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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2019

Open Access 01-12-2019 | Care | Research article

Assessing quality indicators related to mental health emergency room utilization

Authors: Marie-Josée Fleury, Marilyn Fortin, Louis Rochette, Guy Grenier, Christophe Huỳnh, Éric Pelletier, Helen-Maria Vasiliadis

Published in: BMC Emergency Medicine | Issue 1/2019

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Abstract

Background

This descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI).

Methods

Data emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06.

Results

PMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low.

Conclusions

This study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.
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Metadata
Title
Assessing quality indicators related to mental health emergency room utilization
Authors
Marie-Josée Fleury
Marilyn Fortin
Louis Rochette
Guy Grenier
Christophe Huỳnh
Éric Pelletier
Helen-Maria Vasiliadis
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Emergency Medicine / Issue 1/2019
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-019-0223-8

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