Emergency Room Utilization of Participants with Mental Health Conditions Enrolled in Health Home Services

Emergency Room Utilization of Participants with Mental Health Conditions Enrolled in Health Home Services by Amanda Duff MST, State University of New York at Cortland, 2010 BS, State University of New York at Oswego, 2009 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Community Health Education Walden University December 2016 Abstract Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeatedmeasures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions.Large numbers of individuals utilize the ER each year for mental health reasons. The health home agency in this study was designed under the Affordable Care Act with the intention of increasing patient self-management thus decreasing high-cost service utilization. The effectiveness of health homes in reducing mental health-related ER visits has remained unexplored. In this study, the relationship between participation in this program and ER utilization was examined, using the theoretical framework of the Health Belief Model. The sample of 128 health home participants with documented mental health conditions was selected using systematic random sampling. A one-way, repeatedmeasures t-test and a one-way, repeated-measures ANCOVA were used to analyze hospital records for ER visits with a primary or secondary mental health diagnosis. The results indicated that health home participation did not have a statistically significant impact on ER utilization when comparing overall 12-month means or at quarterly anniversary dates when controlling for age, race, and gender. These findings suggested opportunities for improvement in professional practice, identified areas that require further research, and will be used to initiate discussion into the existing and potential value that health homes offer to the mental health clientele being served. Those discussions have the potential to create social change through infrastructure changes that lead to improved service coordination, increased resources for improving access and quality of care, and overall enhancement of outcomes for individuals with mental health conditions. Emergency Room Utilization of Participants with Mental Health Conditions Enrolled in Health Home Services by Amanda Duff MST, State University of New York at Cortland, 2010 BS, State University of New York at Oswego, 2009 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health, Community Health Education Walden University December 2016 Acknowledgements Thank you to Dr. Harold Griffin, my dissertation chair. Your knowledge and guidance have helped me develop a product that I am proud of. Your support, accompanied with your high expectations, have been instrumental in my success as both a scholar and a health professional. Under your direction, I have achieved tremendous growth and am very grateful to have had you as my chair throughout this process. Thank you Dr. Diana Naser for your time and encouragement, it is appreciated. I would also like to thank my family for their ongoing support. Thank you Mom and Dad for raising me to value education and always strive to be better. Thank you to my twin sister Jessica and my husband Rich. Your encouragement and support has been invaluable.