu-1055312450) Brown SM, Aboumatar HJ, Francis L, Halamka J, Rozenblum R, Rubin E, Sarnoff Lee B, Sugarman J, Turner K, Vorwaller M, Frosch DL; Privacy, Access, and Engagement Task Force of the Libretto Consortium of the Gordon and Betty Moore Foundation. J Am Med Inform Assoc. pii: ocv182. doi: 10.1093/jamia/ocv182. \[Epub ahead of print\] 2016 Mar 16 - Publication ### [Physicians’ well-being linked to in-basket messages generated by algorithms In electronic health records.](https://www.sutterhealth.org/research/publications/md-well-being-and-in-basket-messages-from-ehr-algorithms-1055312699) Tai-Seale M, Dillon EC, Yang Y, Nordgren R, Steinberg R, Nauenberg T, Lee TC, Meehan A, Li J, Chan AS, Frosch D. Health Aff. 38(7): https://doi.org/10.1377/hlthaff.2018.05509. 2019 Jul 01 - Publication ### [The relationship between primary care physician burnout and patient-reported care experiences: a cross-sectional study.](https://www.sutterhealth.org/research/publications/primary-care-md-burnout-and-pt-reported-care-experiences-1055312771) Chung S, Dillon EC, Meehan AE, Nordgren R, Frosch DL. J Gen Intern Med. doi: 10.1007/s11606-020-05770-w. \[Epub ahead of print\]. 2020 Mar 23 - Publication ### [Physicians’ well-being linked to in-basket messages generated by algorithms In EHRs.](https://www.sutterhealth.org/research/publications/md-wellbeing-in-basket-messages-from-ehr-algorithms-1055312708) Tai-Seale M, Dillon EC, Yang Y, Nordgren R, Steinberg R, Nauenberg T, Lee TC, Meehan A, Li J, Chan AS, Frosch D. Health Aff. 38(7): https://doi.org/10.1377/hlthaff.2018.05509. 2019 Jul 01 - Publication ### [Using electronic health record data to measure care quality for individuals with multiple chronic medical conditions.](https://www.sutterhealth.org/research/publications/ehr-care-quality-pts-mccs-1055312497) Bayliss EA, McQuillan DB, Ellis JL, Maciejewski ML, Zeng C, Barton MB, Boyd CM, Fortin M, Ling SM, Tai-Seale M, Ralston JD, Ritchie CS, Zulman DM. J Am Geriatr Soc. doi: 10.1111/jgs.14248. \[Epub ahead of print\] 2016 Jul 07 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/serious-mental-illness-and-regional-er-use-1055312801#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Serious mental illness and regional ER use."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/serious-mental-illness-and-regional-er-use-1055312801#medicalscholarlyarticle","name":"Serious mental illness and health-related factors associated with regional emergency department utilization.","headline":"Serious mental illness and regional ER use.","abstract":"Frequent emergency department (ED) utilization is an indicator of unmet health and social needs, especially among patients with mental and physical health problems. The authors aimed to characterize frequent ED utilizers and drivers of multiple ED use, including presence of serious mental illness (SMI), across 2 large health care systems in Northern California. Using electronic health records and a data-sharing platform, a cross-sectional analysis was conducted of patients aged 18+ years with ≥10 ED visits in 2016. Logistic regression was used to determine factors associated with multiple ED use versus single ED use. Among the 8036 patients who met inclusion criteria, the mean age was 55.9 years (95% CI = 55.5-56.4), 53% were female, 54% were non-Hispanic white, and 38% had any SMI. Overall, 51% of patients were single ED utilizers. Patients ages ≥65 years were less likely to use multiple EDs compared to younger patients (ages 18-23) (OR = 0.3, 95% CI = 0.2-0.4). African Americans exhibited more than 3 times the likelihood of multi-ED use compared to non-Hispanic whites (OR = 3.8, 95% CI = 3.3-4.3). A diagnosis of any SMI (OR = 2.3 [95% CI: 2.1-2.6]), major depressive disorder (OR = 1.3, 95% CI = 1.1-1.4), schizophrenia (OR = 2.1, 95% CI = 1.6-2.6), or suicidal attempts/ideation (OR = 2.7, 95% CI = 2.1-3.6) was significantly associated with increased likelihood of multi-ED use. 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