LA County Psychiatric Emergency Room Outcomes Study

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UCLA CTSI-Los Angeles County Department of Health Services (DHS) Projects

Principal Investigators: Kristen Ochoa (DHS), Kenneth Wells (UCLA)

Our project assembles a partnership between UCLA and The Los Angeles County Department of Health Services in order to determine the outcomes of patients who utilize the psychiatric emergency service in Los Angeles County at Olive View-UCLA Medical Center, Harbor-UCLA Medical Center and LAC+USC Medical Center. The limited literature on patients using psychiatric emergency services suggests that they are a vulnerable, high risk population. This CTSI Pilot/Collaborative project employs a novel methodology for data linkage and integration across County and State datasets allowing us to follow a cohort of patients and track forensic, outpatient and inpatient outcomes as well as mortality. Results will enable the Department of Health Services to make efficient, data-driven and outcomes-based decisions regarding the disposition of patients from the Psychiatric Emergency Service, thereby improving both clinical care and productivity. This project also creates a new collaboration between the Department of Health Services and UCLA CTSI and a new area of investigation that, despite its importance and relevance within the changing healthcare environment, has not yet been explored by researchers nationally.

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LA County Psychiatric Emergency Room Outcomes Study

  1. 1. 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 
  2. 2.   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
  3. 3.   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?
  4. 4.   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
  5. 5. 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 
  6. 6.   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.  
  7. 7.   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. 
  8. 8.   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.
  9. 9. 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:
  10. 10.   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. 
  11. 11.   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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