County of San Diego Division of Emergency Medical Services EMS 1 Mental Health Disorders and Substance Use and Abuse in the Emergency Department County.

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Presentation transcript:

County of San Diego Division of Emergency Medical Services EMS 1 Mental Health Disorders and Substance Use and Abuse in the Emergency Department County of San Diego April 13, 2006

County of San Diego Division of Emergency Medical Services EMS 2 Background Includes all patients treated and discharged from the ED. –Does not represent all patients presenting to the Emergency Department –Admitted patients are transferred to the hospital discharge (inpatient) database Inpatient and ED databases are mutually exclusive 12% – 20% of patients presenting to the ED are admitted ED Data represents the less serious injuries Unique identifiers not included in ED database –Multiple visits by the same person cannot be identified

County of San Diego Division of Emergency Medical Services EMS 3 Data Elements Facility ID Number Patient ZIP code Date of Birth Sex Race Ethnicity Service Date Patient Disposition Expected Source of Payment Principal Diagnosis Other Diagnoses Principal E-Code Other E-Codes Principal Procedure (CPT-4) Other Procedures

County of San Diego Division of Emergency Medical Services EMS 4 Methods 18 Civilian EDs in San Diego County 3 rd Quarter ED Records were examined –July - September 2005 –16 hospitals reporting –147,001 total ED discharges –>97% of total ED discharges for San Diego County.

County of San Diego Division of Emergency Medical Services EMS 5 Methods All records with a “Mental Disorder” diagnosis code were extracted (ICD-9-CM 290 – 319) –18,559 total patients identified Any mental illness: ICD-9-CM 290, , –10,192 patients with any MI diagnoses –3,746 patients with a primary diagnosis Any substance use/abuse: ICD-9-CM , –10,304 patients with any substance use/abuse diagnosis –334 patients with a primary diagnosis

County of San Diego Division of Emergency Medical Services EMS 6 Rate Calculations Rate Formula Number of events in the population per year X 100,000 Number of people in the population per year Calculating annual rates for quarterly data –Should be comparable to annual rates Number of events in the population per quarter X 100,000 (Number of people in the population per year) / 4 Example Number of ED Discharges, 2005 Qtr3 X 100,000 (Total Population, 2005) / 4 =147,001 X 100,000 = 147,001 X 100,000 = 19,501 per 100,000 (3,015,280) / 4 753,820

County of San Diego Division of Emergency Medical Services EMS 7 Mental Illness in the Emergency Department

County of San Diego Division of Emergency Medical Services EMS 8 Mental Illness (MI) 10,192 patients with any MI diagnosis (6.9%) –3,746 patients with a primary diagnosis of MI (37%) 1,036 patients with additional MI diagnoses (28%) 728 with at least one additional substance use/abuse diagnosis (19%)

County of San Diego Division of Emergency Medical Services EMS 9 Primary Diagnosis of ED Patients With Any Mental Illness (N = 10,192) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 10 Primary Diagnosis of Mental Illness FrequencyPercent Neurotic Disorders1, Depressive Disorder Otr Affective Psychoses Oth Nonorganic Psychoses Schizophrenic Disorders Special Symptoms Syndromes Psychogenic Malfunction Acute Reaction to Stress Organic Nonpsych Mental Dis Other Mental Illness Total3, Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 11 Primary Diagnosis of Neurotic Disorder FrequencyPercent Unspecified Anxiety State Panic Disorder w/o Agoraphobia Dysthymic Disorder835.5 Unspecified Nonpsychotic Mental Disorder Other Neurotic Disorder130.9 Total1, Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 12 Region of Residence ED Patients With a Primary Diagnosis of Mental Illness San Diego County Population Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 13 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Region of Residence (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 14 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Age Group (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 15 ED Discharge Patients With Any Mental Illness Diagnoses by Age Group (N = 10,192) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 16 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Age Group and Gender (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 17 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Race/Ethnicity (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 18 All ED Discharge Patients by Race/Ethnicity (N = 147,001) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 19 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Race/Ethnicity (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 20 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Race/Ethnicity and Age Group, Rates per 100,000 (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 21 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Disposition Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 22 ED Discharge Patients With Any Mental Illness Diagnosis by Primary Diagnosis and Disposition 360 ED discharge patients (3.5%) with any mental health diagnoses were also reported to have a self-inflicted injury (71%) had a primary diagnosis of injury and poisoning, 94 (26%) had a primary diagnosis of mental illness (31%) were also diagnosed with substance use/abuse. Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 23 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Expected Source of Payment Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 24 All ED Discharge Patients by Expected Source of Payment (N = 147,001) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 25 ED Discharge Patients With Any Mental Illness Diagnoses by Primary Diagnosis and Expected Source of Payment (N=10,192) Underinsured: 44.5% 46.7% 31.3% 35.1% 33.1% Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 26 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Payor Source and Region of Residence (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 27 All ED Discharge Patients by Payor Source and Region of Residence (N = 147,001) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 28 ED Discharge Patients With a Primary Diagnosis of Mental Illness by Payor Source and Race/Ethnicity (N = 3,746) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 29 All ED Discharge Patients by Payor Source and Race/Ethnicity (N = 147,001) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 30 Substance Use/Abuse in the Emergency Department

County of San Diego Division of Emergency Medical Services EMS 31 Substance Use/Abuse 10,304 ED discharge patients identified with substance use/abuse (7.0%) –1,916 ED discharge patients with a primary diagnosis of substance use/abuse (18.6%) 334 (17.4%) were also diagnosed with a mental illness

County of San Diego Division of Emergency Medical Services EMS 32 Primary Diagnosis of ED Discharge Patients With Any Substance Use/Abuse Diagnoses (N=10,304) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 33 Primary Diagnosis of Substance Use/Abuse Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 34 Region of Residence ED Patients With a Primary Diagnosis of Substance Use/Abuse San Diego County Population Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 35 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Region of Residence (N = 1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 36 ED Discharge Patients With A Substance Use/Abuse Primary Diagnosis by Region of Residence (N=1,916) Alcohol Related:74.0% 78.0%70.2% 71.5% Drug Related:26.0% 22.0%29.8% 28.5% Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 37 ED Discharge Patients With A Substance Use/Abuse Primary Diagnosis by Region of Residence (N=1,916) Alcohol Related:67.5% 70.2%75.5% 76.5% Drug Related:32.5% 29.8%24.5% 23.5% Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 38 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Age Group (N = 1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 39 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Age Group and Gender (N = 1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 40 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Race/Ethnicity (N = 1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 41 All ED Discharge Patients by Race/Ethnicity (N = 147,001) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 42 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Race/Ethnicity (N = 1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 43 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Race/Ethnicity and Age Group, Rates per 100,000 (N = 1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 44 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Disposition (N=1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 45 ED Discharge Patients With a Primary Diagnosis of Substance Use/Abuse by Expected Source of Payment (N=1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 46 All ED Discharge Patients by Expected Source of Payment (N = 147,001) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 47 ED Discharge Patients With A Substance Use/Abuse Primary Diagnosis by Expected Source of Payment (N=1,916) Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 48 Mental Illness and Substance Use/Abuse Summary 10,192 ED discharge patients with any mental illness diagnosis –3,746 (37%) with a primary MI diagnosis 1,036 (28%) with additional MI diagnoses 728 (19%) with additional substance use/abuse diagnoses 10,304 ED discharge patients with any substance use/abuse diagnosis –1,916 (19%) with a primary substance use/abuse diagnosis 668 (35%) with additional substance use/abuse diagnoses 334 (17%) with additional MI diagnoses Source: HASD&IC, CHIP, CoSD EMS, Emergency Department Database, July – September 2005.

County of San Diego Division of Emergency Medical Services EMS 49 For More Information, Contact: Holly Shipp or Leslie Upledger Ray 6255 Mission Gorge Road San Diego, CA (619)