Use of high cost care among Veterans with comorbid mental illness and Alzheimer's Disease and related dementias.

dc.contributor.author

Shepherd-Banigan, Megan

dc.contributor.author

Miller, Katherine EM

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Hastings, S Nicole

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Schleiden, Loren J

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Thorpe, Joshua M

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Chung, Frances

dc.date.accessioned

2023-06-01T15:39:41Z

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2023-06-01T15:39:41Z

dc.date.issued

2023-01

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2023-06-01T15:39:39Z

dc.description.abstract

Introduction/objective

Alzheimer's Disease and Other Related Dementias (AD/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD/ADRD increases cognitive and functional disabilities and could contribute to these high rates of intensive health care use. The objective of this paper is to assess the relationship of mental illness on 12-month patterns in hospitalization and ED use among Veterans aged 65 and over with a new AD/ADRD diagnosis.

Methods

We used an existing dataset of administrative electronic health record data of Veterans with AD/ADRD from the US Veterans Health Administration linked with Medicare claims data from 2011-2015. We use multivariable logistic regression to examine the association between no pre-existing mental illness, pre-existing mental illness (e.g., major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder), and pre-existing severe mental illness-or SMI-(e.g., bipolar disorder, major depressive disorder with psychosis, or schizophrenia) and 12- month ED and hospitalization use and readmissions among Veterans who had an initial hospitalization visit. We estimated predicted probabilities, differential effect, and associated 95% confidence intervals.

Results

In our sample, 1.4% had SMI and 11% had non-SMI mental illness. The unadjusted percentage with inpatient and ED use was higher among Veterans with SMI (34% and 26%, respectively) and Veterans with non-SMI mental illness (20%, 16%) compared with Veterans without pre-existing mental illness (12%, 9%). Compared to individuals with no pre-existing mental illness, having a pre-existing mental illness (1.27 percentage points, 95% CI: 0.76, 1.78) and a pre-existing SMI (7.17 percentage points, 95% CI: 5.66, 8.69) were both associated with an increased likelihood of ED use. The same pattern was observed for any inpatient use (mental illness 2.18, 95% CI: 1.59, 2.77; SMI 9.91, 95% CI: 8.21, 11.61). Only pre-existing SMI was associated higher hospitalization readmission.

Discussion

Pre-existing mental illness increases use of high cost, intensive health care and this association is higher of more severe mental health conditions. We also show that pre-existing mental illness exerts a unique influence, above and beyond other comorbidities, such as diabetes, on ED and inpatient visits. More needs to be done to increase recognition of the unique risks of this combination of health conditions and encourage strategies to address them. Developing, testing, and implementing comprehensive strategies that address the intersection of ADRD and mental illness is promising approach that requires more focused attention.
dc.identifier

PONE-D-22-25928

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1932-6203

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1932-6203

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https://hdl.handle.net/10161/27514

dc.language

eng

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Public Library of Science (PLoS)

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PloS one

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10.1371/journal.pone.0282071

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Humans

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Alzheimer Disease

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Mental Disorders

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Stress Disorders, Post-Traumatic

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Depressive Disorder, Major

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Aged

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Veterans

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Medicare

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United States

dc.title

Use of high cost care among Veterans with comorbid mental illness and Alzheimer's Disease and related dementias.

dc.type

Journal article

duke.contributor.orcid

Shepherd-Banigan, Megan|0000-0002-4020-8936

duke.contributor.orcid

Hastings, S Nicole|0000-0002-5750-8820

pubs.begin-page

e0282071

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5

pubs.organisational-group

Duke

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School of Medicine

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Basic Science Departments

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Clinical Science Departments

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Institutes and Centers

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Medicine

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Medicine, Geriatrics

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Institutes and Provost's Academic Units

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Center for the Study of Aging and Human Development

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Initiatives

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Population Health Sciences

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Duke - Margolis Center For Health Policy

pubs.publication-status

Published

pubs.volume

18

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