Behavioral Health Conditions and Potentially Preventable Diabetes-related Hospitalizations in the United States: Findings from a National Sample of Commercial Claims Data

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Mar 1

PMID 30818377

Citations 7

Authors

Erica L Stockbridge

Shlesma Chhetri

Leah E Polcar

Abiah D Loethen

Caroline P Carney

Affiliations

Soon will be listed here.

Abstract

Objective: To characterize the relationship between potentially preventable hospitalizations (PPHs) for diabetes and behavioral health conditions in commercially insured working-age persons with diabetes in the United States.

Research Design And Methods: We retrospectively analyzed medical and pharmacy claims from services rendered between 2011 and 2013 for 229,039 adults with diabetes. Diabetes PPHs were identified using the Agency for Healthcare Research and Quality's Prevention Quality Indicators v6.0 logic. We used negative binomial-logit hurdle regression models to explore the adjusted relationships between diabetes PPHs and schizophrenia, bipolar, depression, anxiety, adjustment disorder, alcohol use disorder, and drug use disorder.

Results: A total of 4,521 diabetes PPHs were experienced by 3,246 of the persons in the sample. The 20.83% of persons with one or more behavioral health conditions experienced 43.62% (1,972/4,521; 95% CI 42.18%-45.07%) of all diabetes PPHs, and the 7.14% of persons with more than one diagnosed behavioral health condition experienced 24.77% (1,120/4,521; 95% CI 23.54%-26.05%) of all diabetes PPHs. After adjusting for sociodemographic and physical health covariates, patients with depression, schizophrenia, drug or alcohol use disorders, or multiple behavioral health conditions were at significantly increased risk of experiencing at least one diabetes PPH, while patients with depression, drug use disorder, or multiple behavioral health conditions were at significantly increased risk of experiencing recurring diabetes PPHs over time.

Conclusions: A number of behavioral health conditions are associated with diabetes PPHs, which are often preventable with timely, high-quality outpatient care. The results of this study will enable clinicians, payers, and policy-makers to better focus outpatient care interventions and resources within the population of persons with diabetes.

Citing Articles

Return on Investment of Enhanced Behavioral Health Services.

Hawrilenko M, Smolka C, Ward E, Ambwani G, Brown M, Mohandas A JAMA Netw Open. 2025; 8(2):e2457834.

PMID: 39908020 PMC: 11800021. DOI: 10.1001/jamanetworkopen.2024.57834.

Type 2 Diabetes Health Care Outcomes for Patients with Alcohol Use Disorder Starting Addiction Treatment.

Iturralde E, Slama N, Balapal N, Knox M, Gilliam L, Satre D J Gen Intern Med. 2024; .

PMID: 39627543 DOI: 10.1007/s11606-024-09209-4.

Effects of Mental Illness Amongst Adults in the United States Living With Diabetes Mellitus on Hospital Admissions.

Gettas M, Banta J, Herring R, Beeson W, Oh J, Shaheen R Cureus. 2023; 15(9):e46145.

PMID: 37779678 PMC: 10539007. DOI: 10.7759/cureus.46145.

Untreated substance use disorder affects glycemic control: Results in patients with type 2 diabetes served within a network of community-based healthcare centers in Florida.

Horigian V, Schmidt R, Duan R, Parras D, Chung-Bridges K, Batycki J Front Public Health. 2023; 11:1122455.

PMID: 37006591 PMC: 10060525. DOI: 10.3389/fpubh.2023.1122455.

Behavioral Health in Primary Care: Expanding Applications in Practice.

Ferber M, Meyer D, Heiden-Rootes K, Zubatsky M Mo Med. 2022; 119(3):237-242.

PMID: 36035567 PMC: 9324695.

References

Clark R, Weir S, Ouellette R, Zhang J, Baxter J . Beyond health plans: behavioral health disorders and quality of diabetes and asthma care for Medicaid beneficiaries. Med Care. 2009; 47(5):545-52. DOI: 10.1097/MLR.0b013e318190db45. View

Mai Q, Holman C, Sanfilippo F, Emery J, Preen D . Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med. 2011; 9:118. PMC: 3215928. DOI: 10.1186/1741-7015-9-118. View

Shrivastava S, Shrivastava P, Ramasamy J . Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord. 2013; 12(1):14. PMC: 3599009. DOI: 10.1186/2251-6581-12-14. View

Carrasquillo O, Lebron C, Alonzo Y, Li H, Chang A, Kenya S . Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial. JAMA Intern Med. 2017; 177(7):948-954. PMC: 5818804. DOI: 10.1001/jamainternmed.2017.0926. View

McBain H, Lamontagne-Godwin F, Haddad M, Simpson A, Chapman J, Jones J . Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals. BMJ Open. 2018; 8(2):e019400. PMC: 5829882. DOI: 10.1136/bmjopen-2017-019400. View

Lin H, Huang C, Chen S, Chen Y . Increased risk of avoidable hospitalization among patients with schizophrenia. Can J Psychiatry. 2011; 56(3):171-8. DOI: 10.1177/070674371105600307. View

Kisely S, Ehrlich C, Kendall E, Lawrence D . Using Avoidable Admissions to Measure Quality of Care for Cardiometabolic and Other Physical Comorbidities of Psychiatric Disorders: A Population-Based, Record-Linkage Analysis. Can J Psychiatry. 2016; 60(11):497-506. PMC: 4679130. DOI: 10.1177/070674371506001105. View

Yoon J, Yano E, Altman L, Cordasco K, Stockdale S, Chow A . Reducing costs of acute care for ambulatory care-sensitive medical conditions: the central roles of comorbid mental illness. Med Care. 2012; 50(8):705-13. DOI: 10.1097/MLR.0b013e31824e3379. View

McGinty E, Baller J, Azrin S, Juliano-Bult D, Daumit G . Quality of medical care for persons with serious mental illness: A comprehensive review. Schizophr Res. 2015; 165(2-3):227-35. PMC: 4670551. DOI: 10.1016/j.schres.2015.04.010. View

10.

Leung K, Parks J, Topolski J . Preventable hospitalizations among adult Medicaid beneficiaries with concurrent substance use disorders. Prev Med Rep. 2016; 2:379-84. PMC: 4721431. DOI: 10.1016/j.pmedr.2015.04.022. View

11.

Frayne S, Halanych J, Miller D, Wang F, Lin H, Pogach L . Disparities in diabetes care: impact of mental illness. Arch Intern Med. 2005; 165(22):2631-8. DOI: 10.1001/archinte.165.22.2631. View

12.

Cahoon E, McGinty E, Ford D, Daumit G . Schizophrenia and potentially preventable hospitalizations in the United States: a retrospective cross-sectional study. BMC Psychiatry. 2013; 13:37. PMC: 3599909. DOI: 10.1186/1471-244X-13-37. View

13.

Druss B, Zhao L, Cummings J, Shim R, Rust G, Marcus S . Mental comorbidity and quality of diabetes care under Medicaid: a 50-state analysis. Med Care. 2012; 50(5):428-33. PMC: 3360811. DOI: 10.1097/MLR.0b013e318245a528. View

14.

Mulligan K, McBain H, Lamontagne-Godwin F, Chapman J, Haddad M, Jones J . Barriers and enablers of type 2 diabetes self-management in people with severe mental illness. Health Expect. 2017; 20(5):1020-1030. PMC: 5600230. DOI: 10.1111/hex.12543. View

15.

Sajatovic M, Dawson N, Perzynski A, Blixen C, Bialko C, McKibbin C . Best practices: Optimizing care for people with serious mental illness and comorbid diabetes. Psychiatr Serv. 2011; 62(9):1001-3. PMC: 4497574. DOI: 10.1176/appi.ps.62.9.1001. View

16.

Ghitza U, Wu L, Tai B . Integrating substance abuse care with community diabetes care: implications for research and clinical practice. Subst Abuse Rehabil. 2013; 4:3-10. PMC: 3558925. DOI: 10.2147/SAR.S39982. View

17.

Leung G, Zhang J, Lin W, Clark R . Behavioral health disorders and adherence to measures of diabetes care quality. Am J Manag Care. 2011; 17(2):144-50. View

18.

Kilbourne A, Pirraglia P, Lai Z, Bauer M, Charns M, Greenwald D . Quality of general medical care among patients with serious mental illness: does colocation of services matter?. Psychiatr Serv. 2011; 62(8):922-8. DOI: 10.1176/ps.62.8.pss6208_0922. View

19.

Pratt S, Bartels S, Mueser K, Naslund J, Wolfe R, Pixley H . Feasibility and effectiveness of an automated telehealth intervention to improve illness self-management in people with serious psychiatric and medical disorders. Psychiatr Rehabil J. 2013; 36(4):297-305. PMC: 5472060. DOI: 10.1037/prj0000022. View

20.

McBain H, Mulligan K, Haddad M, Flood C, Jones J, Simpson A . Self management interventions for type 2 diabetes in adult people with severe mental illness. Cochrane Database Syst Rev. 2016; 4:CD011361. PMC: 10201333. DOI: 10.1002/14651858.CD011361.pub2. View