Acute Care Utilization in Patients With Concurrent Mental Health and Complex Chronic Medical Conditions

Area of Science:

• Health Services Research
• Clinical Medicine
• Public Health

Background:

• Coexisting mental health disorders and chronic diseases increase patient vulnerability.
• Poor health outcomes are linked to higher acute care utilization in this population.

Purpose of the Study:

• To assess the association between mental health disorders and acute care utilization.
• To analyze emergency department (ED) use, hospitalization, and 30-day rehospitalization rates.
• To identify patterns of comorbidity using disease clustering.

Main Methods:

• Retrospective cohort analysis of 10,408 adult patients.
• Inclusion criteria: seen at least twice in primary care between 2010-2013.
• Outcome measure: count of acute care use (hospital or ED); analysis via linear regression and agglomerative hierarchical clustering.

Main Results:

• Non-white race, resident physician involvement, and public insurance were associated with increased utilization.
• Patients in multiple chronic conditions (MCC), COPD/asthma, or renal disease clusters showed significantly higher predicted utilization.
• Mental health diagnoses independently predicted higher utilization (1.41 times).
• Co-occurring mental health disorders and chronic diseases, particularly in COPD/asthma, renal disease, and MCC clusters, significantly increased acute care utilization.

Conclusions:

• Patients with co-occurring chronic medical conditions and mental health disorders exhibit higher acute care utilization.
• Integrating mental health care within primary care settings may effectively reduce healthcare utilization and improve outcomes.