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.

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.