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Brief Reports   |    
Potentially Preventable Medical Hospitalizations Among Maryland Residents With Mental Illness, 2005–2010
Emma Elizabeth McGinty, Ph.D., M.S.; Srinivas Sridhara, Ph.D., M.H.S.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300323
View Author and Article Information

Dr. McGinty is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (e-mail: emcginty@jhsph.edu). Dr. Sridhara is with the Maryland Health Care Commission, Baltimore.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The goal of this study was to assess the association between mental illness and potentially preventable ambulatory care–sensitive (ACS) hospitalizations among children, adults, and older adults.

Methods  This was a retrospective, cross-sectional study that used 2005–2010 Maryland hospital discharge data (N=508,142 hospitalizations). Logistic regression was used to assess the associations between mental illness and ACS hospitalizations.

Results  Any mental illness diagnosis was associated with heightened odds of ACS hospitalization in all three age groups. Any mental illness diagnosis was associated with 84% higher odds of ACS hospitalization among children, 32% higher odds of ACS hospitalization among adults, and 30% higher odds of ACS hospitalization among older adults.

Conclusions  Mental illness was associated with increased odds of ACS hospitalization across the life span. Future research should examine the potential for integrated medical and behavioral health care models to address the poorly controlled somatic conditions that lead to ACS hospitalizations among persons with mental illness.

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Table 1Association between mental illness and 508,142 ambulatory care–sensitive (ACS) hospitalizations in Maryland, by age group, 2005–2010a
Table Footer Note

a Models controlled for the covariates age, sex, race, marital status (adult models only), primary payer (Medicaid, Medicare, private insurance, self-pay, or no insurance), and length of hospital stay in days and the medical comorbidities substance use disorder, valvular disease, pulmonary circulation disease, peripheral vascular disease, paralysis, hypothyroidism, renal failure, liver disease, lymphoma, metastatic cancer, solid tumor without metastasis, rheumatoid arthritis, coagulopathy, obesity, fluid and electrolyte disorders, and anemia.

Table Footer Note

b For adults, the Agency for Healthcare Research and Quality (AHRQ) defines ACS hospitalizations as those involving primary diagnoses of diabetes with short-term complications, perforated appendix, diabetes with long-term complications, chronic obstructive pulmonary disease or asthma among older adults, hypertension, congestive heart failure, dehydration, bacterial pneumonia, urinary tract infection, angina without procedure, uncontrolled diabetes, asthma among younger adults, and lower-extremity amputation among patients with diabetes. For children, AHRQ defines ACS hospitalizations as those involving primary diagnoses of asthma, diabetes, gastroenteritis, urinary tract infection, and perforated appendix.

Table Footer Note

c Odds of ACS hospitalization were compared with odds of hospitalization for a marker condition, including appendicitis with appendectomy, gastrointestinal obstruction, and any acute fracture (excluding stress fractures).

Table Footer Note

d Odds of ACS hospitalization were compared with odds of hospitalization for a marker condition, including appendicitis with appendectomy, acute myocardial infarction, gastrointestinal obstruction, and fracture of the hip or femur.

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