Background Emergency departments (EDs) have become entry points for treating behavioural health (BH) conditions, thereby rendering the evaluation of their utilisation necessary. Objectives This study estimated behavioural-related hospital-based ED visits and outcomes of leaving against medical advice as well as the incurred charges within the primarily rural State of Nebraska. Also, the study correlated behavioural workforce distribution and location of EDs with ED utilisation. Methods Nebraska State Emergency Department Database provided information on utilisation of services, charges, diagnoses and demographic. Health Professional Tracking Services survey provided the distribution of EDs and BH workforce by region. To examine the effect of patient characteristics on discharge against medical advice, multivariable logistic regression modelling was used. Findings US$96.4 million were ED charges for 52 035 visits for BH disorders over 3 years. Of these, 35% and 50% were between 25 and 44-years old and privately insured, respectively. The uninsured (OR:1.53, p=0.0047) and 45–64 years old (OR:2.31, p<0.001) had higher odds of leaving against medical advice. The findings from this study identified ED outcomes among high-risk cohort. Conclusions There were high ED rates among the limited number EDs facilities in rural Nebraska. Rural regions of Nebraska faced workforce shortages and had high numbers of ED visits at relatively few accessible EDs. Clinical implications Customised rural-centric public health programmes, which are based in clinical settings, can encourage patients to adhere to ED-treatment. Also, increasing the availability of BH workforce (either via telehealth or part-time presence) in rural areas can alleviate the problem and reduce ED revisits.

中文翻译：

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内布拉斯加州的行为异常急诊室和劳动力供应。

背景技术紧急部门（ED）已成为治疗行为健康（BH）状况的切入点，因此有必要对其使用进行评估。目的这项研究估计了与行为有关的医院急诊就诊和不遵医嘱的结果以及在内布拉斯加州主要农村地区发生的费用。此外，该研究还将行为劳动力的分布和ED的位置与ED的利用联系起来。方法内布拉斯加州急诊部数据库提供有关服务使用，收费，诊断和人口统计的信息。卫生专业人员跟踪服务调查提供了按地区划分的急诊室和卫生保健工作人员分布。为了根据医疗建议检查患者特征对出院的影响，使用多变量逻辑回归建模。调查结果显示，在3年中，针对BH疾病的52 035次就诊急诊费用为9,640万美元。其中35％和50％的年龄分别在25岁至44岁之间，并有私人保险。未投保（OR：1.53，p = 0.0047）和45-64岁（OR：2.31，p <0.001）的人更有可能接受医疗建议。这项研究的发现确定了高危人群的ED结果。结论内布拉斯加州农村地区有限数量的EDs设施中ED率很高。内布拉斯加州的农村地区面临着劳动力短缺的问题，急诊就诊的次数很高，可访问的急诊就很少。临床意义基于临床环境的以农村为中心的定制公共卫生计划可以鼓励患者坚持接受ED治疗。也，