Follow-Up After Emergency Department Visit for Substance Use (FUA)

The percentage of emergency department (ED) visits among persons age 13 years and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up. Two rates are reported: 

  1. The percentage of ED visits for which the person received follow-up within 30 days of the ED visit (31 total days). 
  2. The percentage of ED visits for which the person received follow-up within 7 days of the ED visit (8 total days). 

Why It Matters

SUDs are a prevalent and serious public health issue and, if left untreated, can lead to damaging effects on an individual’s health, finances and overall well-being. In 2019, 20.4 million individuals in the U.S. 12 or older (i.e., approximately 7.4% of the population) reported having an SUD within the past year (1). 

The use of ED services among the SUD or drug misuse population is common, where 1 in 8 ED visits in the U.S. were found to be related to SUDs and mental health disorders in 2007 (2). Utilization of ED services for substance use is growing among certain subpopulations, particularly individuals aged 18 to 34, as the Centers for Disease Control and Prevention (CDC) reports that the rate of ED visits for a primary diagnosis or primary complaint of SUD increased from 45.4 to 77.0 visits per 10,000 individuals between 2008 and 2016 (3). In addition to visits for an SUD diagnosis, ED visits attributed to drug overdose are also prevalent. National surveillance data reveals that approximately 75% (435,983) of all ED visits for drug-related poisonings in the U.S., excluding alcohol, were due to nonfatal drug overdoses of unintentional or undetermined intent in 2016 (age-adjusted rate of 137.2 visits per 100,000 population) (4). 

The ED is uniquely positioned to improve care for patients with SUD and prevent overdose death because this care setting is the primary provider of acute illness stabilization, timely diagnosis and links to appropriate follow-up care (5). Individuals who are seen in the ED due to substance misuse are at high-risk of subsequent adverse events, especially within the year following their ED visit (6,7,8). This measure focuses on ensuring care coordination for members who are discharged from the ED following high-risk substance use events, since those individuals may be particularly vulnerable to losing contact with the health care system. 

* Adapted from an NCQA measure with financial support from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) under Prime Contract No. HHSP23320100019WI/HHSP23337001T, in which NCQA was a subcontractor to Mathematica. Additional financial support was provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). 

Historical Results – National Averages

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References

  1. Substance Abuse and Mental Health Services Administration. 2019. Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. (HHS Publication No. PEP19‐5068, NSDUH Series H‐54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq[1]reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindings
  2. Weiss, A., M. Barrett, K. Heslin, C. Stocks. 2016.Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013. HCUP Statistical Brief #216. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb216-Mental-Substance-Use-Disorder-ED-VisitTrends.pdf
  3. Centers for Disease Control and Prevention (CDC). 2019b. “QuickStats: Number of Emergency Department Visits for Substance Abuse or Dependence per 10,000 Persons Aged ≥18 Years, by Age Group — United States, 2008–2009 and 2016–2017.” MMWR Morb Mortal Wkly Rep 2019 68:1171. DOI: http://dx.doi.org/10.15585/mmwr.mm6850a7externalicon
  4. CDC. 2019a. Annual Surveillance Report of Drug-Related Risks and Outcomes. CDC National Center for Injury Prevention and Control. https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf
  5. Samuels, E.A., K. Dwyer, M.J. Mello, J. Baird, A.R. Kellogg, & E. Bernstein. 2016. “Emergency Department‐Based Opioid Harm Reduction: Moving Physicians from Willing to Doing.” Academic Emergency Medicine, 23(4), 455-465.
  6. Karmali, R., T. Ray, A. Rubinstein, S. Sterling, C. Weisner, C. Campbell. 2020. “The Role of Substance Use Disorders in Experiencing a repeat Opioid Overdose, and Substance Use Treatment Patterns Among Patients with a Non-Fatal Opioid Overdose.” Drug and Alcohol Dependence 209, 107923.
  7. Goldman-Mellor, S., M. Olfson, C. Lidon-Moyano, & M. Schoenbaum. 2020. “Mortality Following Nonfatal Opioid and Sedative/Hypnotic Drug Overdose.” American Journal of Preventive Medicine, 59(1), 59-67. doi:10.1016/j.amepre.2020.02.012
  8. Weiner, S.G., O. Baker, D. Bernson, J.D. Schuur. 2020. “One-Year Mortality of Patients after Emergency Department Treatment for Nonfatal Opioid Overdose.” Ann Emerg Med 5(1):13–17

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