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Industry: Email Alert RSS FeedMental illness and length of inpatient stay for Medicaid recipients with AIDS
Health Services Research, Oct, 2004 by Donald R. Hoover, Usha Sambamoorthi, James T. Walkup, Stephen Crystal
Table 1: Breakdown of 1992-1998 Inpatient Admissions, LOS, and Time to
Readmission among HIV-Infected New Jersey Medicaid Recipients by Visit
and Patient Characteristics
Number of Percentage of
Characteristic Admissions Admissions
Total 24,975 100.0
Mental and Neurological Illness
Mental Illness Diagnosis and
History
SMI--Primary 607 2.4
SMI--Secondary 347 1.4
SMI--History (a) 3,697 14.8
OMI--Acute 1,261 5.0
OMI--History (b) 7,086 28.4
No MI 11,977 48.0
HIV Dementia at or before Visit
Yes 161 0.6
No 24,814 99.4
Other Patient-Visit Characteristics
Opportunistic Infection at Visit
Yes 9,463 37.9
No 15,512 62.1
Died in Hospital at Visit
Yes 1,732 6.9
No 23,243 93.1
Substance Abuse Diagnosed
at Visit
Primary substance abuse 1,665 6.7
Secondary substance abuse 6,257 25.0
No substance abuse 17,053 68.3
Season of Admission for Visit
Fall/Winter 12,360 49.5
Spring/Summer 12,615 50.5
Year of Admission for Visit
1992 1,564 6.3
1993 4,583 18.4
1994 5,848 23.4
1995 5,782 23.2
1996 3,517 14.1
1997 2,131 8.5
1998 1,550 6.2
Age at Visit
18-29 years 4,457 17.9
30-39 years 13,040 52.2
40-49 years 6,100 24.4
50 and older 1,378 5.5
PI/NNRTI Use at or before Visit
Yes 3,562 14.3
No 21,413 85.7
Other Patient Characteristics
Gender
Female 10,632 42.6
Male 14,343 57.4
Race/Ethnicity
Non-Latino white 4,816 19.3
African American 15,542 62.2
Latino 4,534 18.2
Risk Group
Missing 1,933 7.7
IDU 16,896 67.7
Non-IDU 6,146 24.6
County of Residence at Visit of
HIV Diagnosis
High Prevalence 18,318 73.4
Elsewhere 6,657 26.1
Waiver Participation at Visit of
HIV Diagnosis
ACCAP 6,915 27.7
Non-ACCAP 18,060 72.3
Medicare Enrollment at Visit of
HIV Diagnosis
No Medicare 18,220 72.9
Medicare 6,755 27.1
Year of Initial HIV Disease
Diagnosis
Before 1990 1,739 7.0
1990-1992 8,305 33.3
1993-1994 12,191 48.8
1995-1996 2,740 11.0
Mean Length Mean Months
Characteristic of Stay in Days to Readmission
Total 12.7 4.6
Mental and Neurological Illness
Mental Illness Diagnosis and
History
SMI--Primary 12.4 5.0
SMI--Secondary 11.9 4.8
SMI--History (a) 11.3 4.4
OMI--Acute 12.4 4.5
OMI--History (b) 12.4 4.7
No MI 13.5 4.5
HIV Dementia at or before Visit
Yes 16.3 4.0
No 12.7 4.6
Other Patient-Visit Characteristics
Opportunistic Infection at Visit
Yes 15.6 4.1
No 11.0 4.9
Died in Hospital at Visit
Yes 21.2 NA
No 12.1 NA
Substance Abuse Diagnosed
at Visit
Primary substance abuse 5.9 6.1
Secondary substance abuse 11.4 5.0
No substance abuse 13.9 4.3
Season of Admission for Visit
Fall/Winter 12.9 4.6
Spring/Summer 12.6 4.5
Year of Admission for Visit
1992 13.9 2.1
1993 14.8 3.2
1994 14.2 3.8
1995 13.0 4.0
1996 10.8 5.1
1997 9.2 6.9
1998 9.1 8.2
Age at Visit
18-29 years 11.2 4.2
30-39 years 12.7 4.5
40-49 years 13.2 5.0
50 and older 16.8 5.2
PI/NNRTI Use at or before Visit
Yes 8.9 6.9
No 12.4 4.0
Other Patient Characteristics
Gender
Female 12.5 4.7
Male 13.0 4.4
Race/Ethnicity
Non-Latino white 11.3 5.1
African American 13.3 4.6
Latino 12.3 3.9
Risk Group
Missing 13.9 4.4
IDU 13.0 4.5
Non-IDU 12.5 4.7
County of Residence at Visit of
HIV Diagnosis
High Prevalence 13.2 4.5
Elsewhere 11.4 4.8
Waiver Participation at Visit of
HIV Diagnosis
ACCAP 13.0 4.2
Non-ACCAP 12.7 5.7
Medicare Enrollment at Visit of
HIV Diagnosis
No Medicare 12.0 4.0
Medicare 13.0 6.3
Year of Initial HIV Disease
Diagnosis
Before 1990 12.4 5.1
1990-1992 12.9 4.9
1993-1994 12.9 4.4
1995-1996 11.8 4.3
(a) For visits without a Severe Mental Illness Diagnosis.
(b) For visits without a Mental Illness Diagnosis.
Note: Based on HIV-diagnosed persons 18 years of age and older,
receiving Medicaid with at least one inpatient stay from 1992
to 1998. Values may not add up to 100 percent due to rounding.
Abbreviations: AIDS: Acquired Immune Deficiency Syndrome.
PI/NNRTI: Protease Inhibitor or Non-Nucleoside Reverse
Transcriptase Inhibitors; MI: Mental Illness; SMI: Severe
Mental Illness; OMI: Other (nm-severe) Mental Illness; IDU:
Injection Drug User; ACCAP: AIDS Community Care Alternatives
Care Program.
Table 2. Robust Least Squares Regression on Log Length of Stay (in
Days) and Log Time (in Months) to Readmission, Adjusted and Unadjusted
Ratios ([e.sup.[beta]]) (with 95% Confidence Intervals)
Length of Stay Ratio
Unadjusted Effect
Mental and Neurological Illness
Mental Illness Diagnosis and History
SMI Acute Primary 1.05 (0.97, 1.14)
SMI Acute Secondary 0.91 (0.83, 1.01)
SMI History 0.83 (0.78, 0.88) ***
OMI Acute 0.89 (0.84, 0.94) ***
OMI History 0.91 (0.88, 0.95) ***
No MI History --
HIV Dementia at or Prior to Visit
Yes 1.38 (1.22, 1.55) ***
No --
Other Patient-Visit Characteristics
Opportunistic Infection Diagnoses
at Visit
Yes 1.49 (1.46, 1.52) ***
No --
Died in Hospital at Visit
Yes 1.46 (1.38, 1.55) ***
No --
Substance Abuse Diagnosis at Visit
Primary substance abuse 0.49 (0.47, 0.51) ***
Secondary substance abuse 0.85 (0.82, 0.89) ***
No substance abuse --
PI/NNRTI Use at or before Visit
Yes 0.72 (0.69, 0.75) ***
No --
Season of Admission for Visit
Fall/Winter 1.04 (1.02, 1.06) **
Spring/Summer --
Year of Admission of Visit
1998 0.68 (0.63, 0.73) ***
1997 0.68 (0.62, 0.74) ***
1996 0.79 (0.75, 0.84) ***
1995 0.91 (0.86, 0.97) **
1994 0.98 (0.92, 1.04)
1993 1.03 (0.97, 1.09)
1992 --
Other Patient Characteristics
Gender
Female 1.00 (0.96, 1.04)
Male --
Age at Initial Diagnosis of
HIV Disease
18-29 years 0.68 (0.63, 0.74) ***
30-39 years 0.79 (0.73, 0.85) ***
40-49 years 0.81 (0.75, 0.88) ***
50 years and older --
Race/Ethnicity
Latino 1.07 (1.01, 1.14) *
African American 1.16 (1.12, 1.21) ***
Non-Latino white --
Risk Group
Missing 1.03 (0.97, 1.09)
IDU 0.95 (0.91, 1.99) **
Non-IDU --
County of Residence at Initial
Diagnosis of HIV Disease
High Prevalence 1.14 (1.10, 1.18) ***
Elsewhere --
Waiver Participation at Initial Diagnosis
of HIV Disease
ACCAP 1.05 (1.01, 1.09) **
Non-ACCAP --
Medicare Enrollment at Initial
Diagnosis of HIV Disease
Medicare 0.94 (0.91, 0.98) ***
No Medicare --
Year of Initial Diagnosis of
HIV Disease
1995-1996 1.02 (0.94, 1.10)
1993-1994 1.00 (0.92, 1.08)
1990-1992 1.02 (0.94, 1.10)
Before 1990 --
Length of Stay Ratio
Adjusted Effect
Mental and Neurological Illness
Mental Illness Diagnosis and History
SMI Acute Primary 1.32 (1.21, 1.44) ***
SMI Acute Secondary 1.11 (1.00, 1.21) *
SMI History 0.97 (0.93, 1.01)
OMI Acute 1.04 (0.99, 1.10)
OMI History 0.98 (0.94, 1.02)
No MI History --
HIV Dementia at or Prior to Visit
Yes 1.31 (1.13, 1.52) ***
No --
Other Patient-Visit Characteristics
Opportunistic Infection Diagnoses
at Visit
Yes 1.42 (1.38, 1.46) ***
No --
Died in Hospital at Visit
Yes 1.27 (1.20, 1.35) ***
No --
Substance Abuse Diagnosis at Visit
Primary substance abuse 0.57 (0.54, 0.60) ***
Secondary substance abuse 0.87 (0.84, 0.90) ***
No substance abuse --
PI/NNRTI Use at or before Visit
Yes 0.90 (0.85, 0.95) ***
No --
Season of Admission for Visit
Fall/Winter 1.03 (1.01, 1.06) *
Spring/Summer --
Year of Admission of Visit
1998 0.75 (0.69, 0.82) ***
1997 0.74 (0.69, 0.80) ***
1996 0.79 (0.74, 0.84) ***
1995 0.84 (0.80, 0.90) ***
1994 0.90 (0.86, 0.96) ***
1993 0.97 (0.91, 1.04)
1992 --
Other Patient Characteristics
Gender
Female 1.01 (0.95, 1.06)
Male --
Age at Initial Diagnosis of
HIV Disease
18-29 years 0.71 (0.66, 0.77) ***
30-39 years 0.80 (0.75, 0.86) ***
40-49 years 0.85 (0.80, 0.91) ***
50 years and older --
Race/Ethnicity
Latino 1.05 (1.00, 1.10) *
African American 1.14 (1.09, 1.19) ***
Non-Latino white --
Risk Group
Missing 1.02 (0.99, 1.05)
IDU 1.06 (1.00, 1.13) *
Non-IDU --
County of Residence at Initial
Diagnosis of HIV Disease
High Prevalence 1.14 (1.10, 1.18) ***
Elsewhere --
Waiver Participation at Initial Diagnosis
of HIV Disease
ACCAP 1.04 (1.00, 1.08) *
Non-ACCAP --
Medicare Enrollment at Initial
Diagnosis of HIV Disease
Medicare 0.98 (0.94, 1.02)
No Medicare --
Year of Initial Diagnosis of
HIV Disease
1995-1996 0.95 (0.88, 1.02)
1993-1994 0.94 (0.89, 1.00) *
1990-1992 0.93 (0.88, 0.99) *
Before 1990 --
Time to Readmission Ratio
Unadjusted Effect
Mental and Neurological Illness
Mental Illness Diagnosis and History
SMI Acute Primary 1.14 (0.97, 1.13)
SMI Acute Secondary 1.01 (0.83, 1.23)
SMI History 0.93 (0.83, 1.05)
OMI Acute 1.04 (0.96, 1.13)
OMI History 1.01 (0.93, 1.09)
No MI History --
HIV Dementia at or Prior to Visit
Yes 0.81 (0.68, 1.03)
No --
Other Patient-Visit Characteristics
Opportunistic Infection Diagnoses
at Visit
Yes 0.87 (0.82, 0.92) ***
No --
Died in Hospital at Visit
Yes NA
No --
Substance Abuse Diagnosis at Visit
Primary substance abuse 1.45 (1.29, 1.63) ***
Secondary substance abuse 1.16 (1.10, 1.23) ***
No substance abuse --
PI/NNRTI Use at or before Visit
Yes 1.49 (1.38, 1.61) ***
No --
Season of Admission for Visit
Fall/Winter 1.06 (1.02, 1.10) **
Spring/Summer --
Year of Admission of Visit
1998 2.83 (2.47, 3.25) ***
1997 2.59 (2.30, 2.91) ***
1996 2.03 (1.84, 2.24) ***
1995 1.60 (1.45, 1.76) ***
1994 1.57 (1.42, 1.73) ***
1993 1.38 (1.25, 1.52) ***
1992 --
Other Patient Characteristics
Gender
Female 0.95 (0.90, 1.01)
Male --
Age at Initial Diagnosis of
HIV Disease
18-29 years 0.76 (0.66, 0.87) ***
30-39 years 0.82 (0.73, 0.92) **
40-49 years 0.92 (0.80, 1.06)
50 years and older --
Race/Ethnicity
Latino 0.79 (0.72, 0.88) ***
African American 0.90 (0.84, 0.98) *
Non-Latino white --
Risk Group
Missing 1.04 (0.90, 1.19)
IDU 0.96 (0.88, 1.04)
Non-IDU --
County of Residence at Initial
Diagnosis of HIV Disease
High Prevalence 0.95 (0.90, 1.01)
Elsewhere --
Waiver Participation at Initial Diagnosis
of HIV Disease
ACCAP 0.88 (0.83, 0.93) ***
Non-ACCAP --
Medicare Enrollment at Initial
Diagnosis of HIV Disease
Medicare 1.88 (1.77, 1.99) ***
No Medicare --
Year of Initial Diagnosis of
HIV Disease
1995-1996 0.78 (0.68, 0.90) ***
1993-1994 0.81 (0.72, 0.91) ***
1990-1992 0.93 (0.83, 1.05)
Before 1990 --
Time to Readmission Ratio
Adjusted Effect
Mental and Neurological Illness
Mental Illness Diagnosis and History
SMI Acute Primary 0.98 (0.85, 1.13)
SMI Acute Secondary 0.90 (0.75, 1.09)
SMI History 0.84 (0.77, 0.90) ***
OMI Acute 0.84 (0.75, 0.94) ***
OMI History 0.93 (0.88, 0.99) *
No MI History --
HIV Dementia at or Prior to Visit
Yes 0.98 (0.73, 1.33)
No --
Other Patient-Visit Characteristics
Opportunistic Infection Diagnoses
at Visit
Yes 0.98 (0.94, 1.02)
No --
Died in Hospital at Visit
Yes NA
No --
Substance Abuse Diagnosis at Visit
Primary substance abuse 1.49 (1.34, 1.66) ***
Secondary substance abuse 1.17 (1.11, 1.24) ***
No substance abuse --
PI/NNRTI Use at or before Visit
Yes 1.02 (0.90, 1.05)
No --
Season of Admission for Visit
Fall/Winter 1.06 (1.02, 1.11) ***
Spring/Summer --
Year of Admission of Visit
1998 3.39 (2.81, 4.08) ***
1997 3.00 (2.56, 3.52) ***
1996 2.41 (2.10, 2.76) ***
1995 1.97 (1.74, 2.24) ***
1994 1.84 (1.63, 2.08) ***
1993 1.54 (1.37, 1.72) ***
1992 --
Other Patient Characteristics
Gender
Female 1.08 (1.02, 1.15) **
Male --
Age at Initial Diagnosis of
HIV Disease
18-29 years 0.78 (0.68, 0.89) ***
30-39 years 0.83 (0.74, 0.94) **
40-49 years 0.94 (0.83, 1.07)
50 years and older --
Race/Ethnicity
Latino 0.82 (0.75, 0.90) ***
African American 0.91 (0.85, 0.99) *
Non-Latino white --
Risk Group
Missing 0.91 (0.82, 1.01)
IDU 0.90 (0.84, 0.96) ***
Non-IDU --
County of Residence at Initial
Diagnosis of HIV Disease
High Prevalence 0.94 (0.88, 1.01)
Elsewhere --
Waiver Participation at Initial Diagnosis
of HIV Disease
ACCAP 0.89 (0.84, 0.94) ***
Non-ACCAP --
Medicare Enrollment at Initial
Diagnosis of HIV Disease
Medicare 1.82 (1.70, 1.95) ***
No Medicare --
Year of Initial Diagnosis of
HIV Disease
1995-1996 0.61 (0.52, 0.70) ***
1993-1994 0.77 (0.69, 0.87) ***
1990-1992 1.01 (0.85, 1.18)
Before 1990 --
Note: Based on HIV-diagnosed persons aged 18 and older, receiving
Medicaid with at least one inpatient stay between 1992 and 1998.
Parameter estimates are based on robust ordinary least squares
regression on log length of stay and log time in months to readmission.
The regressions include an intercept term. The asterisks denote
significant effects relative to the reference group:
*** p<0.001;
** p<0.01;
* p<0.05.
Abbreviations: AIDS: Acquired Immune Deficiency Syndrome; PI/NNRTI:
Protease Inhibitor or Non-Nucleoside Reverse Transcriptase Inhibitors;
MI: Mental Illness; SMI: Severe Mental Illness; OMI: Other (non-severe)
Mental Illness; OI: Opportunistic Infection; IDU: Injection Drug User;
ACCAP: AIDS Community Care Alternatives Care Program; NA: Not
applicable.
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