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Mental Illness and Hospitalization for Ambulatory Care Sensitive Medical Conditions

Mental Illness and Hospitalization for Ambulatory Care Sensitive Medical Conditions. Yue Li, PhD, SUNY at Buffalo Laurent Glance, MD, University of Rochester Xueya Cai, MA, SUNY at Buffalo Dana Mukamel, PhD, Univ. of California, Irvine.

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Mental Illness and Hospitalization for Ambulatory Care Sensitive Medical Conditions

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  1. Mental Illness and Hospitalization for Ambulatory Care Sensitive Medical Conditions Yue Li, PhD, SUNY at Buffalo Laurent Glance, MD, University of Rochester Xueya Cai, MA, SUNY at Buffalo Dana Mukamel, PhD, Univ. of California, Irvine

  2. Introduction:Barriers to primary medical care for mentally-ill patients • Less preventive medical care Colon cancer screening Pneumonia vaccination Breast cancer screening Influenza vaccination Cervical cancer screening Prostate cancer screening • Poor quality of outpatient care for: eye examination foot inspection Diabetes glycemic control lipemic control …

  3. Introduction (cont’d) • Ambulatory Care Sensitive (ACS) Medical Conditions • An outcome indicator for primary care access and effectiveness • Inversely related to primary care access (Bindman et al JAMA 1995) • Adopted by the Institute of Medicine in 1993

  4. Introduction(cont’d) This Study • ACS admission patterns between medical patients with and without co-occurring mental disorders • Resource use during ACS hospitalization • Hospital cost • Length of stay

  5. Data Sources • New York State Hospital Discharge Data for 2004 • Computerized discharge abstracts from short-stay, nonfederal hospitals (demographics, insurance, clinical info., charges etc) • Area Resource File (ARF) • Geographic and health care resource info. for patient’s county of residence • U.S. Census Data • Income and education data for the zip code area of patient residence • Medicare Cost Report • Cost-to-charge ratio for each hospital

  6. Study Sample • All discharge records for either ACS or “marker” conditions (describe in next slide) • Patients aged 20 to 64 years

  7. ACS Conditions (Billings et al. Health Affair 1993 ) • Immunization-related and preventable conditions • Convulsions • Severe ENT (ear, nose, and throat) infections • Tuberculosis • Chronic obstructive pulmonary disease • Bacterial pneumonia • Asthma • Congestive heart failure • Hypertension • Angina (next slide)

  8. (cont’d) • Cellulitis • Diabetes • Hypoglycemia • Gastroenteritis • Kidney/urinary infection • Dehydration • Nutritional deficiencies • Pelvic inflammatory disease • Certain dental conditions

  9. Marker Conditions (Billings et al. Health Affair 1993 ) • Appendicitis with appendectomy • Acute myocardial infarction(with LOS>5 days or disposition of death) • Gastrointestinal obstruction • Fracture of hip/femur • The rationale for comparing ACS to marker conditions

  10. Analyses Part I – Multivariate Logistic Models • The dependent variable 1 for ACS admission, 0 for marker admission • The independent variable • Model 1: any mental disorder Model 2: psychiatric disorder only substance use only dual diagnosis • Model 3: schizophrenia other psychoses major depression bipolar substance abuse PTSD other

  11. Analyses Part II – Linear Models • The dependent variable • In-hospital cost for ACS condition • Length of stay during ACS admission • Log-transformation of cost and LOS • Independent variables for mental disorders (see before) • Covariates at patient, zip-code and county level • Hospital fixed-effects

  12. Results Table 1. Description of the Sample (n=155,312)

  13. Results (cont’d) Table 2. Mental Illness and ACS Hospitalization

  14. Table 3. Mental Illness and ACS Hospitalization

  15. Figure 1. Adjusted Average Incremental Hospital Cost for Patients with Mental Illness during an Ambulatory Care Sensitive Hospitalization (error bars indicate 95% confidence intervals )

  16. Figure 2. Adjusted Average Incremental Length of Stay (LOS) for Patients with Mental Illness during an Ambulatory Care Sensitive Hospitalization (error bars indicate 95% confidence intervals )

  17. Summary of Findings • Mentally-ill patients show higher risk of ACS admission • Mentally-ill patients have higher resource consumption during ACS hospitalization • The most vulnerable mental groups: combined psychiatric and substance-abuse disorders, psychoses, major depression

  18. Discussion • Integrated medical & mental care • On-site general practitioners • Medically-trained psychiatrists • Referrals to off-site medical providers • The cost-effectiveness of integrated care • Incremental cost of $500 or higher for a typical ACS admission • Mentally-ill patients as a targeted group

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