1 UCLA NIMH Partnered Research Center for Quality Care 2 Department of Psychiatry, Olive View‐UCLA Medical Center
3 DHS Office of Planning and Data AnalyKcs
Understanding uKlizaKon and outcomes of Psychiatric Emergency Service (PES) paKents may help establish standards of care across the three psychiatric ER's and improve clinical producKvity, quality of care and overall paKent outcomes.
There is limited internal LAC DHS data and liUle published data on the characterisKcs of paKents who use psychiatric emergency services
No prospecKve or retrospecKve studies have been done to compare outcomes of paKents who were discharged from PES to the community versus referred for acute psychiatric inpaKent admission.
The limited literature on paKents using psychiatric emergency services suggests that they are a vulnerable, high risk populaKon
What are the demographics, presenKng complaints, diagnoses, comorbidiKes, source of referrals, hold status, and disposiKons of paKents uKlizing the PES at each of the three LAC DHS hospitals?
What are the predictors associated with paKents discharged vs. admiUed from PES?
What are the longitudinal outcomes of paKents discharged vs. admiUed from PES?
RetrospecKve cohort of adult paKents admiUed to PES involuntarily at each of the three LAC DHS hospitals from 2008 through 2010
we will trace longitudinal uKlizaKon and clinical outcomes for paKents in the cohort from 2008 through 2012
Our esKmates for combined number of unique paKents across three years is N=48,693
The Enterprise Linkages Project (ELP) will perform a data match to idenKfy DHS paKent entries in four databases listed below and create a de‐idenKfied master file for analysis
Source Database Independent Variables Dependent Variables
LAC DHS – Affinity Demographics Insurance status Presenting psychiatric diagnoses Presenting medical diagnoses Referral source
Psychiatric inpatient admission PES readmissions Medical admissions
LA Sheriff – Automated Jail Information System (AJIS)
Booking information Arrest offense code Release date Housing location
LA Dept. Mental Health – IS Outpatient mental health care visits PES revisits Inpatient psychiatric admissions PMRT (field emergency) contacts Forensic (jail) mental health episodes
CA Dept. Public Health – California Death Statistical Master File
Place where death occurred Cause of death code Manner of death Underlying cause of death Type of event Type of place of death
There will be substanKal variaKon across the three LAC DHS PES sites in admission and discharge rates for high‐acuity PES paKents.
A major goal of the analyses is to determine whether outcomes such as readmissions, deaths, and arrests are significantly higher for paKents with high acuity that are discharged than those who are admiUed, and whether this leads to overall poorer outcomes for PES sites with higher rates of discharge rather than admission of high acuity paKents.
Discharge of high acuity paKents is expected to lead to poorer outcomes. This may depend on the level of follow‐up available or other characterisKcs of paKents, such as social support or established relaKonships with providers; or of systems, such as availability of providers for rapid outpaKent follow‐up.
We expect racial and ethnic dispariKes in discharge/admission rates and outcomes, including readmissions, deaths and arrests, with under‐resourced communiKes of color having worse outcomes and especially when having been discharged in high acuity status from PES.
Our project focuses on a diverse, understudied populaKon, and expands invesKgaKon into an understudied area.
Our project establishes and strengthens collaboraKons between County Departments, between County Hospitals and between LAC DHS and UCLA CTSI with the goal of improving systems level delivery of care and research, while improving community services and reducing costs.
This project represents the first collaboraKon between the Dept. of Psychiatry at Olive View‐UCLA and the UCLA Center for Health Services and Society and the Partnered Research Center for Quality Care, and as such will help iniKate a new services research program in psychiatry at DHS/Olive View.
Our Stakeholder Advisory Board will inform the data analysis and development of manuscripts and our Community Forum will present findings to CTSI, stakeholders and partners and obtain their feedback.
Activity (per month)
1 2 3 4 5 6 7 8 9 10 11 12
Stakeholder input
IRB review/approvals
Data matching
Dataset validation
Dataset cleaning
Data analysis
Community forum
Manuscripts
Preparation of R21
Timeline:
Enterprise Linkages Project consulKng to provide data matching and linkage across County departments using their novel methodology.
Purchasing vital staKsKcs data (mortality data) from the State of California, Health InformaKon and Strategic Planning Division.
StaKsKcal consulKng, UCLA Center for Health Services and Society by Senior StaKsKcian experienced in analyses of complex longitudinal data sets.
ConsulKng by Dr. Isabel Lagomasino who will provide liaison with LAC+USC PES and help conceptualize service delivery improvements based on regional findings.
Research Assistant support.
We have obtained IRB from the Los Angeles County Department of Public Health; Our UCLA IRB is currently under review.
In preparaKon for this project, we have established relaKonships and made verbal agreements for data transfer with Department of Mental Health, the Department of Public Health, the LA County Sheriff, and the CEO’s Office.
We have also strengthened our alliances and capabiliKes across the three psychiatric emergency rooms at LAC+USC, Harbor‐UCLA and Olive View‐UCLA.
Stakeholder Advisory Board development also underway.
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