Psychiatric wells

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  • 1. 1UCLANIMHPartneredResearchCenterforQualityCare 2DepartmentofPsychiatry,OliveViewUCLAMedicalCenter 3DHSOceofPlanningandDataAnalyKcs

2. UnderstandinguKlizaKonandoutcomesofPsychiatricEmergencyService (PES)paKentsmayhelpestablishstandardsofcareacrossthethree psychiatricER'sandimproveclinicalproducKvity,qualityofcareand overallpaKentoutcomes. ThereislimitedinternalLACDHSdataandliUlepublisheddataonthe characterisKcsofpaKentswhousepsychiatricemergencyservices NoprospecKveorretrospecKvestudieshavebeendonetocompare outcomesofpaKentswhoweredischargedfromPEStothecommunity versusreferredforacutepsychiatricinpaKentadmission. ThelimitedliteratureonpaKentsusingpsychiatricemergencyservices suggeststhattheyareavulnerable,highriskpopulaKon 3. Whatarethedemographics,presenKngcomplaints,diagnoses, comorbidiKes,sourceofreferrals,holdstatus,anddisposiKonsof paKentsuKlizingthePESateachofthethreeLACDHShospitals? WhatarethepredictorsassociatedwithpaKentsdischargedvs. admiUedfromPES? WhatarethelongitudinaloutcomesofpaKentsdischargedvs. admiUedfromPES? 4. RetrospecKvecohortofadultpaKentsadmiUedtoPESinvoluntarilyat eachofthethreeLACDHShospitalsfrom2008through2010 wewilltracelongitudinaluKlizaKonandclinicaloutcomesforpaKentsin thecohortfrom2008through2012 OuresKmatesforcombinednumberofuniquepaKentsacrossthree yearsisN=48,693 TheEnterpriseLinkagesProject(ELP)willperformadatamatchto idenKfyDHSpaKententriesinfourdatabaseslistedbelowandcreatea deidenKedmasterleforanalysis 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. TherewillbesubstanKalvariaKonacrossthethreeLACDHSPESsitesin admissionanddischargeratesforhighacuityPESpaKents. Amajorgoaloftheanalysesistodeterminewhetheroutcomessuchas readmissions,deaths,andarrestsaresignicantlyhigherforpaKentswith highacuitythataredischargedthanthosewhoareadmiUed,and whetherthisleadstooverallpooreroutcomesforPESsiteswithhigher ratesofdischargeratherthanadmissionofhighacuitypaKents. 7. DischargeofhighacuitypaKentsisexpectedtoleadtopooreroutcomes.This maydependontheleveloffollowupavailableorothercharacterisKcsof paKents,suchassocialsupportorestablishedrelaKonshipswithproviders;or ofsystems,suchasavailabilityofprovidersforrapidoutpaKentfollowup. WeexpectracialandethnicdispariKesindischarge/admissionratesand outcomes,includingreadmissions,deathsandarrests,withunderresourced communiKesofcolorhavingworseoutcomesandespeciallywhenhaving beendischargedinhighacuitystatusfromPES. 8. Ourprojectfocusesonadiverse,understudiedpopulaKon,andexpands invesKgaKonintoanunderstudiedarea. OurprojectestablishesandstrengthenscollaboraKonsbetweenCounty Departments,betweenCountyHospitalsandbetweenLACDHSandUCLA CTSIwiththegoalofimprovingsystemsleveldeliveryofcareand research,whileimprovingcommunityservicesandreducingcosts. ThisprojectrepresentstherstcollaboraKonbetweentheDept.of PsychiatryatOliveViewUCLAandtheUCLACenterforHealthServices andSocietyandthePartneredResearchCenterforQualityCare,andas suchwillhelpiniKateanewservicesresearchprograminpsychiatryat DHS/OliveView. OurStakeholderAdvisoryBoardwillinformthedataanalysisand developmentofmanuscriptsandourCommunityForumwillpresent ndingstoCTSI,stakeholdersandpartnersandobtaintheirfeedback. 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. EnterpriseLinkagesProjectconsulKngtoprovidedatamatchingand linkageacrossCountydepartmentsusingtheirnovelmethodology. PurchasingvitalstaKsKcsdata(mortalitydata)fromtheStateof California,HealthInformaKonandStrategicPlanningDivision. StaKsKcalconsulKng,UCLACenterforHealthServicesandSocietyby SeniorStaKsKcianexperiencedinanalysesofcomplexlongitudinaldata sets. ConsulKngbyDr.IsabelLagomasinowhowillprovideliaisonwithLAC +USCPESandhelpconceptualizeservicedeliveryimprovementsbasedon regionalndings. ResearchAssistantsupport. 11. WehaveobtainedIRBfromtheLosAngelesCountyDepartmentofPublic Health;OurUCLAIRBiscurrentlyunderreview. InpreparaKonforthisproject,wehaveestablishedrelaKonshipsand madeverbalagreementsfordatatransferwithDepartmentofMental Health,theDepartmentofPublicHealth,theLACountySheri,andthe CEOsOce. WehavealsostrengthenedouralliancesandcapabiliKesacrossthethree psychiatricemergencyroomsatLAC+USC,HarborUCLAandOliveView UCLA. StakeholderAdvisoryBoarddevelopmentalsounderway.