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Author Notes:

R.S. Shim: 720 Westview Drive, National Center for Primary Care, Atlanta, GA 30310, USA. Tel.: +1 404 756 8821; fax: +1 404 756 5767. rshim@msm.edu

Ruth Shim designed the study and wrote the first draft of the manuscript; Benjamin Druss wrote and reviewed all manuscript drafts and designed the study; Shun Zhang undertook the statistical analysis and wrote the portions of the manuscript; Giyeon Kim wrote and reviewed all manuscript drafts; Adesoji Oderinde and Sosunmolu Shoyinka reviewed all manuscript drafts; George Rust designed the study, managed the analyses, and wrote and reviewed all manuscript drafts.

All authors contributed to and have approved the final manuscript.

The authors have no acknowledgements to report.

George Rust, MD, MPH is the principal investigator of a center grant from the Bristol-Myers Squibb Foundation.

All other authors declare that they have no conflicts of interest.


Research Funding:

This project was funded under contract/grant number R24 HS 019470-01 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Psychiatry
  • Schizophrenia
  • Diabetes
  • Emergency department utilization
  • Medicaid

Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: The consequences of increasing medical complexity


Journal Title:

Schizophrenia Research


Volume 152, Number 2-3


, Pages 490-497

Type of Work:

Article | Post-print: After Peer Review


Objective: Individuals with both physical and mental health problems may have elevated levels of emergency department (ED) service utilization either for index conditions or for associated comorbidities. This study examines the use of ED services by Medicaid beneficiaries with comorbid diabetes and schizophrenia, a dyad with particularly high levels of clinical complexity. Methods: Retrospective cohort analysis of claims data for Medicaid beneficiaries with both schizophrenia and diabetes from fourteen Southern states was compared with patients with diabetes only, schizophrenia only, and patients with any diagnosis other than schizophrenia and diabetes. Key outcome variables for individuals with comorbid schizophrenia and diabetes were ED visits for diabetes, mental health-related conditions, and other causes. Results: Medicaid patients with comorbid diabetes and schizophrenia had an average number of 7.5 ED visits per year, compared to the sample Medicaid population with neither diabetes nor schizophrenia (1.9 ED visits per year), diabetes only (4.7 ED visits per year), and schizophrenia only (5.3 ED visits per year). Greater numbers of comorbidities (over and above diabetes and schizophrenia) were associated with substantial increases in diabetes-related, mental health-related and all-cause ED visits. Most ED visits in all patients, but especially in patients with more comorbidities, were for causes other than diabetes or mental health-related conditions. Conclusion: Most ED utilization by individuals with diabetes and schizophrenia is for increasing numbers of comorbidities rather than the index conditions. Improving care in this population will require management of both index conditions as well as comorbid ones.

Copyright information:

© 2013 Elsevier B.V.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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