Matthew L Goldman1, Christina Mangurian2, Tom Corbeil3, Melanie M Wall4, Fei Tang5, Morgan Haselden4, Susan M Essock6, Eric Frimpong5, Franco Mascayano3, Marleen Radigan5, Matthew Schneider7, Rui Wang5, Lisa B Dixon4, Mark Olfson4, Thomas E Smith4. 1. Department of Psychiatry, University of California, San Francisco, United States of America. Electronic address: Matthew.Goldman@ucsf.edu. 2. Department of Psychiatry, University of California, San Francisco, United States of America; UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, United States of America. 3. New York State Psychiatric Institute, United States of America. 4. New York State Psychiatric Institute, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, United States of America. 5. Office of Performance Measurement and Evaluation, New York State Office of Mental Health, United States of America. 6. Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, United States of America. 7. Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, United States of America.
Abstract
OBJECTIVE: Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. METHODS: Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. RESULTS: 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. CONCLUSIONS: A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.
OBJECTIVE: Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. METHODS: Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. RESULTS: 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. CONCLUSIONS: A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.
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