2012 National Meeting

1046 — One-Year Cost Implications of Mental Healthcare Following an Inpatient Health Shock

Benzer JKSullivan JLWilliams S, and Burgess JF, COLMR, VA Boston Healthcare System;

We describe the concept of an inpatient health shock and test the hypothesis that mental healthcare in the 30-day period following an inpatient health shock will reduce the impact of length of stay on costs in the following year. The health shock concept is drawn from the economics literature and represents the onset of new serious health conditions that may be unanticipated or anticipated. There are many possible conduits for understanding the costliness of a healthcare system, but one important conduit is the sequence of costly care that occurs after a “new” inpatient admission.

Administrative data were drawn from the following four time periods: one year pre-admission, an inpatient stay, 30 days post-discharge, and the following one year. The cohort included patients actively engaged in primary care with and without reliably established mental health diagnoses who experienced a medical inpatient stay with no inpatient utilization in the prior year. Generalized linear models were estimated to determine the impact of variables on post-discharge costs.

The association between length of stay and one year costs was decreased for patients who received a mental health visit in the 30 days following discharge. A post-discharge mental health visit was also found to decrease costs associated with established mental health diagnoses, disability-related free care, and the Charlson co-morbidity index.

Results provide initial support to our hypothesis that post-discharge mental healthcare is an important factor following an inpatient health shock. Related research has shown that individuals with prior hospitalizations who screen positive for depression are three times more likely to be readmitted. This study extends this prior research by focusing on long-term costs in a population without a recent inpatient history prior to the index admission.

Post-discharge mental health treatment may reduce the long-term costs associated with a hospitalization for a new medical condition. As part of a broad effort to implement integrated mental healthcare in the primary care setting, VA has recently instituted mental health screening procedures in primary care clinics. Primary care could therefore be an ideal setting to conduct post-discharge mental health screening as part of care transitions.