Association Between the Affordable Care Act and Emergency Department Admission by Psychiatric Patients

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Asgharian, A. (2020). Association Between the Affordable Care Act and Emergency Department Admission by Psychiatric Patients. Unc Charlotte Electronic Theses And Dissertations.
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Abstract

AbstractThis was a cross-sectional study to evaluate the association between the Affordable Care Act (ACA) and the emergency department (ED) admission by psychiatric patients, characteristics of psychiatric patients admitted to ED, and the ED visits with the disposition of Treat-and-Release of psychiatric patients admitted to the ED for adults aged 18-64. MethodsThe National Emergency Department Sample database for the years 2009 (Pre-ACA), and 2011 to 2016 (Post-ACA) were selected. The psychiatric-related ED visits were identified as the ED visits with at least one diagnosis code of the Behavioral and Mental Health disorders with code of either 290 to 319 or F01 to F99 for the International Classification of Disease edition 9 or 10, respectively. The statistical analysis was using logistic regression adjusting for covariates, age, sex, payer and hospital region. For each analysis, odds ratio (OR) and 95% confidence interval and statistical significance using χ2 statistics were reported. For statistical analysis, all tests were two-sided with significance interpreted at α = 0.05. The SAS software version 9.4 was used for all analyses.ResultsThe proportion of psychiatric-related ED visits increased from Pre-ACA (24.1%) to Post-ACA years (26.4% to 31.3%). The adjusted analyses of the proportion of psychiatric-related ED visits were statistically significant for each of Post-ACA years versus Pre-ACA, with the ORs increasing from 1.12 to 1.36. The proportion of psychiatric-related ED visits with the disposition of Treat-and-Release increased from Pre-ACA (73.4%) to Post-ACA years (72.5% to 78.9%). The adjusted analyses of the proportion of ED visits with Treat-and-Release disposition were statistically significant for each Post-ACA years versus Pre-ACA, with ORs increasing over time from 1.17 to 1.54 with the exception of 2015 with OR of 1.03. The proportions of psychiatric-related ED visits were the highest for adults aged 26-49 followed by adults aged 50-64 and 18-25; higher for females than males and higher for urban than rural hospitals. It increased for Medicare, Medicaid, and private and decreased for uninsured payers in Post-ACA 2014 to 2016 compared to Pre-ACA 2009. ConclusionThis study demonstrated an association in the proportion of ED visits for patients with a psychiatric condition admitted to the ED and the ACA as well as an association between the ACA and the proportion of psychiatric-related ED visits with the disposition of Treat-and-Release. There was evidence of an association between the ACA and the characteristics of psychiatric patients admitted to ED. After the full implementation of the ACA, from Post-ACA 2014 to 2016, there were increases in Medicare and private payers and a significant increase in Medicaid and a decrease in uninsured payers.

Details
Author

Asgharian, Afsaneh

Title

Association Between the Affordable Care Act and Emergency Department Admission by Psychiatric Patients

Physical Description

1 online resource (177 pages) : PDF

Date

2020

Degree Granting Institution

University of North Carolina at Charlotte

Abstract

AbstractThis was a cross-sectional study to evaluate the association between the Affordable Care Act (ACA) and the emergency department (ED) admission by psychiatric patients, characteristics of psychiatric patients admitted to ED, and the ED visits with the disposition of Treat-and-Release of psychiatric patients admitted to the ED for adults aged 18-64. MethodsThe National Emergency Department Sample database for the years 2009 (Pre-ACA), and 2011 to 2016 (Post-ACA) were selected. The psychiatric-related ED visits were identified as the ED visits with at least one diagnosis code of the Behavioral and Mental Health disorders with code of either 290 to 319 or F01 to F99 for the International Classification of Disease edition 9 or 10, respectively. The statistical analysis was using logistic regression adjusting for covariates, age, sex, payer and hospital region. For each analysis, odds ratio (OR) and 95% confidence interval and statistical significance using χ2 statistics were reported. For statistical analysis, all tests were two-sided with significance interpreted at α = 0.05. The SAS software version 9.4 was used for all analyses.ResultsThe proportion of psychiatric-related ED visits increased from Pre-ACA (24.1%) to Post-ACA years (26.4% to 31.3%). The adjusted analyses of the proportion of psychiatric-related ED visits were statistically significant for each of Post-ACA years versus Pre-ACA, with the ORs increasing from 1.12 to 1.36. The proportion of psychiatric-related ED visits with the disposition of Treat-and-Release increased from Pre-ACA (73.4%) to Post-ACA years (72.5% to 78.9%). The adjusted analyses of the proportion of ED visits with Treat-and-Release disposition were statistically significant for each Post-ACA years versus Pre-ACA, with ORs increasing over time from 1.17 to 1.54 with the exception of 2015 with OR of 1.03. The proportions of psychiatric-related ED visits were the highest for adults aged 26-49 followed by adults aged 50-64 and 18-25; higher for females than males and higher for urban than rural hospitals. It increased for Medicare, Medicaid, and private and decreased for uninsured payers in Post-ACA 2014 to 2016 compared to Pre-ACA 2009. ConclusionThis study demonstrated an association in the proportion of ED visits for patients with a psychiatric condition admitted to the ED and the ACA as well as an association between the ACA and the proportion of psychiatric-related ED visits with the disposition of Treat-and-Release. There was evidence of an association between the ACA and the characteristics of psychiatric patients admitted to ED. After the full implementation of the ACA, from Post-ACA 2014 to 2016, there were increases in Medicare and private payers and a significant increase in Medicaid and a decrease in uninsured payers.

Genre

doctoral dissertations

Subjects--Topics

Government policy
Mental health

Degree

Ph.D.

Keywords

Affordable Care Act
Emergency Department
Psychiatric Patients

Subject Area

Public Health

Advisor(s)

Huet, Yvette

Committee Members

Neese, Jane
Thomas, Lori
Boyd, Suzanne

Degree Note

Thesis (Ph.D.)--University of North Carolina at Charlotte, 2020.

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Rights Holder Information

Copyright is held by the author unless otherwise indicated.

Identifier

Asgharian_uncc_0694D_12559

Permalink

http://hdl.handle.net/20.500.13093/etd:2546