The Impact of Psychiatric Comorbidity on General Hospital Length of Stay

Bressi, Sara; Marcus, Steven C.; Solomon, Phyllis

doi:10.1007/s11126-006-9007-x

Cited by 66 publications

(50 citation statements)

References 14 publications

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“…Patients with MHC spent more of FY03 on inpatient status than did patients with no MHC; this was a consistent and robust finding across every algorithm examined. This finding is consistent with other studies that have shown heavier use of inpatient services by patients with MHC [6,[14][15][16][17][18][19]. Our study also shows that some types of care (e.g., EXT) are associated with a disproportionately greater MHC effect.…”

Section: Discussionsupporting

confidence: 93%

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Mental illness-related disparities in length of stay: Algorithm choice influences results

Frayne¹,

Berg²,

Holmes³

et al. 2010

JRRD

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Abstract-Methodological challenges arise when one uses various Veterans Health Administration (VHA) data sources, each created for distinct purposes, to characterize length of stay (LOS). To illustrate this issue, we examined how algorithm choice affects conclusions about mental health condition (MHC)-related differences in LOS for VHA patients with diabetes nationally (n = 784,321). We assembled a record-level database of all fiscal year (FY) 2003 inpatient care. In 10 steps, we sequentially added instances of inpatient care from various VHA sources. We processed databases in three stages, truncating stays at the beginning and end of FY03 and consolidating overlapping stays. For patients with MHCs versus those without MHCs, mean LOS was 17.7 versus 13.6 days, respectively (p < 0.001), for the crudest algorithm and 37.2 versus 21.7 days, respectively (p < 0.001), for the most refined algorithm. Researchers can improve the quality of data applied to VHA systems redesign by applying methodological considerations raised by this study to inform LOS algorithm choice.

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Section: Discussionsupporting

confidence: 93%

“…Prior studies both within and outside the VHA have documented that, compared with patients without MHCs, patients with MHCs tend to use more inpatient care [6,[14][15][16][17][18][19]. Thus, patients with MHCs represent a particularly high-intensity, high-cost group likely to merit special attention by VHA policy makers.…”

Section: Introductionmentioning

confidence: 99%

Mental illness-related disparities in length of stay: Algorithm choice influences results

Frayne¹,

Berg²,

Holmes³

et al. 2010

JRRD

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“…Depression is associated with longer medical hospital stays, particularly for older adults (Bressi, Marcus, & Solomon, 2006). Depressive symptoms are also associated with increased emergency department use for suicide-related injuries (Carter & Reymann, 2014), disproportionate hospital admissions (Nagamine, Jiang, & Merrill, 2006), and an increased likelihood of rehabilitation needs and inpatient death (Cullum, Metcalfe, Todd, & Brayne, 2008).…”

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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“…Co-morbid psychiatric disorders and new onset of psychiatric disorders are associated with prolonged length of hospitalization [21]. Depressive symptoms may become manifest in older adults when recovery slows or functional abilities deteriorate.…”

Section: Literature Backgroundmentioning

confidence: 99%

“…A responsive system has in place a structured classification of mobility rating [12] that focuses on high risk older adults (i.e. women, those with limited education, multiple co-morbidities, pain and fatigue) who are less likely to walk independently while in hospital [2,14,21,29], and develop innovative programs to enhance the mobility of older adults, such as the "Walking for Wellness Program" [9].…”

Section: Responsive Proffesional Nurses Within a Responsive Systemmentioning

confidence: 99%

Cultivating Responsive Systems for the Care of Acutely and Critically Ill Older Adults

Richmond

Jacoby

2007

Critical Care Nursing Clinics of North America

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The Impact of Psychiatric Comorbidity on General Hospital Length of Stay

Cited by 66 publications

References 14 publications

Mental illness-related disparities in length of stay: Algorithm choice influences results

Mental illness-related disparities in length of stay: Algorithm choice influences results

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

Cultivating Responsive Systems for the Care of Acutely and Critically Ill Older Adults

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