The Effect of Serious Mental Illness on the Risk of Rehospitalization Among Patients With Diabetes

Abstract

Objective Medical-surgical re-hospitalizations within a month after discharge among patients with diabetes result in tremendous costs to the US healthcare system. This study aims to examine if comorbid serious mental illness (SMI) diagnoses (bipolar disorder, schizophrenia, or other psychotic disorders) among patients with diabetes are independently associated with medical-surgical re-hospitalization within a month of discharge after an initial hospitalization. Methods This cohort study of all community hospitals in Washington State evaluated data from 82,060 adults discharged in the state of Washington with any ICD-9 CM diagnosis indicating diabetes mellitus between 2010 and 2011. Data on medical-surgical hospitalizations were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Comorbid SMI diagnoses were identified based on ICD-9 CM diagnosis codes indicating bipolar disorder, schizophrenia or other psychotic disorders. Logistic regression analyses identified factors independently associated with re-hospitalization within a month of discharge. Cox Proportional Hazard analyses estimated time to re-hospitalization for the entire study period. Results After adjusting for demographics, medical comorbidity, and characteristics of the index hospitalization, comorbid SMI diagnosis was independently associated with increased odds of re-hospitalization within one month among patients with diabetes who had a medical-surgical hospitalization (Odds Ratio: 1.24, 95% Confidence Interval: 1.07, 1.44). This increased risk of re-hospitalization persisted throughout the study period (up to 24 months). Conclusions Comorbid SMI in patients with diabetes is independently associated with greater risk of early medical-surgical re-hospitalization. Future research is needed to define and specify targets for interventions at points of care transition for this vulnerable patient population.

Examining the impact of comorbid serious mental illness on rehospitalization among medical and surgical inpatients

“…The findings support prior studies documenting the relationship between comorbid SMI diagnoses and rehospitalization [10,13,15,17] and expand this work by highlighting poor health outcomes among persons with a comorbid SMI diagnosis in a population of patients having heterogeneous medical needs. Hospitalized patients with a comorbid SMI diagnosis likely face a complex array of barriers to quality health care including limited access to transitional support postdischarge, community-based care options, and integrated health and behavioral health care [20,21].…”

“…Even among this highly monitored group, having a comorbid SMI diagnosis, with its associated cognitive impairments, social deficits and stigma, still may complicate postdischarge treatment in the context of a complex medical care system. As such, health systems should be open to practices that target interventions addressing the transitional care needs of this vulnerable population [4,[10][11][12][13]22]. …”

“…Acute care medical episodes for persons with a comorbid psychotic disorder, bipolar disorder or major depression may challenge care providers to properly stabilize these patients within the context of vast medical and social needs. Development of tailored coordinated transitional care interventions between the hospital and community-based service settings may provide important opportunities for improvement [10,11,13,23]. In response to the ACA mandates, many health systems are examining various care coordination and transitional care programs to improve posthospital outcomes of patients with chronic health conditions.…”

“…Prior research suggests that comorbid psychiatric illness among medical inpatients with cardiovascular disease, pneumonia and diabetes is associated with rehospitalization within 30 days of discharge and beyond [6,[10][11][12][13]. A few studies more specifically examined the impact of a comorbid SMI diagnoses on subsequent medical rehospitalization for patients with specific chronic health conditions, such as diabetes.…”

“…A few studies more specifically examined the impact of a comorbid SMI diagnoses on subsequent medical rehospitalization for patients with specific chronic health conditions, such as diabetes. For example, in one study, acute care patients with diabetes were more likely to be rehospitalized within 30 days if they had a comorbid bipolar or psychotic disorder, and this increased risk carried through the 24-month study time frame [13]. Another study examined cohorts of inpatients using longitudinal data and demonstrated over a 4-year period that rehospitalization was associated with a comorbid SMI diagnosis defined as co-occurring mood disorders (bipolar disorder, major depression or dysthymia), or substance abuse among diabetic inpatients.…”