{"title":"Variation in Hospital Admission Rates for Schizophrenia Spectrum Disorder Emergency Department Visits in 11 States.","authors":"Y Nina Gao, Mark Olfson","doi":"10.1176/appi.ps.20240441","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The authors examined patterns in hospital admission rates for patients with a schizophrenia spectrum disorder (SSD)-related visit to an emergency department (ED).</p><p><strong>Methods: </strong>The authors identified 116,928 ED visits for SSD across 1,071 hospitals in an 11-state sample drawn from the 2020 State Emergency Department Databases and State Inpatient Databases. The distribution of hospital-level admission rates was described by using a finite mixture model. Hospital- and county-level characteristics were compared across hospitals with low, medium, or high SSD admission shares.</p><p><strong>Results: </strong>Admission shares for patients with an SSD ED visit were highly variable and multimodal across hospitals. Although the overall mean admission share for patient ED visits with a primary SSD diagnosis was 56.6% (95% CI=53.0%-60.2%), the mean admission share was 5.6% (95% CI=4.8%-6.4%) in the lowest quintile and was 95.4% (95% CI=94.6%-96.3%) in the highest quintile. The presence of psychiatric beds in a hospital was associated with increased odds of admission (OR=2.56, 95% CI=1.83-3.59). A hospital's size, mental health visit volume, urbanicity, availability of psychiatric consultation, emergency mental health services, and outpatient mental health services, as well as county-level inpatient beds, were not significantly associated with admission rates.</p><p><strong>Conclusions: </strong>Hospital admission rates for patients with an SSD ED visit varied widely, and the presence of inpatient psychiatric beds was positively associated with admission. These findings raise equity concerns by suggesting that variation in inpatient psychiatric bed availability contributes to ED disposition of patients with an SSD-related visit.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240441"},"PeriodicalIF":3.3000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psychiatric services","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1176/appi.ps.20240441","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: The authors examined patterns in hospital admission rates for patients with a schizophrenia spectrum disorder (SSD)-related visit to an emergency department (ED).
Methods: The authors identified 116,928 ED visits for SSD across 1,071 hospitals in an 11-state sample drawn from the 2020 State Emergency Department Databases and State Inpatient Databases. The distribution of hospital-level admission rates was described by using a finite mixture model. Hospital- and county-level characteristics were compared across hospitals with low, medium, or high SSD admission shares.
Results: Admission shares for patients with an SSD ED visit were highly variable and multimodal across hospitals. Although the overall mean admission share for patient ED visits with a primary SSD diagnosis was 56.6% (95% CI=53.0%-60.2%), the mean admission share was 5.6% (95% CI=4.8%-6.4%) in the lowest quintile and was 95.4% (95% CI=94.6%-96.3%) in the highest quintile. The presence of psychiatric beds in a hospital was associated with increased odds of admission (OR=2.56, 95% CI=1.83-3.59). A hospital's size, mental health visit volume, urbanicity, availability of psychiatric consultation, emergency mental health services, and outpatient mental health services, as well as county-level inpatient beds, were not significantly associated with admission rates.
Conclusions: Hospital admission rates for patients with an SSD ED visit varied widely, and the presence of inpatient psychiatric beds was positively associated with admission. These findings raise equity concerns by suggesting that variation in inpatient psychiatric bed availability contributes to ED disposition of patients with an SSD-related visit.
期刊介绍:
Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The peer-reviewed journal features research reports on issues related to the delivery of mental health services, especially for people with serious mental illness in community-based treatment programs. Long known as an interdisciplinary journal, Psychiatric Services recognizes that provision of high-quality care involves collaboration among a variety of professionals, frequently working as a team. Authors of research reports published in the journal include psychiatrists, psychologists, pharmacists, nurses, social workers, drug and alcohol treatment counselors, economists, policy analysts, and professionals in related systems such as criminal justice and welfare systems. In the mental health field, the current focus on patient-centered, recovery-oriented care and on dissemination of evidence-based practices is transforming service delivery systems at all levels. Research published in Psychiatric Services contributes to this transformation.