TY - JOUR
T1 - Data mining-based clinical profiles of substance use-related emergency department utilizers
AU - Monti, Kristina
AU - Bachi, Keren
AU - Gray, Madeline
AU - Mahajan, Vibhor
AU - Sweeney, Gabrielle
AU - Oprescu, Anna M.
AU - Munjal, Kevin G.
AU - Hurd, Yasmin L.
AU - Lim, Sabina
N1 - Funding Information:
This research was supported by the Mount Sinai Health System . KB has received grant funding from the National Institute on Drug Abuse (NIDA) ( K23-DA045928 ); all other authors disclose employment by their respective identified institutional affiliation. Authors report no conflicts of interest regarding the paper. YH and KB maintain access to all study data until the end of such period (7 years post study) as determined by IRB guidelines.
Publisher Copyright:
© 2022
PY - 2022/3
Y1 - 2022/3
N2 - Objective: Substance-use is a prevalent presentation to the emergency department (ED); however, the clinical characterization of patients who are treated and discharged without admission for further treatment is under-investigated. The study aims to define and characterize the clinical profiles of this patient population. Methods: Patients' presentations were examined by clinical data mining (chart review) of ED records of substance use-related events of individuals discharged without admission for further treatment. Records (N = 199) from three major hospitals in New York City from March and June 2017 were randomly sampled with primary diagnosis of alcohol, opioid-related and other psychoactive substance-use presentations. Qualitative thematic coding of clinical presentation with inter-rater reliability was performed. Quantitative distinctive validity tested independence through Pearson's chi-squared and analysis of variance using Fisher's F-test. Results: Six distinct clinical profiles were identified, including, High Utilizers (chronically intoxicated with comorbid health conditions) (36.7%), Single Episode (20.1%), Service Request (14.1%), Altered Mental Status (13.6%), Overdose (9.0%), and Withdrawal (7.5%). The profiles differed (p < 0.05) in age, housing status, payor, mode of arrival, referral source, index visit time, prescribed treatment, triage acuity level, psychiatric history, and medical history. Differences (p < 0.05) between groups across clinical profiles in age and pain level at triage were observed. Conclusions: The identified clinical profiles represent the broad spectrum and complex nature of substance use-related ED utilization, highlighting critical factors of psychosocial and mental-health comorbidities. These findings provide a preliminary foundation to support person-centered interventions to decrease substance use-related ED utilization and to increase engagement/linkage of patients to addiction treatment.
AB - Objective: Substance-use is a prevalent presentation to the emergency department (ED); however, the clinical characterization of patients who are treated and discharged without admission for further treatment is under-investigated. The study aims to define and characterize the clinical profiles of this patient population. Methods: Patients' presentations were examined by clinical data mining (chart review) of ED records of substance use-related events of individuals discharged without admission for further treatment. Records (N = 199) from three major hospitals in New York City from March and June 2017 were randomly sampled with primary diagnosis of alcohol, opioid-related and other psychoactive substance-use presentations. Qualitative thematic coding of clinical presentation with inter-rater reliability was performed. Quantitative distinctive validity tested independence through Pearson's chi-squared and analysis of variance using Fisher's F-test. Results: Six distinct clinical profiles were identified, including, High Utilizers (chronically intoxicated with comorbid health conditions) (36.7%), Single Episode (20.1%), Service Request (14.1%), Altered Mental Status (13.6%), Overdose (9.0%), and Withdrawal (7.5%). The profiles differed (p < 0.05) in age, housing status, payor, mode of arrival, referral source, index visit time, prescribed treatment, triage acuity level, psychiatric history, and medical history. Differences (p < 0.05) between groups across clinical profiles in age and pain level at triage were observed. Conclusions: The identified clinical profiles represent the broad spectrum and complex nature of substance use-related ED utilization, highlighting critical factors of psychosocial and mental-health comorbidities. These findings provide a preliminary foundation to support person-centered interventions to decrease substance use-related ED utilization and to increase engagement/linkage of patients to addiction treatment.
KW - Clinical data mining
KW - Clinical profiles
KW - Emergency department
KW - High utilizers
KW - Mixed methods research
KW - Substance use
UR - http://www.scopus.com/inward/record.url?scp=85122481084&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2021.12.059
DO - 10.1016/j.ajem.2021.12.059
M3 - Article
C2 - 35007871
AN - SCOPUS:85122481084
VL - 53
SP - 104
EP - 111
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
ER -