scholarly journals Using ESSENCE to Meet Local Needs for Mental Health Data: Query & Results

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Lily Sussman ◽  
Talia Brown
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Emergency Department ◽  
Mental Illness ◽  
Suicide Ideation ◽  
Age Groups ◽  
Discharge Diagnosis ◽  
Emergency Department Data ◽  
Self Harm ◽  
Ed Visits

ObjectiveIn order to meet local mental health surveillance needs, we created multiple mental health-related indicators using emergency department data from the Colorado North Central Region (CO-NCR) Early Notification of Community Based Epidemics (ESSENCE), a Syndromic Surveillance (SyS) platform.IntroductionMental health is a common and costly concern; it is estimated that nearly 20 percent of adults in the United States live with a mental illness[1] and that more money is spent on mental illness than any other medical condition.[2] One spillover effect of unmet mental health needs may be increasing emergency department utilization. National analysis by Healthcare Cost and Utilization Project (H-CUP) found a 55% increase in emergency department visits for depression, anxiety, and stress reactions between 2006-2013.[3] Local public health agencies (LPHAs) can play an important role in reducing costs and burden associated with mental illness. There is opportunity to use emergency department data at a local level to monitor trends and evaluate the effectiveness of local strategies. ESSENCE, available in 31 states, provides near-real time observation-level emergency department data, which can be analyzed and disseminated according to local needs. Using ESSENCE data from 6 local counties in Colorado, we developed methods to estimate the overall burden of mental health and specific mental health disorders seen in the emergency department.MethodsBoulder County Public Health expanded on existing methods to develop multiple mental health queries in ESSENCE using data from the six Colorado counties that currently participate in the Colorado North Central Region (CO-NCR) SyS (i.e., Adams, Arapahoe, Boulder, Denver, Douglas, and Jefferson Counties). Our query was based solely off relevant International Classification of Disease version 10 Clinical Modification (ICD-10-CM) mental health codes: F20-F48, F99, R45.851, X71–X83, T14.91, and R45.851. We also included T36-T65 and T71 where intentional self-harm was specified. In addition to an overall mental health query we created 11 sub-queries for: anxiety disorder, conversion disorder, intentional self-harm/suicide attempt, mood disorder, obsessive compulsive disorder (OCD), dissociative disorder, schizophrenia, somatoform disorders, stress adjustment disorder, suicide ideation, and other mental health disorder). One observation could fall into multiple subcategories through inclusion of multiple discharge diagnosis (DD).One challenge of using the DD field in ESSENCE is that in Colorado, similar to other states, there can be excess of 40 unique ICD-10-CM codes listed in the DD field, and queries identify cases by searching all listed codes. For this project, that is problematic as codes may refer to historic and underlying health conditions, rather than acute cause of the ED visit. To handle this, we performed a secondary analysis to determine whether observations were “true mental health cases” based on order of codes listed in DD field, triage notes and chief complaint. We then calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value(NPV) of including observations where mental health was listed as the first (or primary) code, first or second, or first second or third code. Our analysis revealed that observations where mental health codes are listed later were less likely to be identifiable as true mental health cases, and led to our decision to only include observations with qualifying codes listed first or second.To assess the mental health burden, we developed code in SAS 9.4 that parsed ESSENCE output by discharge diagnosis, create aforementioned sub-queries, and calculated counts and age-adjusted rates (based on 2000 US Population) to summarize demographic and geographic trends.ResultsThere were 22,451 observations with mental health discharge diagnosis codes for the six Colorado counties between January and June 2018. Of these codes, 13,331 had a mental health code as the first and/or second listed DD and were counted as true mental health visits. The age-adjusted rates of any mental health visit ranged from approximately 425 per 100,000 in Douglas County to 1,026 per 100,000 in Denver County. The most common reasons for mental health visits across the region were anxiety, mood disorder, and suicide ideation (Figure 1). There was a significant spike in mental health ED visits among the 15-24 age group, followed by decreasing rates in older age groups (Figure 2). Younger age groups most commonly had ED visits for mood disorder (all age groups under 24), while in the age groups 25-34, 35-44, 65-74 and 75+ the most common reason for ED visit was anxiety. Also of note, ED visits for suicide ideation and self- harm were highest for the 15-24 age group. Males and females had similar rates of ED visits for most diagnoses, which is notable given males generally utilize healthcare services at lower rates than females.ConclusionsSyndromic surveillance is a valuable addition to available mental health surveillance. Our methods and results demonstrate the feasibility of tracking overall and specific mental health trends using the ESSENCE platform. Unlike other available mental health data, ESSENCE provides data that is local, observation level, and near-real time. Through continued collaboration with public health, medical and other stakeholders we hope this data can be pivotal in gauging disparities in mental health burden, monitoring trends, and prioritizing solutions.References[1] Mental Illness. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml[2] Roehrig C. Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion. Health Aff (Millwood). 2016 Jun 1;35(6):1130-5. https://www-healthaffairs-org.ezp.welch.jhmi.edu/doi/pdf/10.1377/hlthaff.2015.1659[3]Weiss AJ, Barrett ML, Heslin KC. , Stocks C. Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006-2013. HCUP Statistical Brief #216. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-Visit-Trends.pdf. December 2016.

Unacceptably high: an audit of Kimberley self-harm data 2014–2018

2021 ◽  
pp. 103985622110107
Author(s):  
Rob McPhee ◽  
Emma Carlin ◽  
Kimberley Seear ◽  
Phoebe Carrington-Jones ◽  
Barbara Sheil ◽  
...  
Keyword(s):  
Emergency Department ◽  
Western Australia ◽  
Aboriginal People ◽  
Age Groups ◽  
Indigenous Status ◽  
Cross Sectional ◽  
Alcohol And Drug Use ◽  
Emergency Department Data ◽  
Police Data ◽  
Self Harm

Objective: To explore the rates and characteristics of self-harm across the Kimberley region of Western Australia. Method: Retrospective, cross-sectional audit. We obtained and descriptively analysed routinely collected self-harm data from the Kimberley District of the Western Australia Police Force (2014–2018) and the Emergency Department Data Collection (June 2017–December 2018). Variables included age, sex, Indigenous status, time of incident, and alcohol and drug use. Results: The rate of emergency department attendance for self-harm was three times higher in the Kimberley than the rest of Western Australia. Both emergency department and police data showed a disproportionately high percentage of incidents involving Aboriginal people, with highest rates in the 15–19 and 20–24 year age groups. Almost 80% of self-harm events recorded by police involving individuals aged 25–50 years involved alcohol. Many self-harm incidents occurred in the evening and at night. Conclusions: The rates of self-harm across the Kimberley region from 2014–2018 are unacceptably high. Increased funding and alignment of services to meet regional need are required as part of a holistic effort to reduce regional rates of self-harm.

scholarly journals P060: Incidence of child and youth presentations to the emergency department for addictions and mental health

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S78-S78
Author(s):  
H. Hair ◽  
K. Huebert ◽  
M. Bercov ◽  
N. Fraser ◽  
A. Allen
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Group Analysis ◽  
Clinical Information ◽  
Primary Diagnosis ◽  
Health And Wellness ◽  
Changing Trends ◽  
Icd 10 ◽  
Self Harm ◽  
Ed Visits

Introduction: As reported by the Canadian Institute for Health Information, the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients has been identified as a major priority of Alberta Health Services As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks undertook an analysis of administrative data to define incidence in Alberta and changing trends. Methods: The data analyzed included 5 different clinical information systems encompassing the 17 highest volume hospitals in Alberta, from April 2013 to March 2016. Patient encounters were included if the patient was under 25 years of age at the time of visit, and if the encounter included a CEDIS Presenting Complaint and/or an ICD-10 Primary Diagnosis relating to Addiction and/or Mental Health (AMH). A total of 54,810 patient encounters were included. Data was analyzed using descriptive statistics. Sub-group analysis was undertaken based upon age, presenting complaint, and primary diagnosis. Results: The incidence of children and youth presenting to an ED with an AMH complaint and an AMH primary diagnosis increased 22% and 7%, respectively, from 2013/14 to 2015/16. Admissions of patients were constant throughout this period. The largest increase in ED visits occurred among children aged 7-10, with a 60% increase in visits defined by presenting complaint and a 21% increase in primary diagnosis. The second largest increase was in young adults aged 18-21 with a 26% increase defined by presenting complaint, and a 12% increase in primary diagnosis. Analyzed by age group, the largest increase in primary diagnosis between 2013/14 and 2015/16 was seen in Depression/Suicidal/Self Harm with a 667% increase among ages 0-6, and a 79% increase among ages 7-10. The second highest increase was for Anxiety/Situational Crisis with a 223% increase among ages 0-6, and 74% among children aged 7-10. Conclusion: Within Alberta there has been a substantial increase in the incidence of child and youth visits to the ED for issues of mental health and addictions. It is clear is that these changing trends are placing an increased burden on our healthcare system and necessitate strategic planning to ensure the health and wellness of our patients.

scholarly journals Trends in Psychiatric Emergency Department Visits in Northern Israel During the COVID-19 Outbreak

2021 ◽  
Vol 12 ◽  
Author(s):  
Yael Pikkel Igal ◽  
Irit Meretyk ◽  
Aziz Darawshe ◽  
Samer Hayek ◽  
Limor Givon ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Adjustment Disorder ◽  
Emergency Department Visits ◽  
Post Traumatic Stress ◽  
Health Seeking ◽  
Community Clinic ◽  
Seeking Behavior ◽  
Self Harm ◽  
Ed Visits

Background: During the spread of coronavirus disease (COVID-19), mandatory quarantines increased social isolation and anxiety, with inevitable consequences on mental health and health seeking behavior. We wished to estimate those trends.Methods: We examined all psychiatric visits to the emergency department (ED) during March, April 2020, compared to identical months in 2018, 2019. We evaluated both number and nature of referrals.Results: Throughout the years, psychiatric referrals comprised about 5% of the total number of ED visits. In March-April 2020, 30% decreases were observed in overall ED visits and in psychiatric referrals in the ED. Compared to 2018–2019, in 2020, the proportions of these diagnoses were higher: anxiety disorders (14.5 vs. 5.4%, p < 0.001), personality disorders (6.7 vs. 3.2%, p = 0.001), psychosis (9.5 vs. 6.7%, p = 0.049), post-traumatic stress disorder (3.2 vs. 1.5%, p = 0.023). Compared to 2018–2019, in 2020, proportions were lower for adjustment disorder (5.8 vs. 8.9%, p = 0.036) and for consultation regarding observation (11.7 vs. 31.6%, p < 0.001). Differences were not observed between 2018-2019 and 2020 in the proportions of other diagnoses including suicide and self-harm disorders. Referrals concerning suicide and self-harm in a rural hospital and community clinic were 30% lower in the COVID-19 lockdown than in the same months in 2018, 2019.Conclusion: Psychiatric ED visits decreased by the same proportion as overall visits to the ED, apparently driven by fears of COVID-19. Referrals relating suicidality and self-harm shown nominal decrease, but their proportioned share remained constant. Increased anxiety and delayed care may eventually lead to increased mental health needs.

Using the ‘presenting problem’ field in emergency department data improves the enumeration of intentional self-harm in NSW hospital settings

2020 ◽  
pp. 000486742098141
Author(s):  
Sandro Sperandei ◽  
Andrew Page ◽  
Matthew J Spittal ◽  
Katrina Witt ◽  
Jo Robinson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Data ◽  
Self Harm

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

scholarly journals Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data

2019 ◽  
Vol 72 ◽  
pp. 132-140 ◽  
Author(s):  
Cristina Lidón-Moyano ◽  
Deborah Wiebe ◽  
Paul Gruenewald ◽  
Magdalena Cerdá ◽  
Paul Brown ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Chronic Disease ◽  
Emergency Department Data ◽  
Self Harm

Phone-Related Distracted Walking Injuries as a Function of Age and Walking Environment

2021 ◽  
Vol 65 (1) ◽  
pp. 611-615
Author(s):  
Zheng Haolan ◽  
Isabella M. Campbell ◽  
Wayne C.W. Giang*
Keyword(s):  
Emergency Department ◽  
Surveillance System ◽  
Age Groups ◽  
Injury Surveillance ◽  
Future Research ◽  
Home Environments ◽  
Injury Surveillance System ◽  
Different Types ◽  
Ed Visits ◽  
Walking Environment

Using phones while walking has been a factor that has led to accidents and injuries. However, few studies have analyzed the propensity of injuries due to distracted walking for different age groups and in different types of walking environments. This study aims to examine the number of emergency department (ED) visits due to distracted walking across different age groups and walking environments using a publicly available dataset, the National Electronic Injury Surveillance System (NEISS) database. The results suggest that there were an estimated 29140 distracted walking injuries between the years 2011-2019. Individuals between 11 and 20 years old had the most injuries, followed by 21 to 30, and 31 to 40. Furthermore, the proportion of estimated injuries that occurred in different walking environments differed across age groups. Safety-orient interventions for future research for stairs and home environments were also recommended in the present study.

The health service contact patterns of people with psychotic and non-psychotic forms of severe mental illness in New South Wales, Australia: A record-linkage study

2021 ◽  
pp. 000486742110314
Author(s):  
Rachael C Cvejic ◽  
Preeyaporn Srasuebkul ◽  
Adrian R Walker ◽  
Simone Reppermund ◽  
Julia M Lappin ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Illness ◽  
Health Service ◽  
Confidence Interval ◽  
Physical Health ◽  
Severe Mental Illness ◽  
New South ◽  
Service Utilisation ◽  
South Wales

Objective: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. Methods: We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. Results: People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Conclusion: Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.

scholarly journals Effect of the SARS outbreak on visits to a community hospital emergency department

CJEM ◽  
2006 ◽  
Vol 8 (05) ◽  
pp. 323-328 ◽  
Author(s):  
Michael Heiber ◽  
W.Y. Wendy Lou
Keyword(s):  
Emergency Department ◽  
Community Hospital ◽  
Early Stage ◽  
Age Groups ◽  
Respiratory Illness ◽  
Hospital Emergency Department ◽  
Infants And Toddlers ◽  
Hospital Emergency ◽  
Ed Visits ◽  
Number Of Visits

ABSTRACTObjectives:To examine the effect of severe acute respiratory syndrome (SARS) on visits to a community hospital emergency department (ED) during the early stage of the Toronto outbreak in 2003 and for the same period in 2004. We focused on visits for respiratory illness (SARS-like symptoms) and different age groups.Methods:This study is a retrospective review of ED discharge diagnoses obtained from a computerized database, examining the 4-week period starting March 28 for the years 2001-2004. We obtained the discharge diagnosis, age and visit date for each ED patient during the relevant time intervals, then compared visit data from 2003 and 2004 with a baseline derived from the average number of visits during 2001 and 2002. We constructed groupings based on age and respiratory-illness symptoms.Results:During the SARS outbreak in 2003, ED visits declined by 21% (95% confidence interval [CI], 18%–24%) over the 4-week study period. The greatest reduction was for combined infant and toddler visits (69%; 95% CI, 58%–79%); these did not recover the following year. However, during the SARS outbreak there was a large increase in the number of visits for respiratory illnesses in adults (61%; 95% CI, 46%–75%) and in teenagers (132%; 95% CI, 82%–182%).Conclusions:During the SARS outbreak, total ED visits fell. The relative decline was most notable for infants and toddlers. By contrast, there was an increase in respiratory illness–related visits for adults and teenagers. In 2004, the year following the SARS outbreak, visit patterns shifted toward baseline levels, but ED visits by infants and toddlers remained depressed.

scholarly journals Changing Approaches to Mental Healthcare in the Caribbean Conferences on Mental Health, 1957-1969

2020 ◽  
Vol 4 ◽  
Author(s):  
Deborah Toner ◽  
Clare Anderson ◽  
Shammane Joseph Jackson
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Mental Illness ◽  
Mental Healthcare ◽  
Health Conditions ◽  
Late Nineteenth Century ◽  
Religious Leaders ◽  
Public Health Officials ◽  
The Caribbean ◽  
Late Nineteenth

This paper examines discussions among physicians, psychologists, public health officials, religious leaders and others who participated in the Caribbean Conferences on Mental Health between 1957 and 1969. Their discussions demonstrate major changes in the understanding of causes, definitions and appropriate treatments of mental health conditions, compared to the late nineteenth century, which saw a wave of major reforms to the management of mental illness in public asylums. Although major shifts in professional understandings of mental health were evident in the mid-twentieth century, the Caribbean Conferences on Mental Health reveal that the problems hindering the implementation of these new approaches were largely similar to those that Guyana and other Caribbean countries continue to face today.

Sign in / Sign up

Export Citation Format

Share Document