Duration and Costs of AIDS Hospitalizations in New York

Kelly, Joyce V.; Ball, Judy K.; Turner, Barbara J.

doi:10.1097/00005650-198912000-00001

Cited by 19 publications

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“…The associations between indicators of severity of disease and access to health care on the one hand, and LOS and TR on the other that were observed in this study, are mostly expected and consistent with prior findings (Kelly, Ball, and Turner 1989; Stein 1994; Bonuck and Arno 1997; Dal Pan, Skolasky, and Moore 1997). Diagnosis of a major opportunistic AIDS illness at the visit was associated with an adjusted 42 percent increase in LOS, which is only somewhat greater than the 32 percent increase in LOS associated with a primary diagnosis of severe mental illness.…”

Section: Discussionsupporting

confidence: 93%

“…Besides being expensive (Van Haastrecht et al 1996), hospitalization days put AIDS patients at risk for nosocomial infections and disrupt their economic and social lives. To this end, many studies have found substantial (i.e., of two to four days) reductions in hospital LOS for patients infected with HIV have occurred since the mid‐1980s (Grabau, Kaufman, and Han 1991; Markson, Turner, and Fanning 1992; Paul et al 1999; Kelly, Ball, and Turner 1989; Stein 1994; Bonuck and Arno 1997).…”

mentioning

confidence: 99%

“…Other potential confounders are gender, insurance coverage, social economic status, and season, all of which have been found to be associated with psychiatric illness (Eastwood and Stiasny 1978; Takei et al 1992; Sturm and Wells 2000; McAlpine and Mechanic 2000; Stoskopf, Kim, and Glover 2001; Dal Pan, Skolasky, and Moore 1997; Fleishman and Mor 1993; Hellinger 1993; Federman et al 2000). Among these characteristics, some studies have found: neurological disorders caused by HIV (Dal Pan, Skolasky, and Moore 1997) and insurance coverage (Fleishman and Mor 1993) were associated with increased length of stay; women received fewer hospital resources (Hellinger 1993); nonwhite patients had longer lengths of stay (Kelly, Ball, and Turner 1989; Stein 1994; Bonuck and Arno 1997); and admissions in the spring and summer had shorter LOS (Markson, Turner, and Fanning 1992). Longer LOS may increase the chance for a patient to be diagnosed with a psychiatric comorbidity as a secondary diagnosis (Cheng et al 2001; Glesby and Hoover 1996).…”

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confidence: 99%

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Mental Illness and Length of Inpatient Stay for Medicaid Recipients with AIDS

Hoover

Sambamoorthi²,

Walkup³

et al. 2004

Health Services Research

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Objective. To examine the associations between comorbid mental illness and length of hospital stays (LOS) among Medicaid beneficiaries with AIDS. Data Source and Collection/Study Setting. Merged 1992–1998 Medicaid claims and AIDS surveillance data obtained from the State of New Jersey for adults with ≥1 inpatient stay after an AIDS diagnosis from 1992 to 1996. Study Design. Observational study of 6,247 AIDS patients with 24,975 inpatient visits. Severe mental illness (SMI) and other less severe mental illness (OMI) diagnoses at visits were ascertained from ICD–9 Codes. About 4 percent of visits had an SMI diagnosis; 5 percent had an OMI diagnosis; 43 percent did not have a mental illness diagnosis, but were patients who had been identified as having an SMI or OMI history; and 48 percent were from patients with no identified history of mental illness. Principal Findings. The overall mean hospital LOS was 12.7 days. After adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary severe mental illness (SMI) diagnoses had ∼32 percent and ∼11 percent longer LOS, respectively, than did similar patients without a mental illness history (p<0.001 for each). But in these adjusted models of length of stay: (1) diagnosis of OMI was not related to LOS, and (2) in the absence of a mental illness diagnosed at the visit, an identified history of either SMI or OMI was also not related to LOS. In adjusted models of time to readmission for a new visit, current diagnosis of SMI or OMI and in the absences of a current diagnosis, history of SMI or OMI all tended to be associated with quicker readmission. Conclusions. This study finds greater (adjusted) LOS for AIDS patients diagnosed with severe mental illness (but not for those diagnosed with less severe mental comorbidity) at a visit. The effect of acute severe mental illness on hospitalization time may be comparable to that of an acute AIDS opportunistic illness. While previous research raises concerns that mental illness increases LOS by interfering with treatment of HIV conditions, the associations here may simply indicate that extra time is needed to treat severe mental illnesses or arrange for discharge of afflicted patients.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

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confidence: 99%

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