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Diagnostic inconsistency: a marker of service utilization in bipolar disorder

Sheri L Johnson1, Andrew L Brickman

  • 1Adult Division, Department of Psychology, Miller School of Medicine, University of Miami, Coral Gables, Florida 33124-2070, USA. sjohnson@miami.edu

Managed Care Interface
|May 13, 2006
PubMed

Insights

Poor recognition of bipolar disorder leads to high healthcare costs and frequent hospitalizations. Improving mania diagnosis is crucial for better patient outcomes and reduced inpatient charges.

Area of Science:

  • Psychiatry
  • Health Services Research
  • Mental Health Services

Background:

  • Community outcomes for bipolar disorder treatment are suboptimal, marked by frequent hospitalizations.
  • Limited recognition and suboptimal medication management are potential drivers of poor outcomes.
  • Healthcare charges associated with inadequate recognition of mania require examination.

Purpose of the Study:

  • To investigate the association between the underdiagnosis of bipolar disorder and associated healthcare charges.
  • To analyze service utilization patterns in a large cohort of individuals with bipolar disorder.

Main Methods:

  • Analysis of service utilization data for 3,856 individuals with bipolar disorder enrolled in a managed care plan.
  • Examination of diagnostic accuracy and its correlation with inpatient utilization and charges.
  • Comparison of hospitalization rates between correctly diagnosed bipolar disorder cases and those misdiagnosed as unipolar depression.

Main Results:

  • Only 8.2% of patients were accurately diagnosed with bipolar disorder.
  • Despite low diagnosis rates, patients with bipolar disorder accounted for 45% of total inpatient charges.
  • Individuals whose diagnoses were altered from bipolar disorder to unipolar depression experienced more rapid hospitalizations.

Conclusions:

  • Underrecognition of bipolar disorder significantly contributes to high healthcare expenditures, particularly inpatient costs.
  • Inconsistent diagnostic practices, including misdiagnosis as unipolar depression, are linked to increased hospitalization frequency.
  • Interventions aimed at improving the consistent recognition of manic history in patients are recommended to enhance care and reduce costs.

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