Resource use of elderly emergency department patients with alcohol-related diagnoses

Saleh, Shadi; Szebenyi, Steve E.

doi:10.1016/j.jsat.2005.08.007

Cited by 15 publications

(5 citation statements)

References 25 publications

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“…Gender-neutral SUD identification tools have known limitations (Bao and Sturm, 2001; Chisolm and Kelleher, 2006; Elixhauser et al, 2011; Merrick et al, 2011; Saleh and Szebenyi, 2005). This study employs a new SUD identification algorithm, the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), adapted from the Substance Need Index (McAuliffe et al, 1999 a , 1999 b ; 2002) to enhance capture of SUD from women’s own substance-related health conditions and those of their neonates.…”

Section: Methodsmentioning

confidence: 99%

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Bernstein

Derrington

Belanoff

et al. 2015

Drug and Alcohol Dependence

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Introduction Longitudinal patterns of treatment utilization and relapse among women of reproductive age with substance use disorder (SUD) are not well known. In this statewide report spanning seven years we describe SUD prevalence, SUD treatment utilization, and differences in subsequent emergency department (ED) use and post-treatment relapse rates by type of treatment: none, ‘acute only’ (detoxification/stabilization), or ‘ongoing’ services. Methods We linked a statewide dataset of hospital discharge, observation stay and ED records with SUD treatment admission records from hospitals and freestanding facilities, and birth/fetal death certificates, in Massachusetts, 2002–2008. We aggregated episodes into individual woman records, identified evidence of SUD and treatment, and tested post-treatment outcomes. Results Nearly 150,000 (8.5%) of 1.7 million Massachusetts women aged 15–49 were identified as SUD-positive. Nearly half of SUD-positive women (71,533 or 48.3%) had evidence of hospital or facility-based SUD treatment; among these, 12% received acute care/detoxification only while 88% obtained ‘ongoing’ treatment. Treatment varied by substance type; women with dual diagnosis and those with opiate use were least likely to receive ‘ongoing’ treatment. Treated women were older and less likely to have a psychiatric history or chronic illness. Women who received ‘acute only’ services were more likely to relapse (12.4% vs. 9.6%) and had a 10% higher rate of ED visits post-treatment than women receiving ‘ongoing’ treatment. Conclusions Many Massachusetts women of reproductive age need but do not receive adequate SUD treatment. ‘Ongoing’ services beyond detoxification/stabilization may reduce the likelihood of post-treatment relapse and/or reliance on the ED for subsequent medical care.

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Section: Methodsmentioning

confidence: 99%

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Bernstein

Derrington

Belanoff

et al. 2015

Drug and Alcohol Dependence

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“…While current research has found that both alcohol and depressive disorders increase health care utilization, few studies have considered the potential additive effect of alcohol disorder on outcomes of inpatient depression admissions specifically (Saleh & Szebenyi, 2005). Thus, this study uses a nationally representative sample of all payer hospitals to examine how the presence of a comorbid alcohol condition influences the cost, length of stay, and disposition (mortality and placement) of older adult patients being treated for a primary depression diagnosis in the hospital.…”

mentioning

confidence: 99%

Hospital Outcomes in Major Depression Among Older Adults: Differences by Alcohol Comorbidity

Sacco

Unick

Zanjani

et al. 2015

Journal of Dual Diagnosis

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Objective The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression. Methods We analyzed a subsample (N = 8,480) of older adults (65 + ) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups. Results Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p < .001) and younger (70.9 versus 75.9 years, p < .001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p < .001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p < .001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p < .02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p < .001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital. Conclusions In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits.

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“…[ 7 ] However, an association between alcohol consumption at the time of injury and worse short- and long-term survival in trauma patients has also been demonstrated. [ 7 10 ] Additionally, it has been suggested that positive BAC in trauma patients is associated with increased resource utilization, due to increased hospital and ICU LOS and increased ICU admissions. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Prevalence and consequences of positive blood alcohol levels among patients injured at work

Foster

2014

J Emerg Trauma Shock

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Aims:The aim of this study was to characterize positive blood alcohol among patients injured at work, and to compare the severity of injury and outcome of blood alcohol concentration (BAC) positive and negative patients.Settings and Design:A retrospective cohort study was performed at a Level 1 academic trauma center. Patients injured at work between 01/01/07 and 01/01/12 and admitted with positive (BAC+) vs negative (BAC−) blood alcohol were compared using bivariate analysis.Results:Out of 823, 319 subjects were tested for BAC (38.8%), of whom 37 were BAC+ (mean 0.151 g/dL, range 0.015-0.371 g/dL). Age (41 years), sex (97.2% men), race, intensive care unit (ICU) and hospital length of stay (LOS), and mortality were similar between groups. Nearly half of BAC+ cases were farming injuries (18, 48.6%): Eight involved livestock, five involved all-terrain vehicles (ATVs), three involved heavy equipment, one fell, and one had a firearm injury. Eight (21.6%) were construction site injuries involving falls from a roof or scaffolding, five (13.5%) were semi-truck collisions, four (10.8%) involved falls from a vehicle in various settings, and two (5.4%) were crush injuries at an oilfield. BAC+ subjects were less likely to be injured in construction sites and oilfields, including vehicle-related falls (2.3 vs 33.9%, P < 0.0001). Over half of BAC+ (n = 20, 54%) subjects were alcohol dependent; three (8.1%) also tested positive for cocaine on admission. No BAC+ subjects were admitted to rehabilitation compared to 33 (11.7%) of BAC− subjects. Workers’ compensation covered a significantly smaller proportion of BAC+ patients (16.2 vs 61.0%, P < 0.0001).Conclusions:Alcohol use in the workplace is more prevalent than commonly suspected, especially in farming and other less regulated industries. BAC+ is associated with less insurance coverage, which probably affects resources available for post-discharge rehabilitation and hospital reimbursement.

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Resource use of elderly emergency department patients with alcohol-related diagnoses

Cited by 15 publications

References 25 publications

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Treatment outcomes for substance use disorder among women of reproductive age in Massachusetts: A population-based approach

Hospital Outcomes in Major Depression Among Older Adults: Differences by Alcohol Comorbidity

Prevalence and consequences of positive blood alcohol levels among patients injured at work

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