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

Abstract

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.

Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use

“…This may then be compounded by short hospitalizations that do not adequately address the complicated nature of co-occurring substance abuse, medical and psychiatric illnesses these patients have. [24] Finally, without proper outpatient post-hospital aftercare that evaluates and treats these illnesses in the outpatient realm, it is quite possible that these problems will inevitably require additional hospitalizations. [42].…”

“…A more recent study in the HAART era found that individuals with AIDS and a history of SMI had similar length of inpatient medical hospital stays, compared to those with no mental illness history. [24] Although both studies noted that injection drug use (IDU) was associated with longer lengths of hospitalization, neither study investigated whether a co-occurring SMI diagnosis and a history of IDU was associated with increased utilization of inpatient medical admissions or longer lengths of stays.…”

Non‐psychiatric hospitalization of people with mental illness: systematic review

“…(2008) found that even with retrospective approaches, the method used to identify mental illness influenced prevalence rates which would influence the measurement of outcomes. All retrospective studies considered in this review used the same method, secondary diagnostic codes, for identifying psychiatric comorbidity, except the study by Hoover et al. (2004), which also included psychiatric history and outpatient psychiatric treatment.…”

Is serious mental illness associated with earlier death among persons with human immunodeficiency virus (HIV)? A ten year follow up in Maryland Medicaid recipients

“…Because administrative data does not contain CD4 cell counts, a biomarker of HIV disease severity, we used the presence or absence of an AIDS Defining Illness, determined by ICD-9 diagnostic codes, as a surrogate marker of disease severity. This has been used in other HIV studies using administrative claims data (Hoover et al, 2004). …”

“…(Hoover et al, 2004) Despite this there may still have been residual confounding. Second, entry into our cohort required two years of continuous…”