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Full Report: Mental Health and Substance Abuse Treatment in Vermont Hospital PopulationConsiderable research has demonstrated that for some conditions, early identification and targeted treatment of mental health and substance abuse disorders leads to a reduction in unnecessary or excessive medical care. These cost reductions, called cost offsets, are consistent with patterns observed in Vermont inpatient data. Specifically, the extant literature demonstrates that non-optimal treatment of anxiety, depression, and some substance abuse problems increases utilization of healthcare. This overutilization increases unnecessary costs that can be reduced by effectively treating mental health and substance abuse problems. This chapter examines patterns of hospitalization charges and explores specific conditions that are reported in the healthcare services literature as being associated with the greatest cost offsets.
In addition to information related to charges for mental health and substance abuse (MH/SA) treatment, this chapter provides an overview of the MH/SA inpatient population in Vermont. Since data suggests that elderly persons have unique needs for mental health and substance abuse treatment, diagnoses for this population are also examined. Finally, a spotlight on substance abuse highlights differences in the drug abuse profile in Vermont and the nation, as well as hospital service areas within the state.
Mental Health and Substance Abuse Outline [click on a section to jump ahead]
This chapter discusses the following:
Findings and Conclusions
Overall, Vermont data on patterns of treatment for mental health and substance abuse diagnoses is consistent with national data. As was the case nationally, about 20% of hospitalizations in Vermont included a primary or secondary mental health diagnosis, and about 6% of hospitalizations were for a primary mental health diagnosis[1]. Additionally, Vermont utilization rates for specific mental health disorders (as reflected in percentage of diagnoses) are generally consistent with national utilization rates.
Consistent with a large body of evidence, there is potential cost savings associated with targeted, effective treatment for mental health and substance abuse problems. Taken together, findings across five years of data are consistent with this extant research showing cost offsets for effective prevention and treatment of mental health and substance abuse disorders.[2] It is clear that the greatest costs, as reflected in total charges, are associated with untreated or ineffectively treated substance abuse disorders and their related medical complications. Additionally, greater costs, as reflected in charges, associated with secondary MH/SA diagnoses, suggest that lack of identification and treatment of these problems may contribute to higher healthcare costs and utilization. In general, some secondary MH/SA diagnoses are, in part, associated with under-identification of these disorders and with lack of consistent or effective treatment for them, resulting in more severe and prolonged impairments and overutilization of healthcare.
Mental Health and the Elderly
About 35% of patients over 65 years were diagnosed with a secondary mental health or substance abuse disorder. Of this group, almost 65% were diagnosed with some history of substance abuse, which often includes complications from alcoholism. This suggests that these disorders may not be effectively identified or treated when the patient is younger or that they may worsen with age
Substance Abuse and Dependence
On average, Vermont inpatient data show that individuals with a secondary substance abuse diagnosis incurred higher total and daily charges and experienced longer lengths of stay than patients with no mental health or substance abuse diagnosis. There appears to be potential for significant reduction in healthcare cost and utilization through prevention and treatment of substance abuse and dependence.
Regional variations in hospitalization patterns for Substance Abuse and Dependence suggest that the types of substance abuse problems differ in parts of the state. Overall, Rutland, Chittenden, and Windham see the greatest hospitalization rates for substance abuse.
Recommendations
- Hospitalization data with a unique patient identifier would allow individual-level analyses. Such patient identifiers could be encrypted such that patient identity is not compromised. Unique patient identifier information will greatly enhance the types of analyses needed to inform policy decisions. These analyses should examine patterns of costs (charges), and treatment for mental health, substance abuse, medical and surgical diagnoses, and their co-morbidities. Additionally, the effect of chronic illness and multiple chronic conditions on charges and patterns of care should be included in follow-up analyses. This set of analyses will provide more complete information to inform policy related to prevention and treatment of mental health and substance abuse problems.
- The current set of analyses suggests potential cost savings and reductions in healthcare utilization might be obtained by increasing identification and evidence-based treatment for mental health and substance abuse disorders.
- Strategies for identification, prevention, treatment, and possible cost savings related to chronic problems with cannabis abuse and dependence in adults aged 45-64 should be considered.
- Needs assessment for identification, prevention, and treatment of opiod and oxycodone abuse should be conducted for targeted hospital service areas that show variation in utilization for these problems. In particular, unique social conditions leading to this utilization should be identified in order to inform policy for reducing these problems.
Data source and methodology [back to top]
The data used in this analysis are from Vermont Inpatient Hospital Discharge Data files for 2002 through 2007. The data files are publically available and do not contain patient or physician identification. The data files include patient demographic and clinical information such as age, gender, diagnoses, and procedures performed and additional information such as payer source, admission source and discharge status for each patient. The files are generated from inpatient discharge claims from all Vermont hospitals through the uniform billing format maintained by the Vermont Department of Health under contract with the Department of Banking, Insurance, Securities, and Health Care Administration and undergo extensive review for completeness and accuracy.
The data files include only treatment provided on an inpatient basis. Conditions treated on an outpatient basis are not reflected. The data files lack a unique patient identifier. Consequently, the patterns and trends presented in this chapter are aggregate in nature. The same individual may be represented in more than one admission and individual patterns over time and episodes cannot be derived from the available data. Total number of chronic conditions is not considered in analyses and a greater number of chronic conditions may increase charges and costs for hospital stays. The data are also limited to patients receiving care in Vermont hospitals. Vermont residents who received care in an out-of-state hospital are not reflected in this data set. The data files reflect patients receiving mental health and substance abuse care at community hospitals. The files do not contain data from Vermont State Hospital nor from the Brattleboro Retreat. It is worth noting that over utilization and cost offsets are not generally related to treatment of severe and persistent mental illness. Rather, inadequate treatment of medical problems is more typically observed in the population of individuals diagnosed with severe and persistent mental illness. [3]
The data files provide considerable information on patient diagnoses. Each discharge includes a major diagnosis and up to 19 additional secondary diagnoses. Throughout this chapter, the major diagnosis is referred to as the “primary” diagnosis. Any other diagnoses listed are referred to as “secondary” diagnoses. In this context, “secondary” refers to any non-primary diagnosis, and not specifically the second diagnosis listed.
The use of hospital discharge data sets, from 2002 through 2007 allows the analysis of aggregate trends over this time period. Where trends have been stable, this also allows the development of a per-year statistic, rather than relying on a single year of data to be representative.
Who receives care for mental health and substance abuse in Vermont? [back to top]
A review of 2002-2006 inpatient data in Vermont yielded the following information about the mental health and substance abuse patient population. Details of the data set used in the analysis are described in the data source and methodology section.
Age
Patients hospitalized with a primary mental health or substance abuse diagnosis averaged 45 years of age. This group of patients is significantly younger than those hospitalized with primary medical diagnoses (p<0.001).
(Note: This comparison excludes births without complications to
|  | prevent confounding effects of a large population of newborn patients (age 0) in the group without a mental health or substance abuse diagnosis.)
Gender
Of patients hospitalized for a primary mental health or substance abuse disorder, about 51% are male and 49% are female (Table 2). This proportion, however, varies considerably on the patient’s primary diagnosis. Among the group hospitalized with a primary diagnosis of substance abuse, 67% are male and 33% are female. In comparison, of the group hospitalized with a primary diagnosis of depression, 46% are male and 54% are female. And of the group hospitalized with a secondary diagnosis of depression, 35% are male and 65% are female.
These observed gender differences by diagnosis are consistent with epidemiological data on lifetime prevalence for these disorders. The gender differences for the populations with and without a mental health or substance abuse primary diagnosis are displayed below. Excluding obstetric hospitalizations, the gender distribution in the mental health or substance abuse group does not differ significantly from non-mental health or substance abuse patients.
Payment Source
Government payers were billed for 67.5% of all mental health or substance abuse hospitalizations as compared with 53% of non-mental health or substance abuse stays. Patients with a primary mental health diagnosis were twice as likely to use Medicaid (95% CI: 1.92, 2.06) and 2.8 times as likely to self pay (95% CI: 2.61, 3.01) as were patients with no mental health or substance abuse diagnosis. In contrast, patients with MH/SA diagnoses were 65% less likely to use commercial insurance than patients with no MH/SA diagnosis (95% CI: 0.34, 0.36).
Hospital Stay
The length of stay for patients hospitalized with a mental health or substance abuse primary diagnosis tended to be longer than the length of stay for other patients. The mean length of stay for those with a mental health or substance abuse primary diagnosis was 7.1 days versus 4.0 days for other patients (effect size d=0.46).
How do Vermont hospitalizations for mental health and substance abuse compare to national data? [back to top]
Overall, Vermont data on patterns of treatment for mental health and substance abuse diagnoses is consistent with national data. As was the case nationally, about 20% of hospitalizations in Vermont included a primary or secondary mental health diagnosis, and about 6% of hospitalizations were for a primary mental health diagnosis. Both at the national level and in Vermont, the number of primary mental health and substance abuse diagnoses remained stable from 2002-2007. However the number of secondary diagnoses rose during this time. In Vermont, secondary diagnoses rose by 139%, which is slightly lower than the national rate increase of 166% over this time period.
Vermont utilization rates for specific mental health disorders (as reflected in percentage of diagnoses) are generally consistent with national utilization rates. As is the case nationally, care for depression and other mood disorders, anxiety, and schizophrenia are associated with most diagnoses in the non-elderly. Care for cognitive disorders, including dementia, compose the majority of diagnoses for the elderly. The panels in Figure 2 show number of discharges for several specific mental health conditions at the national (2a) and state (2b) level.
Are there potential opportunities to reduce healthcare costs through effective mental health and substance abuse treatment? [back to top]
Central to this chapter of the Quality Report are findings suggesting potential mental health/medical care cost offsets. Mental health/medical care cost offsets are cost savings that result from effective mental health and substance abuse treatment. Considerable evidence demonstrates that for many MH/SA conditions, this effective treatment results in a reduction in unnecessary and excessive utilization of healthcare, and thus in lower total healthcare costs. As one example, the extant literature provides considerable evidence that individuals with non-optimal treatment for anxiety and depressive disorders overutilize healthcare services and that effective treatment of those disorders reduces utilization of medical care and reduces cost.[3]
As illustrated in Figures 3a and 3b, there are statistically significant charge differences for treatment of these diagnostic categories. Additionally, a similar pattern of charge differences occurs across all age groups, indicating:
- Primary treatment of MH/SA diagnoses has the lowest charges (Figure 3a).
- Significantly greater charges are incurred for secondary MH/SA diagnoses (Figure 3a).
- Significantly greater charges are incurred for treatment of medical problems caused by a history of substance abuse and dependence (for example, cirrhosis of the liver caused by alcohol dependence) (Figure 3b).
Taken together, these findings across five years of data are consistent with extant research on cost offsets associated with effective prevention and treatment of mental health and substance abuse disorders. The greatest costs, as reflected in total charges, are associated with untreated substance abuse disorders and their related medical complications. Additionally, greater costs as reflected in charges associated with secondary MH/SA diagnoses, suggest that lack of identification and treatment of these problems may lead to higher healthcare costs and utilization. Secondary MH/SA diagnoses are often associated with under-identification of these disorders and with lack of consistent or effective treatment for them, resulting in more severe and prolonged impairments.
Consequently, these data are consistent with the following conclusions:
- Secondary diagnoses of Mental Health and Substance Abuse disorders are associated with greater per visit charges and greater utilization of healthcare than are MH/SA disorders receiving primary, targeted treatment.
- These higher costs (as reflected in charges) are incurred across all age groups.
- Potential cost savings are reflected both in lower charges per day and in lower total charges for treatment based on the diagnostic categories compared here.
- The greatest costs (total per visit charges) appear to be associated with long-term consequences of substance abuse and dependence.
- Consistent with growing public health evidence, effective identification, prevention, and treatment of Mental Health and Substance Abuse Disorders is one avenue that can be effective in lowering unnecessary healthcare utilization and in significant cost savings.
What specific conditions are strongly associated with lower per visit charges and potential cost savings for healthcare?
Certain conditions have been identified as drivers for cost offsets in patients with mental health and substance abuse diagnoses. These conditions include depression and other mood disorders, anxiety disorders, and substance abuse.[4]
Depression & Anxiety Disorders
Depression and anxiety disorders compose about 67% of all primary mental health diagnoses and about 47% of all secondary mental health diagnoses. Hospital utilization and cost for patients with a depression or anxiety disorder diagnosis tend to mirror the experience of the total mental health diagnosis population. Average total charges and charges per day for patients treated with a primary depression or anxiety diagnosis are lower than for patients hospitalized with no mental health diagnosis. But, charges for patients with a secondary depression or anxiety diagnosis are significantly higher. Again, this suggests that treatment of depression and anxiety as primary diagnoses may be more cost effective than treatment as a secondary diagnosis.
Research suggests that certain co-morbidities with depression result in the largest cost offsets. Thompson et al[5] assert that patients with anxiety disorders, coronary heart disease, or chronic fatigue syndrome that are also treated for depression experience significantly lower costs of medical services during one year of follow-up. Analysis of the Vermont inpatient data indicates that episodes of care with a primary diagnosis of anxiety disorder or coronary heart disease that are also identified with a secondary diagnosis of depression experience significantly lower charges per day for inpatient care than hospitalizations for these conditions for which depression was not a co-morbidity (Anxiety: $928 vs. $1,101, p<0.001; CHD: $7390 vs. $9,963, p<0.001). Patients hospitalized with a primary chronic fatigue diagnosis did not show a significant difference in charges per day.
Without a unique patient identifier in the Vermont data, it is not possible to track patient utilization and charges and costs over time. The analysis above treats each hospitalization as a separate experience as opposed to tracking follow-up as performed by Thompson et al. Nevertheless, the charge patterns are consistent with those observed in prospective analysis of individual patient data.
Complications from alcohol dependence
Chronic substance abuse and dependence is associated with increased rates of medical complications.[6] Consequently, both short- and long-term costs (i.e., charges) are important to consider when examining overall resource use for treatment of substance abuse. This section examines medical conditions and associated per visit charges that are attributed to substance dependence. In the Vermont data, these medical conditions are overwhelmingly associated with alcohol dependence.
In general, patients with mental health or substance abuse primary diagnoses experienced lower total charges than patients with no mental health or substance abuse diagnosis (see Table 3). However, patients with a primary diagnosis of a history of substance abuse (typically alcohol dependence) experienced higher total charges than patients with no diagnosis for mental health and substance abuse ($17.4K versus $11.7K, d=0.26) (Figure 4). In addition, patients with a primary diagnosis of complications from a history of substance abuse had longer average lengths of stay than patients with no mental health or substance abuse diagnosis (6.7 days versus 4.0 days, d=0.41) (Figure 5).
The fact that patients primarily diagnosed with a long-term history of substance abuse or dependence have greater total charges, while patients primarily diagnosed with current mental health or substance abuse disorders have lower total charges, underscores the concept that early identification and treatment of mental health and substance abuse disorders is likely to result in reduced utilization and significant cost savings.
How do mental health and substance abuse diagnoses differ in the elderly? [back to top]
As patient age increases, the percentage of primary diagnoses for mental health and substance abuse problems decreases. As displayed in Figure 6, in the 18-44 and 45-64 year age groups, mental health and substance abuse disorders are associated with 13% and 9% of primary diagnoses, respectively. In the 65+ age group, only 2.1% of primary diagnoses are associated with mental health or substance abuse. Figure 6 shows that primary diagnoses for medical conditions, specifically circulatory, respiratory, digestive, and musculoskeletal, take the place of mental health primary diagnoses in later years.
Although primary diagnoses for mental health and substance abuse disorders decrease with patient age, the percentage of secondary diagnoses for these conditions remains constant. Type of secondary diagnosis, however, does change with patient age. Although anxiety, personality, and depression/mood disorders are the most common mental health diagnoses in the 18-44 and 45-64 year age groups, dementia/cognitive disorder is the most common mental health condition in the 65+ age group. Consistent with prevalence of dementia and cognitive disorders in the population, approximately 92% of all secondary cognitive disorder diagnoses occur in those 65 and older.
The literature has not consistently shown age to be strongly associated with cost offsets, however the Vermont data does indicate some differences in total charges and hospital utilization for elderly patients with a mental health or substance abuse secondary diagnosis. About 35% of patients over 65 years were diagnosed with a secondary mental health or substance abuse disorder. Of this group, almost 65% were diagnosed with some history of substance abuse, which often includes complications from alcoholism. This group showed a 23% increase in average charges per day over patients with no mental health or substance abuse diagnosis (d=0.20). Additionally, elderly patients with a secondary diagnosis of substance abuse experienced hospital stays that were 35% longer than patients with no mental health or substance abuse diagnosis (d=0.28).
The fact that almost 15% of elderly patients are diagnosed with complications from a history of mental health or substance abuse suggests that these disorders are sometimes not being effectively identified or treated when the patient is younger.
Spotlight on substance abuse [back to top]
Why focus on substance abuse?
As noted in the section on potential healthcare cost reduction [link to cost offset section], Vermont patients with a secondary substance abuse diagnosis incurred higher total and daily charges than patients with no mental health or substance abuse diagnosis. These patients also experienced significantly longer lengths of stay (Figure 7), making their hospitalizations considerably more resource intensive. A potential for significant reduction in healthcare cost and utilization, coupled with findings that the profile of substance abuse in Vermont has some distinct differences from the national profile, makes this an important population to investigate.
General findings
Patients with primary or secondary diagnoses for substance abuse tend to be males in the 18-44 and 45-65 year age groups. Approximately one out of every sixteen hospital stays involved a diagnosis for some kind of substance abuse. Hospitalizations for alcohol related disorders were about 1.5 times more common than hospitalizations for drug abuse and dependence. Patients hospitalized primarily for drug abuse and dependence were 2.4 times more likely to be admitted from the ER (CI: 1.8, 3.1) and 10.2 times more likely to discharge against advice (CI: 8.1, 12.7) than patients with no mental health or substance abuse diagnosis.
How does substance abuse in Vermont compare to national data?
Although Vermont patient demographics for substance abuse hospitalizations are consistent with national data, Vermont differs from the nation in the specific types of substance abuse observed.
- Opioid abuse and dependence are higher in Vermont than on the national level while cocaine abuse and dependence are lower in Vermont.
- Cannabis abuse and dependence in Vermont are higher than the national level in the 45-64 year age group, but lower in the 0-17 year age group.
- The percentage of patients diagnosed with “Other drug abuse” (containing “Other mixed or unspecified drug abuse” and “Other drug induced mental disorders”) was higher in Vermont for all age groups.
Table 4 details the percentage of drug abuse (and dependence) hospitalizations by drug type for Vermont and nationally. The differences described above are marked in bold in the Vermont data.
How does substance abuse in Vermont differ throughout the state?
The Vermont substance abuse profile differs by areas in the state. Table 5 displays substance abuse related hospitalizations by Vermont County. Chittenden, Rutland, and Washington counties account for the largest percentage of total substance abuse related hospitalizations. When substance abuse related hospitalizations are normalized by county population and risk-adjusted for age and gender, Rutland, Windham, and Chittenden demonstrate the highest hospitalization rates for substance abuse.
Opioid Abuse
Despite data showing that overall opioid abuse has increased in Vermont over the past five years, inpatient data do not show a significant trend by year. However, the areas of concentrated opioid diagnoses within Vermont do appear to be changing. Figure 8 shows the percentage of total opioid abuse that is accounted for in the top three abuse hospital service areas. Hospitalization for opioid abuse in the Rutland service area has decreased from 2002-2006, while hospitalization in the Burlington service area has risen over this time period.
When normalized by population and risk-adjusted for age and gender, Rutland, Chittenden, Washington, and Windham counties have the highest rates of opioid hospitalizations.
Figure 9: Hospitalizations for opioid abuse and dependence, 2002-2006, risk-adjusted for age and gender
Cannabis Abuse
Both as a percent of total hospitalizations and as a percent of substance abuse hospitalizations, cannabis diagnoses have increased over the 2002-2006 time period. No single hospital service area accounted for this increase, although percentages in the Rutland and St. Albans service areas increased consistently over this time period. When risk-adjusted for age and gender, Rutland, Orleans, and Windham counties had the highest hospitalization rates involving cannabis use.
Figure 11: Hospitalizations for cannabis abuse and dependence, 2002-2006, risk-adjusted for age and gender
Oxycodone Abuse
Although oxycodone abuse and dependence account for only a small percentage of substance abuse diagnoses (about 6%), patterns of care related to this drug are interesting with regards to the areas in which the diagnoses are observed. Overall, Rutland, Chittenden, and Windham see the greatest hospitalization rates for substance abuse. This observation is fairly consistent with the findings above for opioid and cannabis hospitalizations. In contrast, the areas with the highest percentage of oxycodone diagnoses are Bennington, Grand Isle, and Orleans. Each experienced a diagnosis for oxycodone abuse or dependence in almost 10% of the substance abuse related stays.
Figure 12: Hospitalizations for oxycodone abuse and dependence, 2002-2006, risk-adjusted for age and gender
Summary and Conclusions [back to top]
Overall, Vermont data on patterns of treatment for mental health and substance abuse diagnoses is consistent with national data. As was the case nationally, about 20% of hospitalizations in Vermont included a primary or secondary mental health diagnosis, and about 6% of hospitalizations were for a primary mental health diagnosis. Additionally, Vermont utilization rates for specific mental health disorders (as reflected in percentage of diagnoses) are generally consistent with national utilization rates.
Consistent with a large body of evidence, there are potential cost savings associated with targeted, effective treatment for mental health and substance abuse problems. Taken together, findings across 5 years of data are consistent with this extant research showing cost offsets for effective prevention and treatment of mental health and substance abuse disorders.2 It is clear that the greatest costs, as reflected in total charges, are associated with untreated or ineffectively treated substance abuse disorders and their related medical complications. Additionally, greater costs, as reflected in charges associated with secondary MH/SA diagnoses, suggest that lack of identification and treatment of these problems may contribute to higher healthcare costs and utilization. In general, some secondary MH/SA diagnoses are, in part, associated with under-identification of these disorders and with lack of consistent or effective treatment for them, resulting in more severe and prolonged impairments and overutilization of healthcare.
Consequently, these data are consistent with the following conclusions:
- Secondary diagnoses of Mental Health and Substance Abuse disorders are associated with greater per visit charges and greater utilization of healthcare than are MH/SA disorders receiving primary, targeted treatment.
- Potential cost savings are reflected both in lower charges per day and in lower total charges for treatment based on the diagnostic categories compared here.
- The greatest costs (total per visit charges) appear to be associated with long-term consequences of substance abuse and dependence.
- Consistent with growing public health evidence, effective identification, prevention, and treatment of Mental Health and Substance Abuse Disorders is one strategy for reducing healthcare utilization and achieving significant cost savings.
- Unique patterns of mental health and substance abuse problems are evident for elderly patients.
- Although primary diagnoses for mental health and substance abuse disorders decrease with patient age, the percentage of secondary diagnoses for these conditions remains constant.
About 35% of patients over 65 years were diagnosed with a secondary mental health or substance abuse disorder. Of this group, almost 65% were diagnosed with some history of substance abuse, which often includes complications from alcoholism.
This group showed a 23% increase in average charges per day over patients with no mental health or substance abuse diagnosis (d=0.20). Additionally, elderly patients with a substance abuse secondary diagnosis experienced hospital stays that were 35% longer than patients with no mental health or substance abuse diagnosis (d=0.28).
- The fact that almost 15% of elderly patients are diagnosed with complications from a history of mental health or substance abuse suggests that these disorders may not be effectively identified or treated when the patient is younger or that they may worsen with age.
Substance Abuse and Dependence
- Vermont patients with a secondary substance abuse diagnosis incurred higher total and daily charges than patients with no mental health or substance abuse diagnosis.
- These patients also experienced significantly longer lengths of stay (Figure 7), making their hospitalizations considerably more resource intensive.
- There appears to be potential for significant reduction in healthcare cost and utilization through prevention and treatment of substance abuse and dependence.
Patterns of hospitalization for Substance Abuse and Dependence in Vermont show differences from national patterns.
- Opioid abuse and dependence are higher in Vermont than on the national level while cocaine abuse and dependence are lower in Vermont.
- Cannabis abuse and dependence in Vermont are higher than the national level in the 45-64 year age group, but lower in the 0-17 year age group.
- The percentage of patients diagnosed with “Other drug abuse” (containing “Other mixed or unspecified drug abuse” and “Other drug-induced mental disorders”) was higher in Vermont for all age groups.
Regional variations in hospitalization patterns for Substance Abuse and Dependence suggest that the types of substance abuse problems differ in parts of the state.
- Overall, Rutland, Chittenden, and Windham see the greatest hospitalization rates for substance abuse.
- Areas of concentrated opioid diagnoses within Vermont appear to be changing. Hospitalization for opioid abuse in the Rutland service area has decreased from 2002-2006, while hospitalization in the Burlington service area has risen over this time period. See Figure 8
- Although oxycodone abuse and dependence account for about 6% of substance related patterns, Bennington, Grand Isle, and Orleans counties experienced a diagnosis for oxycodone abuse or dependence in almost 10% of substance abuse related stays.
Recommendations
- Hospitalization data with a unique patient identifier would allow individual-level analyses. Such patient identifiers could be encrypted such that patient identity is not compromised. Unique patient identifier information will greatly enhance the types of analyses needed to inform policy decisions. These analyses should examine patterns of costs (charges), and treatment for mental health, substance abuse, medical and surgical diagnoses, and their co-morbidities. Additionally, the effect of chronic illness and multiple chronic conditions on charges and patterns of care should be included in follow-up analyses. This set of analyses will provide more complete information to inform policy related to prevention and treatment of mental health and substance abuse problems.
- The current set of analyses suggests potential cost savings and reductions in healthcare utilization might be obtained by increasing identification and evidence-based treatment for mental health and substance abuse disorders.
- Strategies for identification, prevention, treatment, and possible cost savings related to chronic problems with cannabis abuse and dependence in adults aged 45-64 should be considered.
- Needs assessment for identification, prevention, and treatment of opiod and oxycodone abuse should be conducted for targeted hospital service areas that show variation in utilization for these problems. In particular, unique social conditions leading to this utilization should be identified in order to inform policy for reducing these problems.
Note: All findings and conclusions reported here are accompanied by some limitations imposed by the type of data available. For example, number of chronic conditions is likely related to greater overall charges per visit for some individuals. This factor, however, is unlikely to account for the total difference in charges observed. Please see the data source and methodology section for additional detail.
[1] For the purpose of readability, the term substance abuse refers to a diagnosis of either substance abuse or substance dependence. Alcohol, prescription, and illicit drugs are subsumed under the term “substance.” Findings relevant to specific drugs or categories are labeled to indicate the relevant substance or substances. [2] National data: Saba, D.K. (Thomson Reuters), Levit, K.R. (Thomson Reuters), and Elixhauser, A. (AHRQ). Hospital Stays Related to Mental Health, 2006. HCUP Statistical Brief #62. October 2008. Agency for Healthcare Research and Quality, Rockville, MD, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb62.pdf [3] See, for example: M Olfson, M. Sing, & H.J. Schlesinger. Mental health/medical care cost offsets: Opportunities for managed care. Health Affairs 1999:18;79-90; L.G. Kessler et al., Psychiatric Diagnoses of Medical Service Users: Evidence from the Epidemiologic Catchment Area Program, American Journal of Public Health 1987:77;18–24; W.G. Manning and K.B. Wells, The Effects of Psychological Distress and Psychological Well-Being on Use of Medical Services, Medical Care 1992:30(6);541–553; J.L. Levenson, R.M. Hamer, and L.F. Rossiter, A Randomized Controlled Study of Psychiatric Consultation Guided by Screening in General Medical Inpatients, American Journal of Psychiatry 1992:149;631–637; W. Katon et al., A Randomized Trial of Psychiatric Consultation with Distressed High Utilizers, General Hospital Psychiatry 1992:14; 86–98; H.D. Holder, Alcoholism Treatment and Potential Health Care Cost Saving, Medical Care 1987:25;52–71; A.C. Goodman, H.D. Holder, and E. Nishiura, Alcoholism Treatment Offset Effects: A Cost Model, Inquiry 1991:28(2). [4] M Olfson, M. Sing, & H.J. Schlesinger. Mental health/medical care cost offsets: Opportunities for managed care. Health Affairs 1999:18;79-90. [5] Thompson D, et al. Predictors of a Medical-Offset Effect Among Patients Receiving Antidepressant Therapy. Am J Psychiatry 1998:155:6. [6] H.D. Holder, “Alcoholism Treatment and Potential Health Care Cost Saving, Medical Care 25 (1987): 52–71; A.C. Goodman, H.D. Holder, and E. Nishiura, Alcoholism Treatment Offset Effects: A Cost Model, Inquiry 1991:28(2).
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