by Kathy Whitney
In an effort to understand why Shade Tree Clinic patients visit the Vanderbilt University Medical Center Emergency Department, the authors of a study recently published in the Journal of General Internal Medicine found that mental health issues top the list.
The Shade Tree Clinic is a free medical clinic for Nashville’s uninsured population that is run by Vanderbilt University School of Medicine and School of Nursing students with oversight from faculty members.
In a cross-sectional study of VUMC Emergency Department (ED) visits among 254 Shade Tree patients, 59 (23.2%) had a VUMC ED visit during the study year. Of the 87 total ED visits, 14 (16.1%) were ambulatory care sensitive and six were secondary to complications of diabetes. Patients who visited the VUMC ED were more likely to have a mental health disorder — including mood, anxiety, psychotic and substance use disorders, according to the study.
The study fills a knowledge gap in emergency department utilization among patients at Shade Tree Clinic and highlights opportunities to improve education, intervention and outcomes among patients with diabetes and/or mental health disorders, said first author and fourth-year VUSM MD/PhD student Daniel Sack.
“It provides our medical and nursing student administrators with information that will allow them to shape quality improvement projects to reduce avoidable ED utilization,” he said. “These data suggest that future interventions focused on patients with diabetes and patients with mental health conditions could help to reduce ED utilization among Shade Tree patients.”
The study found a lower than expected rate (16.1%) of ambulatory care ED visits, 42.6% attributed to diabetes. This can be attributed to Shade Tree’s Patient Health Education Program, where medical students contact patients with complex medical issues weekly. Sack says the clinic will explore improvements to the education program to address managing common chronic conditions like diabetes.
Shade Tree providers conduct universal depression screening, have a licensed social worker on staff and host a monthly psychiatry clinic in an effort to reduce the burden of mental illness among its patients.
“These data suggest that our ongoing efforts to add a psychiatric nurse practitioner-staffed clinic day, add a monthly group counseling session and implement tele-health mental health services are targeting the correct patients, which we hope will reduce VUMC ED utilization,” Sack said.
Contributing authors include Rohini Chakravarthy, Christian Gerhart, Michael Fowler MD, Robert Miller MD, Eleanor Weaver MD, and Eduard Vasilevskis MD, MPH.
