Medical comorbid diagnoses among adult psychiatric inpatients

Goldman, Matthew L.; Mangurian, Christina; Corbeil, Tom; Wall, Melanie M.; Tang, Fei; Haselden, Morgan; Essock, Susan M.; Frimpong, Eric; Mascayano, Franco; Radigan, Marleen; Schneider, Mark; Wang, Rui; Dixon, Lisa B.; Olfson, Mark; Smith, Thomas E.

doi:10.1016/j.genhosppsych.2020.06.010

Cited by 14 publications

(14 citation statements)

References 41 publications

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“…They are also hospitalized and readmitted more often than patients without MD or CPI (10)(11)(12)(13). Co-occurring CPI frequently occurs among patients with MD (14)(15)(16)(17)(18). Mental disorders-chronic physical illnesses are associated with patient disability (19), social dysfunction (20), treatment complications (21), poor quality of life (19), and higher risk of mortality (22).…”

Section: Introductionmentioning

confidence: 99%

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

et al. 2021

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Background: Patients with mental disorders (MD) are at high risk for a wide range of chronic physical illnesses (CPI), often resulting in greater use of acute care services. This study estimated risk of emergency department (ED) use and hospitalization for mental health (MH) reasons among 678 patients with MD and CPI compared to 1,999 patients with MD only.Methods: Patients visiting one of six Quebec (Canada) ED for MH reasons and at onset of a MD in 2014–15 (index year) were included. Negative binomial models comparing the two groups estimated risk of ED use and hospitalization at 12-month follow-up to index ED visit, controlling for clinical, sociodemographic, and service use variables.Results: Patients with MD, more severe overall clinical conditions and those who received more intensive specialized MH care had higher risks of frequent ED use and hospitalization. Continuity of medical care protected against both ED use and hospitalization, while general practitioner (GP) consultations protected against hospitalization only. Patients aged 65+ had lower risk of ED use, whereas risk of hospitalization was higher for the 45–64- vs. 12–24-year age groups, and for men vs. women.Conclusion: Strategies including assertive community treatment, intensive case management, integrated co-occurring treatment, home treatment, and shared care may improve adequacy of care for patients with MD-CPI, as well as those with MD only whose clinical profiles were severe. Prevention and outreach strategies may also be promoted, especially among men and older age groups.

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Section: Introductionmentioning

confidence: 99%

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

et al. 2021

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“…The sample included patients with claims containing ICD-9-CM codes for HIV and/or AIDS in the 12 months prior to the index psychiatric admission. Additional study criteria been previously described [4].…”

Section: Methodsmentioning

confidence: 99%

“…Little is known about HIV/AIDS detection among individuals receiving inpatient psychiatric treatment, a knowledge gap with potentially significant adverse consequences. A previous study using these data reported that 74.9% of NYS Medicaid beneficiaries in psychiatric inpatient settings had at least one medical comorbidity, and 5.1% had been diagnosed with HIV/AIDS [4]. It is not known how frequently pre-existing HIV/AIDS diagnoses are recognized during inpatient psychiatric hospitalizations –an opportune time to ensure engagement in care [4].…”

Section: Introductionmentioning

confidence: 99%

“…A previous study using these data reported that 74.9% of NYS Medicaid beneficiaries in psychiatric inpatient settings had at least one medical comorbidity, and 5.1% had been diagnosed with HIV/AIDS [4]. It is not known how frequently pre-existing HIV/AIDS diagnoses are recognized during inpatient psychiatric hospitalizations –an opportune time to ensure engagement in care [4]. Because psychiatric hospitalizations often result from behavioral and cognitive disturbances, treatment planning may entail extensive care coordination.…”

Section: Introductionmentioning

confidence: 99%

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Underdetection of pre-existing HIV/AIDS during psychiatric hospitalizations

Mangurian

Goldman

Corbeil³

et al. 2022

Aids

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Objectives:People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with severe mental illness. This study examines documentation rates of pre-existing HIV/ AIDS among inpatients within psychiatric hospitals in New York State.Design:Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients.Methods:Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n = 14 602). Adjusted odds ratios of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses.Results:About 5.1% (741/14 602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher readmission rates also had higher rates of undetected HIV/AIDS diagnoses.Conclusion:Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.

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“…uncomplicated diabetes and diabetes with complications were coded as diabetes) and combined the two comorbidity indices into one list. To focus on physical health conditions, we excluded additional diagnoses of psychoses, depression, and dementia(40). Weight loss was defined as a symptom rather than physical health condition and removed from the final analysis.…”

Section: Methodsmentioning

confidence: 99%

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

Launders¹,

Hayes

Price

et al. 2021

Preprint

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Objective: To investigate the clustering of physical health multimorbidity in people with severe mental illness (SMI) compared to matched comparators. Design: A cohort-nested analysis of lifetime diagnoses of physical health conditions. Setting: Over 1,800 UK general practices (GP) contributing to Clinical Practice Research DataLink (CPRD) Gold or Aurum databases. Participants: 68,392 adult patients with a diagnosis of SMI between 2000 and 2018, with at least one year of follow up data, matched 1:4 to patients without an SMI diagnosis, on age, sex, GP, and year of GP registration. Main outcome measures: Odds ratios for 24 physical health conditions derived using Elixhauser and Charlson comorbidity indices. We controlled for age, sex, region, and ethnicity; and then additionally for smoking status, alcohol and drug misuse and body mass index. We defined multimorbidity clusters using Multiple Correspondence Analysis and K-Means cluster analysis and described them based on the observed/expected ratio. Results: Patients with a diagnosis of SMI had an increased odds of 19 of 24 physical health conditions and had a higher prevalence of multimorbidity at a younger age compared to comparators (aOR: 2.47; 95%CI: 2.25 to 2.72 in patients aged 20-29). Smoking, obesity, alcohol, and drug misuse were more prevalent in the SMI group and adjusting for these reduced the odds ratio of all comorbid conditions. In patients with multimorbidity (SMI cohort: n=22,843, comparators: n=68,856), we identified six multimorbidity clusters in the SMI cohort, and five in the comparator cohort. Five profiles were common to both. The "hypertension and varied multimorbidity" cluster was most common: 49.8% in the SMI cohort, and 56.7% in comparators. 41.5% of the SMI cohort were in a "respiratory and neurological disease" cluster, compared to 28.7% of comparators. Conclusions: Physical health multimorbidity clusters similarly in people with and without SMI, though patients with SMI develop multimorbidity earlier and a greater proportion fall into a "respiratory and neurological disease" cluster. There is a need for interventions aimed at younger-age multimorbidity in those with SMI.

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Medical comorbid diagnoses among adult psychiatric inpatients

Cited by 14 publications

References 41 publications

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

Impact of Co-occurring Mental Disorders and Chronic Physical Illnesses on Frequency of Emergency Department Use and Hospitalization for Mental Health Reasons

Underdetection of pre-existing HIV/AIDS during psychiatric hospitalizations

Clustering of physical health multimorbidity in 68,392 people with severe mental illness and matched comparators: a lifetime prevalence analysis of United Kingdom primary care data

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