Poverty, Preventable Stays, and Mental Health Shortage

Preventable hospitalization and the overuse of the emergency department (ED) is an ongoing concern for health care delivery in the U.S. (Sorel et al., 2015, Pezzin et al., 2018). Since 2010, the rate of ED utilization among young adults with mental illness has increased while overall use has decreased (Hernandez-Boussard et al., 2016). The number of ED visits has increased from 44 million to nearly 150 million since 1968 (Adams, 2013). There is a growing emphasis on improving care coordination and integrating mental health services in order to reduce preventable hospitalizations and to decrease the burden on the ED (Talbot et al., 2016Shen et al., 2018).

Analyzing the Data

The purpose of this analysis is to first determine whether the rate of poverty in an area is related to the rate of preventable hospitalizations and readmission. And second, to identify whether mental health Health Professional Shortage Area (HPSA) are overburdened by ED visits and preventable hospitalizations. 

A HPSA is a designation indicating a shortage of primary care, dental health, or mental health providers based on geography, population, or facility. The rationale for such a finding may be that patients are unable to find suitable care and are "forced" to seek care at their local hospitals. This scenario explores county HPSAs related to mental health, use of the ED and hospital and county demographics.

This data is also available in a text-based table format.

Tutorial: Using the Data

Data Sources

Area Health Resources File (data released 2019)

Defining the Columns

State: The abbreviated name of the state where the county is located.

County: The name of the county where the information was collected. County names are listed as provided on the United States Census Bureau's list of 2019 FIPS Codes for Counties and County Equivalent Entities.

Mental Health HPSA: A county that is considered to have a shortage in mental health professionals including psychiatrists, clinical psychologists, clinical social workers, psychiatric nurse specialists, and marriage and family therapists. This variable has three possible values:

  • None = None of the county designated as a shortage area;

  • Partial = The whole county designated as a shortage area;

  • Whole = One or more parts of the county designated as a shortage area.

Hospital Admissions: The number of patients, excluding newborns, accepted for inpatient service during the reporting period. The number includes patients who visit the emergency room and are later admitted for inpatient services. Neonatal and swing admissions are included.

Readmission Rate: This Medicare Beneficiary Fee-For-Service Hospital Readmission Rate is the percent of inpatient readmissions within 30 days of an acute hospital stay during the reference period.

Preventable Hospital Stays Rate: The hospital discharge rate for ambulatory care-sensitive conditions per 1,000 fee-for-service Medicare enrollees. This measure is age-adjusted.

Hospital Beds: The number of beds regularly maintained (set up and staffed for use) for inpatients as of the close of the reporting period.

FTEs: The number of full‑time personnel plus one‑half the number of part‑time personnel.

Inpatient Days: The number of adult and pediatric days of care, excluding newborn days of care, rendered during the entire reporting period. Neonatal and swing admissions are included.

Emergency Department Visits: The total count of inpatient or hospital outpatient emergency department visits.

Outpatient Visits: The total count of hospital outpatient visits, which consists of emergency visits, other visits (including clinic and referred visits), and total visits. An outpatient visit is defined as a visit by a patient not lodged in the hospital while receiving medical, dental, or other services.

Population Estimate: The total number of individuals residing in the county. The data is derived from the Census Population Estimates from 2018.

Percent in Poverty: The rate of individuals in the county with a total family income less than the poverty threshold appropriate for that family.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,009,121 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.