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1
Emergency Department Visits For Behavioral Health Conditions
in Harris County, Texas 2004-2006
A Report for the
Houston-Galveston Area EMS/Trauma Policy Council and the
Harris County Healthcare Alliance
Prepared by
Charles Begley, Keith Burau, Pat Courtney, Scott Hickey1, Paul Rowan
University of Texas School of Public Health 1Harris County Mental Health Mental Retardation Authority
September 2008
Contact: Pat Courtney, University of Texas Health Science Center, School of Public
Health, 1200 Hermann Pressler, 713-500-9151, [email protected]
2
Emergency Department Visits for Behavioral Health Conditions
in Harris County, Texas 2004-2006
Table Of Contents
Executive Summary……………………………………………………………....……..…3
Introduction…………………………………………………………………….….…….…6
Methods…………………………………………………………………………..…….…..6
Results……………………………………………………………………………..………11
Conclusion and Discussion ...…………………………………………………….……....14
Limitations………………………………………………………………………….…..…16
Tables and Figures…………………………………………………………….…….……18
3
Emergency Department Visits for Behavioral Health Conditions
in Harris County, Texas 2004-2006
Executive Summary
This report presents data on behavior health-related emergency department (BHED) visits
in Harris County, Texas hospitals and the Harris County Mental Health Mental Retardation
Authority’s Neuropsychiatric Center (NPC) in 2004-2006. The annual total and per capita
number of BHED visits, their percentage of total ED visits, the percentage hospitalized, and the
socio-demographic characteristics and behavioral health conditions of patients are described.
The following tasks were completed to describe BHED visits and patients.
1. Identified the number of BHED visits in hospitals that participated in the Harris County
Hospital ED Study during 2004-2006 and the percentage of total ED visits that they
represent.
2. Estimated the number of BHED visits in all Harris County hospitals and the percentage
of total ED visits that they represent.
3. Obtained MHMRA’s BHED visit data for the NPC and merged it with the hospital ED
data to estimate the total number of hospital- and NPC-related BHED visits in the county.
4. Obtained annual U.S. Census estimates of the Harris County population and computed
BHED visit rates of Harris County residents.
5. Determined hospitalization percentages of BHED and medical ED visits and compared
them for the NPC and hospitals.
6. Developed tables that show the frequency of the most prevalent behavioral health
conditions of patients tabulated separately for the NPC and hospitals.
4
7. Determined the lengths of stay in the ED of patients with BHED visits compared to
patients with medical visits and compared the lengths of stays of BHED visits in the NPC
and hospitals.
8. Developed graphs that show trends in the volume of BHED visits by month, day, and
time of day.
9. Developed graphs that compare the socio-demographic and payer source characteristics
of patients with BHED visits in hospitals and the NPC.
The primary data source for the study was the ED visit data of 16 hospitals that
participated in the Houston Hospitals Emergency Department Use Study from 2004-2006. 1
A
second major source of data was Mental Health Mental Retardation Authority’s
Neuropsychiatric Center (NPC) visit data. The third source, obtained from the Texas State Data
Center, was population estimates for Harris County for the years 2004-2006.
The major finding of the study is that a significant number of ED visits in Houston/Harris
County involve a behavioral health problem, accounting for 6.8% of all ED visits over the three
year period. The percentage of total visits with a behavioral health issue and the population rate
of BHED visits is increasing. There was a total of 276,614 BHED visits from 2004 to 2006,
increasing from 78,895 (5.9% of total ED visits) in 2004 to 107,057 (7.6% of all ED visits) in
2006. About 15% of all BHED visits were to the NPC, with the remainder to hospital EDs. On
a per capita basis, BHED visits increased from 1.6 per 100 Harris County residents to 2.0 visits
per 100 residents, an increase of 25%, while medical ED visits declined by 4 %, from 25 per 100
residents to 24 per 100 residents.
1 Annual survey of ED use in Harris County hospitals that has been conducted by UTSPH since 2003. In 2003, 11
hospitals participated. In 2005 and 2006, 25 hospitals participated.
5
The most prevalent diagnoses were mood disorders (37.1% of visits), psychotic disorders
(24.9% of visits), and substance abuse disorders (17.7%), which together constituted 80% of all
BHED visits. Patients with BHED visits were hospitalized more than twice as often as those
with medical ED visits (19% versus 9%) and their lengths of stay in the ED averaged about an
hour longer (7 hours versus 6 hours).
The volume of BHED visits is fairly stable by month with slightly higher numbers in July
and August. Monday was the worst day of the week with the greatest frequency of BHED visits.
At hospitals, the highest volume of BHED visits occurred in the middle of the day, while at the
NPC it occurred right after midnight.
Most patients with BHED visits were adults, and 75% were either uninsured or had
Medicaid coverage. Relative to the general population, adults are over-represented and children
are under-represented. Patients making BHED visits are evenly split between males and
females, blacks had disproportionately high rates, Hispanics were underrepresented, and whites
were proportionately represented.
6
Emergency Department Visits for Behavioral Health Conditions
in Harris County, Texas 2004-2006
Introduction
This report presents data on behavior health-related emergency department (BHED) visits
in Harris County, Texas hospitals and the Harris County Mental Health Mental Retardation
Authority’s Neuropsychiatric Center (NPC) in 2004-2006. The annual total and per capita
number of BHED visits, their percentage of total ED visits, hospitalization percentages, and the
socio-demographic characteristics and behavioral health conditions of patients are presented.
The specific tasks that were completed to develop the statistics are presented in the next section
along with a brief description of the data sources and estimation methods used. Subsequent
sections present findings and conclusions.
Methods
Tasks
The following specific tasks were completed to produce data on BHED visits in Houston
hospitals and the NPC, and to describe patient characteristics.
1. Identified the number of BHED visits in hospitals participating in the Harris County
Hospital ED Study during 2004-2006 and the percentage of total ED visits that they
represent.
2. Estimated the number of BHED visits in all Harris County hospitals and the
percentage of total ED visits that they represent.
7
3. Obtained MHMRA’s BHED visit data for the NPC and merged it with the hospital
ED data to estimate the total number of hospital- and NPC-related BHED visits in the
county.
4. Obtained annual U.S. Census estimates of the Harris County population and
computed BHED visit rates of Harris County residents.
5. Determined hospitalization percentages of BHED and medical ED visits and
compared them for the NPC and hospitals.
6. Developed tables that show the frequency of the most prevalent behavioral health
conditions tabulated separately for the NPC and hospital visits.
7. Determined the lengths of stay in the ED of patients with BHED visits compared to
patients with medical visits and compared the lengths of stays in hospital EDs versus
the NPC.
8. Developed graphs that show trends in total BHED visits by month, day, and time of
day.
9. Developed graphs that compare the socio-demographic characteristics of patients
with BHED visits in hospitals and the NPC .
Data
The primary data source for this study was the ED visit data of 16 hospitals that
participated in the Houston Hospitals Emergency Department Use Study from 2004-2006. 2
This diverse group of public and private hospitals are located throughout the county and include:
2 Annual survey of ED use in Harris County hospitals that has been conducted by UTSPH since 2003. In 2003, 11
hospitals participated. In 2005 and 2006, 25 hospitals participated. Together, the ED visits of the 16 hospitals used
for this study represented 52% of all ED visits made to all hospitals in the county in 2006.
8
Ben Taub General Hospital and LBJ General Hospital (both part of the Harris County Hospital
District system), St. Joseph Medical Center (formerly CHRISTUS St. Joseph Hospital), Texas
Children’s Hospital, St. Luke’s Episcopal Hospital, eight hospitals of the Memorial Hermann
Healthcare System (Hermann/Texas Medical Center, Southwest, Southeast, Northwest, The
Woodlands, Memorial City, Katy, and Sugar Land, formerly Fort Bend), and three hospitals of
the Hospital Corporation of America system (Bayshore Medical Center, Spring Branch Medical
Center, and East Houston Regional Medical Center).
The ED visit data obtained from each hospital contains the following elements.
1. Date and time of admission to ED
2. Primary and secondary discharge diagnosis
3. Discharge date and time
4. Payment source
5. Patient age
6. Patient gender
7. Patient race/ethnicity
8. Patient ZIP code
9. Discharge disposition (e.g. hospital, home, nursing home, etc.)
The second major source of data was MHMRA’s NPC visit data. The NPC is a 24-hour
public psychiatric emergency service located in the Texas Medical Center. It is dedicated to the
provision of emergency psychiatric care to the county. The NPC maintains a comprehensive
client services database which contains detailed records of all visits, services, and service
recipients. This database was queried for all visits to the NPC during 2004-2006. The records of
visit type and duration were matched with client demographics and payer characteristics to
provide a detailed picture of BHED visits at NPC. The NPC data were extracted and arranged
to match the Hospital ED Study variables so that these two data sets could be merged. For
example, hospitals use ICD-9 diagnosis codes for ED visits and the NPC uses DSM-IV codes. A
9
crosswalk was conducted so that NPC visit diagnostic data could be compared to the hospital
diagnostic data.3
The third database was population estimates for Harris County for the years 2004-2006.
County level estimates were obtained from the Texas State Data Center at
http://txsdc.utsa.edu/tpepp/txpopest.php.
Estimation Methods
Identification of BHED Visits. To identify BHED visits in the hospital ED database, we
used a set of International Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9) diagnosis codes that indicated that the ED visits were due to a behavioral health
condition. We used the set of ICD-9 codes indicating “mental disorders,” (codes 290 to 319), as
well as related “v codes” (“other conditions that may be a focus of clinical attention”). We also
included an additional set of medical codes, outside of codes 290 to 319, which indicate
behavioral health-related medical conditions seen in the emergency room setting. This set of
diagnostic codes has been identified by a joint effort of the New York University Center for
Health and Public Service Research and the United Hospital Fund for assessing various aspects
of emergency room utilization (information on this project available online at:
http://wagner.nyu.edu/chpsr/). The conditions in this set included: alcoholic fatty liver (57.10);
alcoholic cirrhosis of the liver (57.12); alcoholic liver damage (57.13); medicolegal assessment
(70.4); alcohol screening (v79.1); suicidal behavior (E95.81); alcoholic polyneuropathy (357.50);
and drug-related neuropathy (357.60), alcoholic cardiomyopathy (425.5); alcoholic gastritis
3 American Psychological Association. Covered Diagnoses and Crosswalk of DSM-IV Codes to ICD-9-CM Codes.
Available online: http://www.aparactice.org/apo/insider/practice/pracmanage. Accessed January, 2008.
10
(535.3 and 535.31); drug dependence in the peripartum (648.3); mental disorders in the
peripartum (648.4); suspected damage to fetus from mother’s drug use antepartum (655.53);
cocaine use affecting fetus or newborn via placenta or breastmilk (760.75); and hyperventilation
(786.01).
All hospitals participating in the ED study have submitted the first two discharge
diagnoses on each ED visit, and some have submitted up to 10 diagnoses. In order to obtain the
most comprehensive estimate of BHED visits including all primary and secondary diagnosis
codes, a two –step process was followed. First, we identified all the BHED visits on the basis of
the first two codes in all 16 hospitals. Second, we identified the additional BHED visits using
codes in position three through 10 in those hospitals who submitted all ten diagnoses. Third, we
adjusted our estimate of BHED visits in the rest of the hospitals by applying the percentage that
the additional BHED visits represented in the hospitals with ten diagnoses.
Total BHED Visits and Their Percentage of Total ED Visits. To estimate the number
of BHED visits at all hospitals in the county, the BHED visit percentage of total ED visits in the
16 hospitals was applied to the number of total ED visits of the other 19 hospitals in the county
with general EDs obtained from the Texas Department of State Health Services.4 The BHED
visits from the NPC were added to the estimated number of hospital-related visits to estimate
total BHED visits in the county.
BH and Medical ED Visits per Capita. Total BHED visits for each year were divided
by population estimates at the county to determine BHED visits per 1000 population.
4 Texas Department of State Health Services, Cooperative DSH/AHA/THA Annual Survey of Hospitals and
Hospital Tracking Database.
11
Hospitalization/Non-Hospitalization Percentages for BHED Visits. The
hospitalization/non-hospitalization percentage of BHED visits and medical ED visits were
computed based on data from the 16 hospitals and the NPC.
Most Frequent Behavioral Health Conditions. All BHED visits were grouped into
common categories of behavioral health conditions, based on the primary discharge diagnosis.
Lengths of Stay in the ED of Patients with BH and Medical ED Visits. The lengths of
stay in the ED of BH and medical ED visits was computed based on data from the 16 hospitals
and the NPC for those patients whose lengths of stay were less than 24 hours.5
BHED Visits by Month, Week, and Time of Day. Total BHED visits were charted by
month, week, and time of day for the NPC, hospitals, and the combination of the two.
BHED Visits by Gender, Age, Race/Ethnicity, and Payor Source. Total BHED visits
by gender, age group, and race/ethnicity were charted for the NPC, the hospitals, and the
combination of the two.
Results
Total and Per Capita BHED Visits, Hospitalization Rates, Major Conditions,, Lengths of Stay,
and Seasonal, Daily, and Hourly Trends
From 2004 to 2006, the number of BHED visits increased by 36%, from 79,000 visits to
107,000 (Table 1). Medical ED visits rose 2.5%, from 1.26 million to 1.3 million. The
proportion of total ED visits represented by BHED visits rose from 5.9% to 7.6%. The growth
in BHED visits was primarily in the hospitals, where the visits rose 44%, from 66,000 to 94,000,
5 The lengths of stay analysis was limited to stays of less than 24 hours because hospitals have observation units
connected to their EDs where patients may be observed for several days.
12
while remaining about the same at the NPC (Table 2). The proportion of total BHED visits at
the hospitals grew from 84% in 2004 to 88% in 2006 while the percentage at the NPC decreased
from 16% to 13%.
The growth in BHED visits exceeded the growth in the Harris County population during
the period; BHED visits rose from 1.6 per 100 residents to 2.0 per 100 residents (Table 3).
During the same period, medical ED visits declined modestly relative to the population.
The hospitalization rate following an ED visit was about twice as high for BHED visits as
for medical ED visits (Table 4). The percentage of BHED visits that were hospitalized at the
NPC was more than twice the percentage at hospitals, and increased over the years (Table 5).
Mean lengths of stay in hospital EDs are about one hour longer for BHED visits than for
medical ED visits (Table 6). Lengths of stay for hospitalized patients ranged between 4 to 7
hours for medical ED visits and 5 to 8 hours for BHED patients. Lengths of stay for non-
hospitalized patients were about 5 hours for medical ED visits and 6 hours for BHED patients.
The lengths of stay of BHED visits at the NPC were 2-3 hours longer than BHED visits in the
hospitals. Admitted patients at the NPC stayed about 9 hours in the ED while discharged
patients stayed between 7-8 hours.
The most frequent behavioral health problems of patients with BHED visits were mood
disorders, psychotic disorders, and substance abuse disorders, which together accounted for 80%
of all BHED visits (Table 7). The most frequent problem of patients with hospital-based BHED
visits was substance abuse -related, while at the NPC it was mood disorders. For the NPC, the
second-most common reason for a visit related to a psychotic disorder, while for hospitals, the
second-most frequent reason for a visit was a mood disorder.
13
For the mood disorders, the most frequent diagnoses were: depressive disorders and
bipolar disorders (Table 8). For the psychotic disorders category, the most frequent diagnoses
were: schizophrenia and schizoaffective disorder. For the substance abuse category, the most
frequent diagnoses were alcohol-related diagnoses (alcohol abuse, alcohol dependence, or
alcohol intoxication), cocaine-related diagnoses (cocaine abuse, dependence, or intoxication),
and abuse of other substances (any of the following: phencyclidine abuse, inhalant abuse,
caffeine abuse, abuse of some “other” drug, or abuse of some “unknown” drug). For the anxiety
disorders, the most frequent diagnoses were panic disorder, stress reactions (including post-
traumatic stress disorder, acute stress reaction, “mixed stress reaction,” “other stress reaction,”
and “unspecified stress reaction), and “anxiety disorder not otherwise specified.” The frequency
of visits across all these conditions was relatively stable over the three years at both the hospitals
and the NPC.
BHED visits showed only a slight variation by month (Figure 1). The months with the
most visits to the NPC were July and August, and the months with the most visits to the hospital
based ERs were May, July, and August.
Hospital- and NPC-based BHED visits showed little variation by day of the week, with
Thursday having the fewest at hospitals and Sunday at the NPC (Figure 2).
There is a distinct contrast between hospital-based BHED visits and NPC-based BHED
visits by time of day (Figure 3). For both groups of patients, the hours with the fewest visits
were from 4-6 AM. The hospital-based BHED visits were most frequent at 1 PM and remained
at a relatively high level for the rest of the day. NPC visits were most frequent at 11-12 PM, then
decreased throughout the day.
14
Characteristics of Patients with BHED Visits
A majority of BHED visits were made by males (52%) (Figure 4). This is largely due to
the NPC, where 55% of visits were by males. In contrast, hospital-based BHED visits were
almost evenly split between females (50%) and males (50%).
Almost half of BHED visits were by adults age 26 to 44 (44.5%) (Figure 5). The NPC
had almost no visits by children (age 0 to 18) (0.5%), whereas 10.5% of the hospital- based
BHED visits were by children.
The distribution of BHED visits by race/ethnicity was blacks (36%), whites (36%),
Hispanics 25%, and Other (e.g. Asian, American Indian, Other, and Unknown) 2% (Figure 6).
There were relatively more blacks at the NPC and relatively more Hispanics at the hospitals.
The proportion of BHED visits by whites was similar at the NPC (39%) and the hospital based
EDs (35%) and reflected the distribution in the Harris County population.
More than half of all BHED visits were by persons who were uninsured (53%), and just
over two in ten (22%) were by persons with Medicaid. Just over one out of ten (12%) had private
insurance and one in ten (11%) had Medicare (Figure 7). The NPC served a relatively greater
proportion of uninsured patients than the hospitals, and had almost no visits by those with private
insurance (0%). The proportion of patients with Medicaid was also greater at the NPC (30%)
compared to the hospital EDs (18%).
Conclusion and Discussion
The latest data on hospital ED use in the United States indicates a population rate of 40.5
visits per 100 persons in 2006, 19% higher than the 1996 rate of 34.1 (1). In Texas the ED use
15
rate was 36.2 visits per 100 persons in 2006, an increase of 33% over the 1997 rate of 27.2.6 The
rise in ED use is a concern because it has occurred while the capacity (facilities and staff) of
hospital EDs has stayed the same or declined, contributing to the “ED overcrowding” problem.
Knowledge about who is using the ED and the extent to which the growth in ED use is related to
access barriers for primary care, or reflects a population preference for ED care, is particularly
important to policymakers.
Following national trends7, Houston/Harris County has experienced increasing BHED
visits that constitute a significant and increasing burden of care. From 2004-2006 there were
276,614 BHED visits in the county, representing an increase from 5.9% to 7.6% of all ED visits,
and an increase from 1.6 to 2.0 visits per 100 Harris County residents. The most prevalent
diagnoses were mood disorders (36.8% of visits), psychotic disorders (24.7% of visits), and
substance abuse disorders (17.2%), which together constituted almost 80% of all visits. Patients
with BHED visits were subsequently hospitalized more than twice as often as those with medical
ED visits, and their lengths of stay in the ED averaged an hour longer. Most patients with BHED
visits are adults with no insurance or with Medicaid coverage. Relative to Harris County
population demographics, BHED visits were evenly split between males and females, blacks had
disproportionately high rates, Hispanics had disproportionately low rates, and whites had BHED
visit rates in proportion to the county population.
6 Texas Department of State Health Services. Center for Health Statistics. 2007. Texas acute care
hospitals:outpatient visits and emergency room visits, 1997-2006. December.
7 Schappert SM, Rechtsteiner EA 2008 Ambulatory Medical Care Utilization Estimates for 2006. National Health
Statistics Reports Number 8. Hyattsville MD; National Center for Health Statistics. August 6, 2008, 1-5. Larkin
GL, Classen CA, Emond JA, Pelletier AJ, Camargo CA 2005. Trends in U.S.emergency department visits for mental
health conditions, 1992 to 2001. Psychiatric Services 56:671-677
16
To a large extent, the pattern found for the hospital based BHED visits compares and
contrasts with the pattern found every year for primary care related ED (PCR ED) visits in the
Harris County Hospital ED Study. The seasonal pattern of BHED hospital visits is in contrast to
the pattern found in the analysis of PCR ED visits. Whereas the highest frequency of BHED
visits were in the summer months, the highest number of PCR ED visits occurred in the winter
months. BHED visits were almost evenly split by gender, but PCR ED visits were
predominantly female. Whereas most BHED visits in this study were by adults between 18 and
64 (88.4%), they made up just over half (54.3%) of all PCR ED visits in 2006. The percentage of
BHED visits by blacks is roughly comparable in this study and the 2006 PCR ED study (36.0%
vs. 34.4%), Whites had a higher percentage of BHED visits (36.3%) than PCR ED visits
(25.7%), and Hispanics had a lower percentage of BHED visits (24.5%) than PCR ED visits
(32.5%). The uninsured represent a much higher percentage of BHED visits (53.1%) than PCR
ED visits (32.4%). This remains true even when BHED visits at the NPC are examined
separately from hospital based BHED visits.
Limitations
The hospital-related estimates are based on a sample of hospitals (i.e. 16 hospitals) over a
three year period of time. It is unclear if or how the existence of free standing psychiatric
hospitals such as the Harris County Psychiatric Center and West Oaks Hospital, which were not
included in this study, have affected the availability or use of emergency services in the county.
Because the primary database unit of analysis is ED visit, we were unable to count the
number of individuals with visits, nor to track those with repeat visits.
17
We relied on ICD-9 diagnosis codes to determine BHED visits, which likely biased our
data below actual experience. Behavioral health problems undoubtedly played a role in more
visits than is reflected by the primary or secondary discharge diagnosis codes. Beyond what
could be inferred from the diagnostic code, we cannot tell the reason for a visit. Also, if a visit
was indicated with a first diagnosis code of schizophrenia, we could not tell whether the person
was in the emergency room for acute psychosis, or simply because the person had lost their
medications and needed a refill.
Despite these limitations, we believe that the data that has been presented reveal the
substantial and growing burden of behavioral health problems on emergency departments in the
county over the period.
18
Table 1. Total Medical and BHED Visits in Harris County Hospitals and the NPC
2004 2005 2006 Average
# (%) # (%) # (%) # (%)
Total ED Visits
1
1,340,650
1,223,296
1,400,398
1,321,448
Total BHED Visits
78,895 (5.9)
81,662 (6.7)
107,057 (7.6)
89,205 (6.8)
Total Medical ED Visits
1,261,755
(94.1)
1,141,634
(93.3)
1,293,341
(92.4)
1,232,243
(93.2)
1Total ED visits regardless of county of residence
19
Table 2. Comparison of BHED Visits in Hospitals and the NPC
2004 2005 2006 Average
# (%) # (%) # (%) # (%)
Total BHED Visits1
78,895
81,662
107,057
89,205
Hospital BHED Visits 66,136
(83.8)
68,258
(83.6)
93,727
(87.5)
76,040
(85.2)
NPC BHED Visits
12,759
(16.2)
13,404
(16.4)
13,330
(12.5)
13,164
(14.8)
1Total visits regardless of county of residence
20
Table 3. Per Capita Medical and BHED Visits in Harris County Hospitals
2004 2005 2006 Average
Rate Rate Rate Rate
Total ED Visits1 Per 100 Persons
26.8
23.3
26.0
25.3
BHED Visits Per 100 Persons
1.6
1.6
2.0
1.7
Medical ED Visits Per 100 Persons
25.2
21.7
24.0
23.6
1Total ED visits regardless of county of residence
21
Table 4. Hospitalized/Non-Hospitalized Percentages of Medical and BHED Visits
2004 2005 2006 Average
% % % %
ED Visits
Hospitalized1
Non-Hospitalized2
Total
3.1
96.9
100.0
9.6
90.4
100.0
15.5
84.5
100.0
9.4
90.6
100.0
BHED Visits
Hospitalized
Non-Hospitalized
Total
11.3
88.7
100.0
17.0
83.0
100.0
25.7
74.3
100.0
18.7
81.3
100.0
Medical ED Visits
Hospitalized
Non-Hospitalized
Total
2.6
97.4
100.0
9.0
91.0
100.0
14.7
85.3
100.0
8.8
91.2
100.0 1For ED visits to hospitals, the hospitalized figures include a small percentage of patients who
died in the ED, left against medical advice or transferred to other patient care settings. 2Discharged to home or self care.
22
Table 5. Comparison of Hospitalization Percentages in Hospitals and the NPC
2004 2005 2006 Average
# (%) # (%) # (%) # (%)
Hospital BHED Visits
Hospitalized1
Non-Hospitalized2
Total
7.0
93.0
100.0
11.6
88.4
100.0
22.1
77.9
100.0
14.5
85.5
100.0
NPC BHED Visits
Hospitalized
Non-Hospitalized
Total
31.2
68.8
100.0
39.7
60.3
100.0
46.8
53.2
100.0
39.4
60.6
100.0 1For ED visits in hospitals, the hospitalized figures include a small percentage of patients who
died in the ED, left against medical advice or transferred to other patient care settings. 2Discharged to home or self care.
23
Table 6. Medical and BHED Visits Mean Lengths of Stay (in hours) in the ED:
Hospitals and the NPC, Hospitalized and Non/Hospitalized
2004 2005 2006 Average
Mean
Mean
Mean
Mean
Hospitals
Medical ED Visits Hospitalized
1
Non-Hospitalized2
BHED Visits
Hospitalized
Non-Hospitalized
3.6
4.8
5.0
6.1
6.7
4.7
7.7
5.9
5.3
4.8
7.1
5.9
5.7
4.8
7.0
5.9
NPC
BHED Visits
Hospitalized
Non-Hospitalized
9.1
7.7
9.1
7.0
9.3
6.6
9.2
7.1 1For ED visits to hospitals, the hospitalized figures and include a small percentage of patients
who died in the ED, left against medical advice or transferred to other patient care settings. 2Discharged to home or self care.
24
Table 7. BHED Visits by Diagnostic Category, 2004-2006
Hospital EDs NPC Both
Diagnostic Category # % # % # %
Mood Disorders 9,237 20.0 22,345 57.6 31,582 37.1
Psychotic Disorders 6,803 14.7 14,408 37.1 21,211 24.9
Substance Abuse
Disorders
14,097 30.5 944 2.4 15,041 17.7
Anxiety Disorders 8,354 18.1 85 0.2 8,439 9.9
Medical Dx with a
Psychiatric
Component
2,902 6.3 0 0.0 2,902 3.4
Unspecified Mental
Disorder
1,230 2.7 10 0.0 1,240 1.5
Other
3,622 7.8 1,014 2.6 4,636 5.5
Total
46,245 100.0 38,806 100.0 85,051 100.0
25
Table 8. BHED Visits by Behavioral Health Condition, 2004-2006
Diagnostic Category Number of
Visits
Percent of
Category Total
Cumulative
Percent
Mood Disorders
Bipolar Disorders 15,069 47.7 47.7
Depressive Disorders 14,746 46.7 94.4
Psychotic Disorders
Schizophrenia 10,057 47.4 47.4
Schizoaffective Disorder 7,041 33.2 80.6
Psychotic Disorder Not
Otherwise Specified
3,800 17.9 98.5
Substance Abuse Disorders
Alcohol Disorders
(Abuse, Dependence,
Intoxication)
7,576 50.4 50.4
Cocaine Disorders
(Abuse, Dependence,
Intoxication)
2,522 16.8 67.2
Other or Unspecified
Abuse
(Inhalants, PCP, caffeine,
other, or unknown)
1,806 12.0 79.2
Anxiety Disorders
Anxiety D/O Not
Otherwise Specified
6,180 73.2 73.2
Panic Disorder 1,232 14.6 87.8
Stress Reactions:
Acute, and PTSD
922 10.9 98.7
26
Figure 1. BHED Visits in Harris County By Month, 2004-2006 Combined
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
NPC
Hospital ED
Total BHED
27
Figure 2. BHED Visits In Harris County By Day Of Week, 2004-2006 Combined
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
Sun Mon Tue Wed Thu Fri Sat
NPC
Hospital ED
Total BHED
28
Figure 3. BHED Visits in Harris County By Hour, 2004-2006 Combined
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
0:0
0
1:0
0
2:0
0
3:0
0
4:0
0
5:0
0
6:0
0
7:0
0
8:0
0
9:0
0
10
:00
11
:00
12
:00
13
:00
14
:00
15
:00
16
:00
17
:00
18
:00
19
:00
20
:00
21
:00
22
:00
23
:00
NPC
Hospital ED
Total BHED
29
Figure 4. BHED Visits in Harris County By Gender, 2004-2006* Combined
Female
47.8%Male
52.1%
Unknown
0.1%
4a. Total BHED
*According to the Texas State Data Center, in 2006 an estimated 50.1% of the population of Harris County was male, and 49.86% was female.
30
Female
44.4%Male
55.4%
Unknown
0.2%
4b. NPC
Female
49.7%
Male
50.3%
Unknown
0.0%
4c. Hospital BHED
31
Figure 5. BHED Visits in Harris County By Age, 2004-2006* Combined
0-17
7.0%
18-25
17.7%
26-44
44.5%
45-64
26.2%
65+
4.6%
5a. Total BHED
*According to the Texas State Data Center, in 2006 an estimated 27.9% of the population of Harris County was between the ages of 0 and 17,
11.8% was between 18 and 25, 30.8% was between 26 and 44, 22.0% was between 45 and 64, and 7.4% were 65 or older.
32
0-17
0.5%
18-25
19.7%
26-44
51.3%
45-64
27.1%
65+
1.4%
5b. NPC
0-17
10.5%
18-25
16.7%
26-44
40.8%
45-64
25.8%
65+
6.3%
5c. Hospital BHED
33
Figure 6. BHED Visits in Harris County By Race/Ethnicity, 2004-2006*Combined
Asian
1.1%
Black
36.0%
Hispanic
24.5%Am. Indian
0.1%
Other
1.4%
Unknown
0.6%
White
36.3%
6a. Total BHED
*According to the Texas State Data Center, in 2006 an estimated 18.9% of the population of Harris County was black, 34.9% was white, 34.4%
was Hispanic, and 6.8% were members of other racial groups.
34
Asian
1.1%
Black
43.5%
Hispanic
15.6%Am. Indian
0.1%
Other
1.0%
Unknown
0.0%
White
38.6%
6b. NPC
Asian
1.1%
Black
31.9%
Hispanic
29.3%
Am. Indian
0.0%
Other
1.6%
Unknown
1.0%
White
35.0%
6c. Hospital BHED
35
Figure 7. BHED Visits in Harris County By Payer Source, 2004-2006* Combined
Private
11.9%
M'caid
22.2%
M'care
10.8%
Other Gov.
0.7%
Other Priv.
0.5%
Uninsured
53.1%
Unknown
0.8%
7a. Total BHED
*According to a UT School of Public Health analysis of primary care related ED visits by Harris County residents in 2006, 30.1% of visits were by
those with private insurance, 25.0% were by those enrolled in Medicaid, 9.2% were by those enrolled in Medicare, 1.9% were by those with some
other government coverage (e.g. Tricare/CHAMPUS, workmen’s comp, etc.), 0.7% were by those with some other form of private insurance, and
32.4% were by those who were uninsured.
36
Private
0.5%
M'caid
29.9%
M'care
7.4%
Other Gov.
0.0%
Other
Priv.
0.0%
Uninsured
62.2%
Unknown
0.0%
7b. NPC
Private
18.1%
M'caid
18.0%
M'care
12.6%
Other Gov.
1.0%
Other Priv.
0.8%
Uninsured
48.1%
Unknown
1.3%
7c. Hospital BHED
