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.

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This study was not supported by any outside funding. The authors declare no conflicts of interest. Study design was created by Burley, McPherson, and Daratha. Burley Daratha, Selinger, and Armstrong collected the data, with interpretation performed by Burley, Daratha, and Tuttle, assisted by McPherson. The manuscript was written by Burley, Daratha, and Selinger, with assistance from White, and revised by Burley, White, and Selinger, with assistance from Daratha and Tuttle.

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Objectives: We examined functional, social, and health needs and service delivery gaps among a geographically expansive and economically diverse population of older adults to identify service priorities. Methods: We conducted analyses based on 1280 respondents aged 60 years and older surveyed for an 8-county needs assessment. Results: We identified three distinct risk profiles using two-step cluster analysis. ANOVA and chi-square analyses revealed significant differences between risk profiles on a range of health and social service needs. Discussion: Identifying high-risk residents can support community providers’ efforts to help older adults age in place. Community-based organizations are well-positioned to respond early to social determinants of health needs. Targeting services and supports that reduce risk, extend independence, and prevent avoidable adverse healthcare situations to improve health and achieve health equity among historically underserved and hard-to-reach populations and prioritizing low-cost community interventions can reduce the need for high-cost interventions (e.g., emergency care and hospitalizations).