Utilization and outcomes among inpatient veterans diagnosed with congestive heart failure and co-morbid mental illness.

摘要

Since mental illness is often associated with worse physical health outcomes, this dissertation examines the effect of specific psychiatric diagnoses on outpatient medical care prior to hospitalization for congestive heart failure (CHF) as well as readmission and mortality subsequent to that hospitalization. It also considers whether greater medical need is associated with reduced receipt of mental health services for patients with psychiatric diagnoses.;The Behavioral Model provided the theoretical underpinning, with psychiatric diagnosis being the key predisposing variable. Patient-level data were drawn from the Department of Veteran's Affairs National Patient Care Database. Analysis was conducted on 15,685 veterans admitted with heart failure to VA hospitals in Fiscal Year 2001.;Analysis included logistic regression with the following dependent variables: primary care (yes/no) and health counseling preceding admission; readmission, mortality and regular mental health care following hospitalization. Linear regression was done for primary care and mental health visits.;Among the 70% of veterans without inpatient care preceding the first CHF hospitalization of FY 2001, those with a psychiatric diagnosis other than dementia were likely to have more primary care than were patients without a psychiatric diagnosis. Among those with inpatient care before the study hospitalization, veterans with dementia were less likely to have primary care than veterans having no psychiatric diagnosis. Those with depression were more likely and those with dementia were less likely than veterans having no psychiatric diagnosis to receive health counseling.;Compared to veterans with no psychiatric diagnosis, patients with depression and anxiety disorders were more likely to be readmitted. Those with dementia, anxiety and "other" mental illness were more likely to die. Primary care services in the year preceding admission increased the chance of readmission; but decreased the chance of inpatient mortality. Increasing medical co-morbidity had a negligible impact on mental health care.;Results suggest that increased efforts to engage patients with co-morbid dementia in primary care may reduce mortality, particularly if those patients have received inpatient care. In another attempt to reduce mortality and readmission, more attention should be placed on heart failure patients discharged with heart failure and co-morbid depression or anxiety.