Hospitalizations and hospital charges for co-occurring substance use and mental disorders.

The Health Education and Promotion Program, Kent State University, Kent, Ohio 44242, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 02/2011; 40(4):366-75. DOI: 10.1016/j.jsat.2010.12.005
Source: PubMed

ABSTRACT Most published studies have examined co-occurring disorders among mental health patients. Our objective was to compare the length of stay and hospital charges between hospitalized patients with alcohol- or substance-related disorders with and without co-occurring disorders. We analyzed nationally representative hospital discharge data (Nationwide Inpatient Sample, 2003-2007) and examined factors associated with length of stay and hospital charges. Forty-four percent of patients who were hospitalized with alcohol- or substance-related disorders were diagnosed with co-occurring mental disorders, representing 979,421 such disorders nationwide between 2003 and 2007. Females, those of White race, those who paid with insurance, and those who stayed in large, rural, nonteaching, and Midwest region hospitals had a high prevalence of co-occurring disorders. Co-occurring disorders were associated with longer hospital stays, but there were mixed results with hospital charges per discharge. An increase in co-occurring disorders among hospitalized patients with substance-related disorder may be due to the improvement in diagnosis and clinical attention.

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    • "These contradictory findings may be explained by important differences in the samples. Schizophrenia and other psychotic disorders comprised almost 50 percent of patients with CODs in the current study, whereas these disorders comprised only 10 percent of patients with CODs in the study reported by Ding et al. (2011). One possible explanation for shorter hospital stays among patients with CODs is that co-occurring substance abuse may temporarily exacerbate psychiatric symptoms (Blow et al. 1998; Ries et al. 2000). "
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    ABSTRACT: Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs. This study was a cross-sectional analysis of the National Hospital Discharge Survey. ICD-9-CM diagnosis codes were used to identify those admitted to a private or non-profit hospital with alcohol dependence syndrome, and a co-morbid diagnosis of an episodic mood disorder (n=358). Descriptive statistics were used to highlight differences in key demographic and hospital variables between those with and without episodic mood disorders. Negative binomial regression was used to associate episodic mood disorders with hospital length of stay. Incidence rate ratios were calculated. Co-morbid episodic mood disorders (β=0.31, P=0.001), referral to a hospital by a physician (β=0.35, P=0.014), and increasing age (β= 0.01, P=0.001) were associated with longer hospital stays. Hospital patients with an admitting diagnosis of alcohol dependence syndrome were 36% more likely to have a longer hospital stay if they also had a co-morbid diagnosis of an episodic mood disorder (IRR=1.36, CI=1.14-1.62). Patients admitted to a hospital with alcohol dependence syndrome should be routinely screened for episodic mood disorders. Opportunities exist for enhanced transitional care between acute, ambulatory, and community-based care settings to lower hospital utilization.
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