Evaluating Mental Health Follow-Up Care After Emergency Department Visits for Mental Illness

Research Question: Follow-up care after an emergency department visit for mental illness within 7 (or 30) days is a new performance measure for mental health care based on the widely used performance measure of receipt of follow-up care after an inpatient hospitalization for mental illness. Little empirical evidence supports the use of this new measure. I examine whether follow-up after an emergency department visit is associated with improved utilization and spending outcomes.

Methods: I use health insurance enrollment and claims data from the Massachusetts all payer claims database and regression analysis. The primary outcome measures are total healthcare spending during the 180-day follow-up period after an emergency department visit for mental illness and whether the patient has a repeat hospital visit post discharge. Explanatory variables are follow-up within 7 or 30 days; controls are included for patient (e.g., clinical, demographic), insurance, and provider factors.

Results: Preliminary results show 106,579 individuals had an index emergency department visit. Average spending for the index emergency department visit and 180 day follow-up period was $9,033. 60.1% had any follow-up within 7 days, and 81.1% within 30 days. 57.2% had a repeat admission or ED visit within the 180 day follow-up period. Additional analyses will use multivariate regressions to control for patient, insurance, and provider factors in estimating associations between follow-up and outcomes.

Conclusions: Quantifying impacts of follow-up care may help improve investment in this care coordination across settings, particularly in the context of high rates of repeat hospitalizations and high healthcare spending.This study helps fill a critical hole in existing research by strengthening the empirical evidence base for the calculation and use of mental health performance measures.