Excess Health Care Service Utilization and Costs Associated With Underrecognition of Psychiatric Comorbidity in a Medical/Surgical Inpatient Setting

Abstract

Psychiatric comorbidity is common among chronically medically ill populations and the presence of psychiatric conditions tends to be associated with increased costs and excess utilization of general medical services. The purpose of this pilot investigation was to determine whether differences in nonpsychiatric inpatient hospitalization frequency, duration, and costs existed between patients receiving outpatient psychiatric treatment and patients without identified psychiatric problems. Length of stay and cost information for patients that had at least 1 inpatient medical/surgical hospitalization during a 6-month period was extracted from the hospital's inpatient billing database (n = 10,865). The medical record numbers of these patients were then cross-referenced against the outpatient psychiatry-billing database for the same 6-month period, thereby identifying all patients that had both a nonpsychiatric inpatient hospitalization and an outpatient psychiatry visit (n = 149). Patients identified as having outpatient psychiatry involvement had significantly more nonpsychiatric hospitalizations on average (mean = 1.60) than nonpsychiatric patients (mean = 1.34) during the study period (t4381 = 2.94, P = .003). There was no difference in the total costs associated with these hospitalizations between the 2 groups. Those that had a psychiatry consult during the nonpsychiatric hospitalization had a significantly higher length of stay and costs than those without. Thus, the criteria used to determine whether or not a psychiatry consultation is triggered, and the timing of the consultation request need further study.

Serious Mental Illness and Acute Hospital Readmission in Diabetic Patients

“…Finally, Borckardt et al(2011) reported a positive association between outpatient psychiatric visits and hospital admissions in a retrospective study of a single hospital population. 22 The prevalence of SMI in our study population (6%) was low compared to that of other studies, in which the reported prevalence of SMI ranges from 8.2% – 34%. 8, 15, 16, 23, 24 This may be due to our dependence upon discharge diagnosis codes to verify mental illness diagnoses.…”

Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis

“…This relationship was described in ten (19%) studies [ 8 , 9 , 44 , 45 , 51 , 61 – 65 ]; of these, nine (90%) revealed that medical-psychiatric comorbidities related to increased rehospitalizations. Seven (70%) studies found a significant increase [[ 8 , 9 , 44 , 51 , 61 , 62 , 64 ], two (20%) noted a non-significant increase [ 45 , 65 ] and one (10%) found neither an increase nor decrease [ 63 ]. A meta-analysis was not executed since the data could not be used in a meta-analysis.…”

Stroke survivors with severe mental illness: Are they at-risk for increased non-psychiatric hospitalizations?

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