Veterans have high rates of life-limiting physical illnesses. Many patients with these illnesses also suffer from depression and/or anxiety (DEP/ANX), which are associated with symptom exacerbation, poor pain control, reduced quality of life, and poor treatment adherence. In non-Veterans, DEP/ANX are associated with increased likelihood of intensive care unit (ICU) admission and readmission and higher care costs. There is some evidence that DEP/ANX treatment might reduce costs and unnecessary care utilization. Palliative care (PC), team-based symptom management for individuals with life-limiting diseases, includes a psychosocial component. It is unclear, however, whether the psychosocial support offered as part of PC is sufficient to address DEP/ANX among Veterans with life-limiting illnesses, and in which cases mental health care (MHC) (medications and/or psychotherapy) is needed in addition to PC.
Our goals were to quantify the magnitude of the relationship between pre-existing and newly diagnosed DEP/ANX and outcomes (ICU admissions and costs of care) in Veterans with life-limiting physical illnesses, and to explore the extent to which these relationships were moderated by receipt of PC and/or MHC. We also sought to develop a case-finding intervention that identifies which Veterans receiving PC may exhibit reduced symptom burden and reduced ICU use following a MHC consult.
Retrospective analysis of administrative data (Medical SAS Inpatient and Outpatient Datasets, Decision Support System National Data Extract Clinical Files, Vital Status Files, and Health Economics Resource Center files) for 35,094 Veterans across the nation with advanced cancer, HIV/AIDS, or congestive heart failure or chronic obstructive pulmonary disease who were hospitalized between fiscal years 2012-2015 and who had past-year hospital or ICU admissions.
Not yet available.
Mental illnesses are common among seriously ill Veterans who are near the end of life, and many Veterans with DEP/ANX receive antidepressant or anxiolytic medication while hospitalized. In our sample, Veterans with DEP/ANX had fewer ICU admissions than Veterans without DEP/ANX. One of our goals was to use administrative data present at the time of a Veteran's hospitalization to identify who would be most likely to benefit from a specialty mental health care consult or additional palliative care. Our results suggest that administrative diagnosis and treatment codes are insufficient for this purpose, at least within the scope of a single hospitalization. To identify short-term risks, more sensitive measures of both psychosocial symptoms and outcomes of interest to Veterans may be needed. Understanding relationships among illness characteristics and need for MHC in addition to the psychosocial support provided as part of PC is important for the VHA's abilities to prioritize care improvement efforts and provide Veteran-centered care.
External Links for this Project
Grant Number: IK2HX000767-01A2
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Health Systems, Mental, Cognitive and Behavioral Disorders
Treatment - Observational, Treatment - Efficacy/Effectiveness Clinical Trial