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Frequent Emergency Department Users: Focusing Solely On Medical Utilization Misses The Whole Person

机译：频繁的急诊署用户：专注于医疗利用率，错过了整个人

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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.
机译：频繁的急诊部（ED）用户通常具有复杂的行为健康和社会需求。但是，在不检查其使用行为健康和社会服务系统的情况下，政策制定者通常专注于本人的医疗系统使用。为了照亮频繁的ED用户的广泛需求，我们比较了加利福尼亚州旧金山县的非先生无频，频繁，超频繁的ED用户的医疗，心理健康，物质使用和社会服务。我们将2013-15财政年度的行政数据联系在县级综合数据系统中，县医疗补助管理计划的受益者。与非频繁用户相比，频繁的用户不成比例地女性，白色或非裔美国人/黑色，无家可归。他们有更多的合并症和年度门诊心理健康访问（11.93与4.16岁），精神招生（0.73与0.07）和Sobering Center访问（0.17与<0.01），以及使用住房和监狱健康服务的使用。我们的发现指出了患者和人口水平跨领域的共享知识的需求。集成数据可以作为系统改进工具，并帮助识别可能受益于协调管理管理的患者。为了提供全方位的关怀，政策制定者应优先于数据共享的改进以及综合医疗，行为和社会护理系统的发展。

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