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Health Care Utilization Patterns Among High-Cost VA Patients With Mental Health Conditions.

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  • 1Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: dzulman@stanford.edu ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.

Psychiatric Services (Washington, D.C.)
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High-cost patients with serious mental illness or substance use disorders utilized more mental health care and incurred higher costs. Stratifying care by psychiatric diagnosis is crucial for effective management of these high-risk individuals.

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Area of Science:

  • Health Services Research
  • Psychiatric Epidemiology
  • Health Economics

Background:

  • High-cost patients represent a significant burden on healthcare systems.
  • Understanding the role of psychiatric diagnoses in healthcare utilization is vital for developing targeted interventions.
  • The Department of Veterans Affairs (VA) health care system serves a large population with diverse health needs.

Purpose of the Study:

  • To investigate the relationship between specific psychiatric diagnoses and healthcare utilization patterns among high-cost patients within the VA.
  • To inform the development of intensive management programs tailored to the needs of high-cost patient populations.
  • To analyze the association between diagnostic groups and the utilization of mental health and general medical services.

Main Methods:

  • Analysis of the costliest 5% of VA patients from fiscal year 2010.
  • Classification of patients into hierarchical diagnostic groups: no mental health condition, serious mental illness, substance use disorder, posttraumatic stress disorder (PTSD), and depression.
  • Multivariable linear regression to assess associations between diagnostic groups, healthcare utilization, and costs, adjusting for sociodemographic factors.

Main Results:

  • Among 261,515 high-cost patients, prevalence rates were: depression (29%), substance use disorder (20%), PTSD (17%), and serious mental illness (13%).
  • Patients with serious mental illness and substance use disorders were younger, had fewer chronic medical conditions, and higher mental health care utilization.
  • These groups also had a greater proportion of costs attributed to mental health care (41% and 31%) compared to PTSD (18%) and depression (11%) groups.

Conclusions:

  • Stratification of high-risk, high-cost patients by psychiatric diagnosis is recommended for optimal management.
  • Integrated care models are beneficial for patients with multiple chronic conditions and comorbid mental health issues.
  • Intensive mental health services are essential for patients whose primary needs are driven by mental health conditions.