DIMACS TR: 2005-10

Mental Illness and Length of Hospital Stay for Medicaid Inpatients Infected with HIV

Authors: Donald R. Hoover, Usha Sambamoorthi, James T. Walkup and Stephen Crystal


OBJECTIVE: Study associations of length of inpatient stay (LOS) for HIV-infected Medicaid recipients with; Severe Mental Illness History (SMI-H), Other (Less Severe) Mental Illness History (OMI-H), and diagnosis with Acute Mental Illness (AMI) during the inpatient visit. DATA SOURCE & COLLECTION / STUDY SETTING: Merged 1992-98 Medicaid claims and HIV/AIDS surveillance data obtained from the State of New Jersey for adults with .1 inpatient stay after an HIV/AIDS diagnosis from 1992-1996. STUDY DESIGN: Observational study of 8,186 HIV patients with 31,515 inpatient visits. SMI-H, OMI-H and Primary/Secondary AMI diagnosis at visits were ascertained from ICD–9-CM Codes; 11% of visits had an AMI diagnosis while 25% and 29% of visits, respectively, were from patients with SMI-H and OMI-H histories. PRINCIPAL FINDINGS: HIV patient-stays with Primary or Secondary AMI diagnoses each had mean LOS=11.0 days and stays of patients with SMI-H and OMI-H had mean LOS of 10.4 and 11.8 days, respectively compared to a mean LOS=12.7 days for stays of patients with no history of mental illness. But after adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary AMI diagnoses had ~32% and ~13% longer LOS, respectively, than did similar patients without AMI (P<0.001). In the absence of a diagnosed AMI, SMI-H and OMI-H alone were not related to LOS in adjusted models. However, in adjusted models, SMI-H was associated with ~20% shorter time to readmission for a new visit. CONCLUSIONS: This study concurs with previous findings of greater (adjusted) LOS for HIV patients that have mental cormibidity. But the patterns seen here suggest that the increase may be mediated by extra time required to treat acute mental illnesses occurring at the visit rather than from mental illness interfering with treatment and discharge of HIV conditions.

KEYWORDS: HIV Disease, Hospitalization, Length of Stay, Mental Illness

Paper Available at: ftp://dimacs.rutgers.edu/pub/dimacs/TechnicalReports/TechReports/2005/2005-10.pdf

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