Impact of COVID-19 on Emergency Visits for Vulnerable Populations

People with Mental Health issues or problems with Substance Use face many challenges when trying to get healthcare. These challenges are often made worse by social factors, like income, housing, and support systems, which greatly affect how often they use healthcare services and how well they live their lives. Identifying these individuals so that they can receive the right kind of help is very important. However, a lack of clear and consistent recording of these social factors in medical records makes it hard to understand how well these groups are being served.

To help with this, organizations like the Centers for Medicare and Medicaid Services have suggested using special codes to record Social Needs. Yet, not many healthcare providers are using these codes, which limits our ability to track and improve care for these vulnerable populations.

The COVID-19 pandemic has made these issues worse. It has increased health differences among populations and has hit those with mental health issues and substance use problems the hardest. Research shows that lockdown measures have led to more visits to Emergency Departments (ED) for mental health and substance use concerns. However, not much research has focused on how these measures have affected the number of visits or Hospital Admissions for those with prior mental health or substance use problems. Additionally, the impact of the pandemic on ED visits for individuals identified with social needs has been under-explored. This article looks into how the pandemic and lockdown measures have changed the number of ED visits and hospital admissions among these vulnerable groups.

#Patient Population

The study involved patients who visited 20 emergency departments in a large healthcare system in the Midwest. This includes large hospitals and smaller, free-standing emergency departments. The analysis covered visits made before and after the shelter-in-place (SIP) orders were put in place, specifically from May 2, 2019 to December 31, 2019 and from May 2, 2020 to December 31, 2020. Information about patients' demographics and health conditions was gathered from their electronic medical records.

Mental health issues and substance use disorders were identified using specific codes. Similarly, social factors impacting health were recorded using their own set of codes. This means that these codes could have been documented in the patient’s medical history at any time, not just during their visit to the ED. The study also had approval from the local institutional review board.

#Statistical Analysis

To analyze the data, researchers used mathematical models to compare the total number of cases before and after the SIP orders. They also looked at the rates of hospital admissions to see if there were any changes over time.

#Patient Demographics

In total, the study looked at 871,020 emergency department visits made by 487,028 different patients. Out of these encounters, 54% took place in 2019 and 46% occurred in 2020. The patients were mostly White, with a majority being female, having private insurance, and averaging 46 years of age. Only 0.53% of these patients had a recorded social need in their medical chart. The most commonly listed social problems were related to housing and economic circumstances, followed by issues with family support and other social challenges.

When compared to those without recorded social needs, patients with social needs were more likely to be Black, younger, male, and have government or self-pay insurance.

#ED Utilization Rates Before and After SIP Orders

The study found that after the SIP orders were enacted, patients with prior mental health or substance use problems were more likely to go to the emergency room. For instance, those with issues related to family support or economic hardships saw a significant rise in ED visits after the SIP orders were put into effect. Patients with both a history of mental health or substance use problems and social needs had an even higher increase in emergency visits compared to those with just one of these issues.

#ED Admission Rates Before and After SIP Orders

Looking at hospital admissions, it was revealed that patients with a history of mental health or substance use problems, as well as those with documented social needs, were less likely to be admitted to the hospital after visiting the ED following the SIP orders. Among those with social needs, only specific categories, like issues with family support and other social problems, showed a significant decrease in admission rates post-SIP. The difference in admission rates for patients with both mental health/substance use issues and social needs was not significant.

#The Effect of SIP Orders on Vulnerable Patient Populations

The COVID-19 pandemic has highlighted how social factors are crucial in determining someone’s health and ability to access care. The analysis showed that individuals with a history of mental health or substance use problems and those with social needs were more likely to present to the ED after the SIP orders were enforced. Past research has also shown that there was an increase in emergency visits for these conditions during the pandemic, which this study expands upon by focusing on vulnerable populations.

Additionally, the group that had both mental health/substance use issues and social needs experienced the highest increase in visits to emergency rooms. This likely reflects the increased barriers to care during the pandemic, as many community resources were less available. Those with multiple challenges are at a higher risk for serious health issues, pointing to the need for targeted help that considers the various factors impacting their health.

It was also noted that patients with mental health or substance use disorders, as well as those with documented social needs, were less likely to be admitted to hospitals after their emergency visits. Although the study didn’t focus on why this might be, potential reasons could include a lack of hospital resources for these patients or biases among healthcare professionals.

#Low Documentation of Social Determinants of Health in Patients Visiting the ED

The study found that a small fraction of emergency department patients had their social needs documented. Only 0.53% had a recorded code for social determinants of health. This number is lower than what some other studies have reported. The method of measuring social needs in this study may explain the difference, as it focused on the patient level instead of visit level.

The underuse of these codes can lead to an underrepresentation of those with social needs in the emergency care system. Future studies may benefit from exploring methodical ways to identify social needs using notes from healthcare providers that are not currently coded.

Identifying individuals with social needs is important because they are likely to face more health issues and frequently use emergency services. Currently, documenting social needs is not reimbursable, which might explain its low use. However, keeping track of social needs could help healthcare systems identify complex situations and trends in how care is being utilized. If hospitals accurately record social needs, they can spot patterns associated with frequent re-admissions and allocate resources better.

#Limitations

While the findings are important, they should be considered with some limitations in mind. First, the study’s design does not allow for direct cause-and-effect conclusions. Second, the data comes from one large healthcare system, which might not reflect what is happening in other systems or regions. However, this study does include a large and varied patient group that represents different types of healthcare settings. Third, different documentation practices by institutions could influence the coding rates and how well findings can be applied elsewhere. Lastly, the study relied on previous medical records to assess patient health, which may not accurately reflect their current conditions during the emergency visit.

#Conclusion

This analysis illustrates the significant effects that the COVID-19 pandemic has had on vulnerable groups with mental health problems, substance use issues, and social needs. The findings point out that these individuals were more likely to seek emergency care yet were less likely to be admitted afterward, signaling a need for tailored approaches to care that address the various social and economic factors affecting their health. There is a clear need for better documentation of social factors in medical records to improve healthcare delivery for these communities.