New data on prevalence and severity of behavioral health conditions among 2014 general hospital inpatients in New York State

Transcription

1 New data on prevalence and severity of behavioral health conditions among 2014 general hospital inpatients in New York State Prepared by the ArthurWebbGroup March 2016 Special populations present special opportunities for health system redesign This is an updated report to the Report we published in 2014 on prevalence and severity of behavioral health conditions. Patients with behavioral health problems present special challenges in achieving the Triple Aim of improved quality of care, better population health, and reduced per capita costs. Documenting such special populations amid the general inpatient and outpatient flow at community hospitals and primary care providers is an important step in planning effective systems of care for the entire community. So too is an understanding of the overlap among some of these groups that results in even higher need for coordinated care. With the recent release of 2014 SPARCS inpatient data by the New York State Department of Health, we are able to update our examination of these issues. As in previous years, the ArthurWebbGroup commissioned a study that applies accepted definitions and software to identify and characterize this special population. We again examine the prevalence of persons with behavioral health conditions among the general inpatient flow at community hospitals in New York State and describe their other chronic illnesses, service intensity, and functional limitations concerns than figure prominently in healthcare redesign. These results confirm patterns noted in our prior studies. 1 We believe our approach can help regional and local stakeholders across New York State improve care to New York s diverse patient populations. 1 Prevalence and Severity of Behavioral Health Conditions: Understanding the prevalence and severity of behavioral health conditions among general hospital inpatients in New York State: Application of the use of new tools and analytics (January, 2013) and Updated data on prevalence and severity of behavioral health conditions among general hospital inpatients in New York State (December, 2014).

2 The data reported here cover only adult inpatients, but they include all inpatient adult service lines. We note that this is not a report on persons hospitalized for behavioral health conditions, but of patients with a diagnosed behavioral health problem among the general inpatient cohorts of community hospitals in New York State. Out of some two million adult hospital stays at general community hospitals in NYS in 2014, about 537,000 (27%) involved patients with major behavioral health conditions: that is, major mental illness, alcohol abuse, or other substance abuse conditions, alone or in combination. 14% of adult discharges in 2014 involved inpatients with major mental illness but no alcohol or substance abuse, another 7% had alcohol or substance abuse but no major mental illness, and just under 6% of were diagnosed with major mental illness and alcohol or substance abuse.. We estimate that 17% (91,000) of the 537,000 hospitalizations with major behavioral health conditions involved dual eligibles (Medicaid and Medicare). Two-thirds (68%) of adult discharges with major behavioral health conditions had at least two other forms of chronic diseases (three or more in total). Among other hospitalizations, 72% had two or more chronic diseases. A majority of each group had at least three chronic conditions. As in previous years, we applied results from AHRQ-funded national research to estimate the number of patients with severe functional impairment associated with their behavioral health problems. The AHRQ study estimated the probability of severe, moderate, and mild functional impairment for behavioral health conditions mapped to ICD9 codes. The authors found the categories were strong predictors of hospital and emergency department use [enhancing] these predictions beyond the clinical disease prognosis algorithms that predict expected resource use. Using the ICD9 mappings from that study and data from the original survey, we estimated the probability of serious functional impairment among patients with behavioral health conditions. (Details and references are found in the body of our report.) Using the above studies, we estimate 52% of hospital discharges among major behavioral health patients in New York State involve patients with serious functional impairment. We estimate that as many as 28,000 annual inpatient discharges involving inpatient stays for high-acuity diagnoses involve patients with major behavioral health problems accompanied by serious functional impairment. The ArthurWebbGroup invites comments and inquiries from organizations that may want to apply these tools to healthcare redesign or collaborative, regional planning efforts. 2

3 Identifying inpatients with behavioral health problems 2 The New York State Department of Health s Statewide Planning and Research Cooperative System (SPARCS) collected discharge summaries on more than two million adult inpatient stays from general community hospitals in the state during Similar data are produced in the vast majority of states and collected in national datasets that drive some of the most informative work undertaken by the federal Agency for Healthcare Research and Quality (AHRQ). AHRQ facilitates health services research not only through funding, but also by providing definitional standards and software to standardize the analysis of state data. We applied AHRQ tools to NYS SPARCS data to characterize hospital inpatients with specific behavioral health problems. One of the most useful AHRQ tools is the Clinical Classification Software (CCS) which collapses the thousands of ICD-9 diagnostic codes into clinically meaningful groupings. We used a hierarchical version of the software to identify behavioral health and other chronic conditions. 3 Level 1 of this schema classifies the ICD-9 diagnoses into 18 groups (for example circulatory diseases), based on the affected body system. It provides a convenient way to group chronic conditions. Level 2 provides a more detailed set of categories: for example, breaking diseases of the circulatory system into hypertension, heart disease, cerebrovascular disease, etc. Here, we used the CCS category for mental illness, whose Level 2 codes identify alcoholism and alcohol abuse, (chemical) substance abuse, several types of mental health disorders, and a history or screening for such disorders. Using the STATA version of AHRQ s CCS program, we coded SPARCS inpatient records for all adults discharged from hospitals in 2014 over two million hospital stays. This created a research file with Level 1 and Level 2 CCS codes for up to 25 diagnoses on each inpatient record. We scanned all the CCS codes for each patient stay to identify those with: Any diagnosis for alcoholism or alcohol abuse Any diagnosis for (chemical) substance abuse Any diagnosis for what we term major mental illness (which included the CCS Level 2 categories for mood disorders, personality disorders, schizophrenia and other psychotic disorders, and suicide or intentional self-inflicted injury) Any diagnosis for what we term other mental illness (CCS Level 2 categories for adjustment disorders, anxiety disorders, attention deficit disorders, delirium, disorders usually diagnosed in infancy, impulse control disorders, and miscellaneous mental disorders) A history or screening for the above. 2 The following analysis was prepared by Welsh Analytics LLC in collaboration with the ArthurWebbGroup. The firm s principal, James Welsh, directed analytic bureaus at the NYS Departments of Social Services and Health and served as healthcare market manager at Esri, a leading GIS firm. He holds a doctorate in psychology from Harvard University and received post-doctoral training at the University of Chicago and Michael Reese Hospital. In addition to the consulting practice, Dr. Welsh holds a part-time position with the Community Health Care Association of New York State, a not-for-profit organization representing federally qualified health centers

4 Our research file recorded each patient s specific combination of the above co-occurring conditions, which we consolidated into three groups of behavioral health patients for this brief: Those with any diagnosis of alcohol or substance abuse and a diagnosis of a major mental illness Those with any diagnosis of a major mental illness but no diagnosis of alcohol or substance abuse Those with any diagnosis of alcohol or substance abuse but no diagnosis of a major mental illness As noted above, all diagnoses on the patient discharge summary were considered, to identify those with behavioral health (BH) problems. The data reported here cover only adult inpatients, but they include all inpatient adult service lines. We note that this is not a report on hospitalizations for BH conditions, but of documented BH diagnoses among general inpatient hospitalizations in New York State. The unit for this analysis is always the discharge (an individual hospitalization). Prevalence and characteristics of behavioral health problems among inpatients About 537,000 adult hospitalizations in 2014 involved patients with a diagnosis of alcohol-or-substance abuse or major mental illness (as defined above). That group with what we term major behavioral health diagnoses is the focus of this paper. Representing 26.8% About 537,000 adult hospital stays at general community hospitals in NYS in 2014 involved patients with major mental illness, alcohol abuse, or other substance abuse conditions. of adult hospital stays, the group included 5.7% with both major mental illness and alcohol and/or substance abuse, 13.9% with major mental illness alone, and 7.2% with alcohol and/or substance abuse alone. Another 9.9% of the adult discharge records had a diagnosis for another (less severe) form of mental illness, and 13.8% were coded with a history of or screening for behavioral health problems. The remaining 49.6% (994,000) had The 26.8% prevalence of major BH diagnoses no BH-related problem in any of the 25 diagnostic fields. in 2014 discharges was similar to the 25.8% observed in 2013 and the 24.6% in our 2011 data. Using the SPARCS Payer Type fields, we observed similar results for the expected primary payer as we observed in The attached Table 1 shows that public programs (Medicare and Medicaid) were the expected principal payers for about three-fourths (77.1%) of the 537,000 hospitalizations involving our group of patients with major behavioral health diagnoses. Medicaid was the expected principal payer for most of the hospitalizations involving patients with underlying alcohol or substance abuse disorders (including those with or without major mental illness), and Medicare was the expected principal payer for most of the hospitalizations involving patients with major mental illness but no diagnosed alcohol or substance abuse. By comparison, Medicare accounted for the largest share (45.4%) of the 1.5 million other adult discharges without major BH conditions, and it was the expected principal payer for 71.6% of stays for the subgroup with other (non-major) forms of mental illness. The SPARCS discharge record identifies up to three expected payers, and we characterized dual eligibles based on the occurrences of both Medicaid and Medicare among the three fields. By this 4

5 convention, 16.9% (91,000) of the 537,000 major behavioral health hospitalizations involved dual eligibles. About 40% of these hospitalizations were identified as funded by Medicaid without Medicare, and about 24% as Medicare without Medicaid, based on the SPARCS Payer Type fields. Paralleling the Medicare results for expected primary payer, dual eligibles were a larger share (25.1%) of the roughly 200,000 hospitalizations among patients with other (non-major) forms of mental illness, and a lower percentage (10.2%) of the patients with no mental health diagnosis. Other chronic diseases among patients with behavioral health problems AHRQ has a long-standing interest in research on chronic conditions, and its Chronic Conditions Indicators (CCI) software provides consistent national standards to identify chronic conditions on the SPARCS inpatient discharge records. 4 We used the STATA version of the software to code all 25 diagnostic fields on each record as chronic or non-chronic. Following a suggestion at the AHRQ website, we measured chronic complexity as the number of CCS Level 1 categories for which a chronic illness was noted. 5 We linked indicators for chronic disease with the CCS Level 1 code for that diagnosis, to track the chronic disease prevalence by the CCS clinical categories. For each discharge record, this allowed us to count the number of CCS categories (body systems) that exhibit a chronic disease, instead of counting the number of discrete chronic diseases for each patient. As the attached Table 2 shows, less than a fifth (16.2%) of hospitalizations among our major behavioral health patients were free of other chronic disease. The most frequent chronic disease among those BH patients was the joint occurrence of chronic endocrine and circulatory diseases (5.1%), followed by circulatory alone (3.6%) and endocrine alone (3.4%). The table shows that various combinations of endocrine, circulatory and respiratory diseases are the most frequent constellations of chronic About five-in-six patients with major behavioral health conditions have other chronic conditions, usually involving circulatory, endocrine, or respiratory systems. conditions among our major behavioral health patients and among other patient discharges. 6 Table 3 provides another view of chronic conditions among patients with major behavioral health diagnoses, focusing on three areas often associated with preventable hospitalizations. For example, 56.0% of behavioral health patients had a chronic disease involving the circulatory system, alone or with other chronic diseases. Among other patients, chronic circulatory diagnoses were found in 57.4% of the hospitalizations. A majority of both groups (Major BH and Other) had a diagnosis for a chronic endocrine disease, and a fifth to a fourth showed evidence of chronic respiratory disease (alone or in combination). By scanning the entire set of diagnoses on the SPARCS record, we find about one-eighth of the hospitalizations in both adult groups suffer from chronic diseases affecting all three systems combined: endocrine, circulatory, and respiratory Alternatively, the Clinical Classifications Software (CCS) may be used in conjunction with the Chronic Condition Indicator in order to obtain a count of the number of relatively discrete chronic conditions. 6 Our term endocrine is a shorthand for the AHRQ category Endocrine, nutritional, and metabolic diseases and immunity disorders. 5

6 Complexity is also evident when we count the number of CCS categories with a chronic condition. As shown in Table 3, two-thirds (68.3%) of adult discharges with major behavioral health conditions had at least two other forms of chronic disease. Among the other 1.5 million hospitalizations, 71.7% had two or more chronic diseases and most had three or more. Estimating functional impairment associated with behavioral health problems As recently as 2011, an AHRQ study 7 commented that disease classification systems have given little attention to mental and substance-use conditions. Therefore, AHRQ funded the creation of a severityof-illness classification of behavioral health conditions based on day-to-day functioning in a social setting, for use with administrative hospital data. As the authors note, Day-to-day functioning in social settings is a key determinant of severity for mental and substance use conditions. Is the person able to avoid violent behavior, maintain relationships, hold a job, and/or retain a place to live in the community? That AHRQ study used data from another prominent national survey involving over 9,000 interviews related to diagnosis, social functioning, and severity of mental illness, the National Comorbidity Survey Replication (NCSR). 8 The NCSR classified persons with mental illness and alcohol/substance use based on the severity of their functional impairment over the past year. The category termed serious functional impairment included patients with a variety of diagnoses and the percentage classified as serious varied by diagnosis: for example, 83% for bipolar patients, 45% for patients with panic disorder, 29% for alcohol abusing patients, etc.. The AHRQ study linked specific ICD9 diagnoses with an estimated percentage of patients suffering serious personal or social impairment in the past year. Classifying hospital administrative records into categories of severity based on the percentage of patients assigned to the serious designation, the authors found the categories were strong predictors of hospital and emergency department use [enhancing] these predictions beyond the clinical disease prognosis algorithms that predict expected resource use. Further, Despite the limitation of the construct of expected functioning that we applied in this study, the surprisingly strong results suggest that this type of method may be an important substitute or adjunct to clinicians' judgments about severity of presenting conditions. 9 Using the study s list of conditions and percentages, we were able to look-up the probability of serious functional impairment in the past year for each behavioral health diagnosis found among the up-to-25 ICD-9 codes on the discharge record. 10 If patients with a specific ICD9 diagnosis were found to have a 48% probability of having serious functional impairment, we assigned that diagnosis a 48 on our 7 Rosanna M Coffey et al., A Severity-of-Illness Classification for Mental and Substance-Use Disorders for Use with Hospital Administrative Data [AHRQ Deliverable #480: June 10, 2011]. 8 R. C. Kessler et al., Prevalence, severity and comorbidity of 12-month DSM-IV conditions in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62: , June Coffey et al., op. cit., p The original study did not estimate the percentage of serious functional impairment for psychoses, which we set at 90%, based on data for other conditions (for example, bipolar at 83%). 6

7 scale. When more than one behavioral health diagnosis was present in the SPARCS record, we used the highest severity for that patient. Functional impairment among behavioral health patients We estimated the number of patients with serious functional impairment by summing the probabilities (severity scores) across patient records. As shown in the attached Table 4, an estimated 51.8% of hospital discharges among patients with major behavioral health diagnoses involve patients with serious functional impairment, based on applying the national prevalence of serious impairment for the behavioral health conditions to these New York State data. Of course, some caution is advised when making such a translation from national data to state populations, but there is no comparable mapping of serious functional impairment rates specifically for New York State patients. Additional caution arises from the use of prevalence data from the general population to estimate prevalence of serious impairment among inpatients with the same diagnoses. Nonetheless, absent a hospital-based survey of functional impairment, we believe this approach is useful in understanding the likelihood of functional impairment that can complicate care for behavioral health patients and the degree of such impairment across groups of patients. Finally, we repeat that our practice was to assign the highest functional impairment score when encountering multiple behavioral health diagnoses for on the discharge record. The estimated percentage of discharges that involve persons who experienced serious functional impairment in the past year as a result of their behavioral health condition varies across our three subgroups of behavioral health patients. Two-thirds (66.4%) Using national data, we estimate that 278,000 hospital stays involve adults with major behavioral health conditions and serious functional impairment in the prior year. of patients with both a diagnosed major mental illness and diagnosed alcohol-or-substance abuse are estimated to have experienced serious functional impairment in the past year. The estimate was 51.9% for those with major mental illness but no alcohol-or-substance abuse, and 40.3% for those with alcohol-or-substance abuse but no major mental illness. Across the three groups, we estimate some 278,000 adult inpatient discharges involve major behavioral health conditions with serious functional impairment (personal or social) in the prior year. These impaired patients may require additional resources either during the hospital stay or in postdischarge care, especially when their stays involve higher service weights. We used the 2014 service intensity weights available at the NYS DoH website 11 and the APR-DRG and APR-SOI data from the SPARCS record to assign a service intensity value to each discharge, highlighting those where the weight was 2.0 or greater. Among the 537,000 discharges with behavioral health problems, 12.1% (almost 65,000) had a service intensity weight of 2.0 or greater. Within that group of high-acuity patients with behavioral health problems, we estimate that nearly 28,000 annual discharges involve patients with serious functional impairment. Subject to the cautions noted above, that estimate was derived by applying the probability

8 of serious functional impairment to each of the nearly 65,000 high-acuity discharges involving patients with major behavioral health diagnoses. Table 5 shows about three-fifths of inpatients with major behavioral health problems (329,000 or 61.3%) are discharged to home. Extending the above approach, we estimate that most (53.7% or 177,000 annual discharges) involve patients who have experienced a serious functional impairment in the past year. The estimated proportion of discharges with serious functional impairment varies by discharge destination, with the highest percentage (71.3%) among those discharged to psychiatric facilities, and a sizeable 63.7% among patients going into assisted living. The estimated proportions are lowest for patients discharged to home care and hospice settings, but even there, we estimate that two out of five discharged patients with major behavioral health problems suffered serious functional impairment in the past year. We estimate that some 26,300 inpatient discharges referred to home care involve patients with major BH problems who suffered serious functional impairment in the prior year. Regional variation Discussions of healthcare redesign in New York State are increasingly adopting a regional view of needs and resources, and the geography of behavioral health needs is an important consideration in that effort. The attached tables offer an updated view of the relative standing of the Public Health and Health Planning Council regions on these behavioral health measures. As shown in Table 6, the proportion of adult hospitalizations that involve patients with major behavioral health conditions is highest among adult inpatient discharges in the Finger Lakes, Tug Hill Seaway, and Western New York regions, where it exceeds 30% of hospitalizations. The rate for the Adirondacks, Central New York, and the Capital District regions exceeds 28%. The rate for the Southern Tier is just under 28%, and the rates for the other regions are below the statewide rate of 26.8%. Patients with both a major mental illness and alcohol-or-substance abuse were 5.7% of adult discharges overall (about 1-in-18 discharges), and the rate ranged from 3.8% (about 1-in-26) on Long Island to almost double that rate (7.2%, 1-in-13) in the Tug Hill Seaway region. Table 7 shows regional variation in the proportion of adult hospital admissions that have underlying major behavioral health diagnoses and other factors that complicate their care. For example, in seven of the eleven regions, the share of adult hospitalizations that involves one or more of the major behavioral health conditions and two or more other chronic conditions approaches or exceeds one in five discharges. Across the regions, patients with major BH conditions whose treatment has a service weight of 2.0 or higher were 2.4% to 5.6% of all adult hospital stays in 2014 (from 1-in-42 to 1-in-18 discharges). Conclusion Identifying and addressing the needs of these special populations, defined by the conjunction of (a) impairment from major behavior health problems, (b) other chronic conditions associated with avoidable hospitalizations, and (c) high-intensity inpatient stays would seem to offer considerable benefit in discussions of health system redesign, quality improvement, and value-based payment. 8

9 Table 1 Payer Arrangements for Adult Inpatients with Behavioral Health Diagnoses in General Community Hospitals in 2014 Major BH Diagnoses Other Discharges A S + M M, no A S A S, no M A S M* Other BH History No BH OTHERS ALL ADULTS Total Discharges 113, , , , , , ,079 1,469,406 2,006,022 Expected Primary Payer Medicare 23.3% 54.2% 22.7% 39.2% 71.6% 52.3% 38.3% 45.4% 43.8% Medicaid 55.9% 23.5% 51.4% 37.9% 10.3% 16.9% 25.3% 21.7% 26.0% Private 14.5% 17.5% 16.3% 16.5% 14.6% 24.4% 30.5% 27.2% 24.3% Self-Pay 3.4% 1.5% 6.0% 3.1% 0.9% 2.2% 2.1% 2.0% 2.3% Others 2.8% 3.2% 3.6% 3.3% 2.6% 4.3% 3.8% 3.7% 3.6% Expected Public Payers Dual: MCR + MCD 13.4% 22.3% 9.4% 16.9% 25.1% 10.5% 10.2% 12.2% 13.5% Medicare, No Medicaid 11.0% 34.5% 14.5% 24.1% 49.0% 45.4% 30.4% 35.7% 32.6% Medicaid, no Medicare 58.3% 24.9% 53.3% 39.6% 11.1% 17.6% 26.6% 22.8% 27.3% Neither MCR or MCD 17.2% 18.4% 22.7% 19.3% 14.9% 26.5% 32.9% 29.3% 26.6% A S M: Alc/subst abuse and/or major mental illness A S + M: Alc/subst abuse and major mental illness OTHERS: No Alc/subst abuse; no major mental illness Other BH: Other mental illness M, no A S: Major mental illness without alc/subst abuse History: No current Dx, but history or screening for BH A S, no M: Alc/subst abuse without major mental illness Row entries are percentage of total discharges associated with payer (row heading). No BH No current DX and no history Sources : Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; Behavioral health categories derived from AHRQ CCS codes. See text for details. Note: NYSDoH is not responsible for the results shown in this table. Table 2 Presence of Other Chronic Conditions among Adult Inpatients with Behavioral Health Conditions and Other Adult Inpatients in 2014, by Type (AHRQ CCS) A S M* Others System(s) % of 536,616 Discharges System(s) % of 1,469,406 Discharges None 16.2% None 14.3% Endocrine + Circulatory 5.1% Endocrine + Circulatory 5.0% Circulatory Alone 3.6% Circulatory Alone 2.1% Endocrine Alone 3.4% Endocrine + Circulatory + Genitourinary 1.9% Respiratory Alone 2.2% Endocrine Alone 1.9% Nervous System Alone 2.0% Endocrine + Circulatory + Musculoskeletal 1.8% Endocrine + Circulatory + Respiratory 2.0% Endocrine + Circulatory + Digestive 1.5% Endocrine + Nervous System + Circulatory 1.9% Complications of Pregnancy, etc. 1.5% Endocrine + Circulatory + Digestive 1.8% Endocrine + Other BH + Circulatory 1.4% Digestive Alone 1.3% Endocrine + Circulatory + Respiratory 1.3% Endocrine + Circulatory + Musculoskeletal 1.2% Endocrine + Nervous System + Circulatory 1.2% *Alc/subst abuse and/or major mental illness ** Endocrine includes nutritional, metabolic and immunity disorders Sources: Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; Chronic conditions and CCS codes from AHRQ. See text for details. Note: NYSDoH is not responsible for the results shown in this table. 9

10 Table 3 Chronic Conditions among Adult Inpatients with Behavioral Health Diagnoses in 2013 Leading CCS Categories with a Chronic Diagnosis A S M* Others A S M* Others Discharges 536,616 1,469,406 Discharges 536,616 1,469,406 Percentage of Discharges Number of Non-BH CCS Categories with a Chronic Diagnosis Percentage of Discharges Circulatory 56.0% 57.4% 1 or More 83.8% 84.8% Endocrine 56.0% 61.5% 2 or More 68.3% 71.7% Respiratory 27.1% 20.9% 3 or More 50.8% 53.7% Endocr + Circ 40.7% 47.0% 5 or More 18.2% 17.6% Endocr+ Circ +Resp 14.3% 12.9% 7 or More 2.8% 2.4% *Alc/subst abuse and/or major mental illness ** Endocrine includes nutritional, metabolic and immunity disorders Sources: Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; Chronic conditions and CCS codes from AHRQ. See text for details. Note: NYSDoH is not responsible for the results shown in this table. Table 4 Functional Impairment (FI) and Service Intensity among Adult Inpatients with Diagnosed Behavioral Health (BH) Conditions: Statewide in 2014 A S M A S + M M, no A S A S, no M BH-Related Discharges 536, , , ,969 Est'd Serious BH FI 278,128 75, ,197 58,431 % BH Discharges 51.8% 66.4% 51.9% 40.3% SIW >= ,904 5,806 41,524 17,574 % BH Discharges 12.1% 5.1% 14.9% 12.1% >= Serious 27,917 3,208 18,150 6,559 % BH Discharges 5.2% 2.8% 6.5% 4.5% A S M: Alc/subst abuse and/or major mental illness A S + M: Alc/subst abuse and major mental illness M, no A S: Major mental illness without alc/subst abuse A S, no M: Alc/subst abuse without major mental illness SIW >= 2.0: Service intensity weight (case mix) 2 or greater Sources : Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; SIWs from NYS DoH website; FI estimation based on percentage with "serious" impairment in Kessler et al matched to ICD-9 codes in Coffey et al See text for references. Note: NYSDoH is not responsible for the results shown in this table. 10

11 Table 5 Discharge Destination (Disposition) of Adult Inpatients with Diagnosed Behavioral Health (BH) Conditions in 2014 and Average Severity (Percentage with Serious Functional Impairment from BH Condition) A S M A S + M M, no A S A S, no M Disposition Discharges % Severity Serious FI Discharges Severity Discharges Severity Discharges Severity Home/Indep/Outpt 329, % ,823 82, , , Home Health Care 61, % ,312 5, , , SNF for Skilled Care 58, % ,711 3, , , Inpt Rehab Facility 11, % ,261 2, , , Short-Term Hosp 10, % ,575 2, , , Assisted Living 2, % , , Hospice Facility 2, % , , Hospice Home 1, % , LTC Hospital 1, % Psychiatric Facility 10, % ,672 4, , Hospital Swing Bed % With Planned Re-ADM % Cancer or Child Hosp 1, % Federal Facility % Law Enforcement 1, % Left AMA 28, % ,792 8, , , Expired 9, % , , , All Other 6, % ,634 2, , , Grand Total 536, % , , , , A S M: Alc/subst abuse and/or major mental illness A S + M: Alc/subst abuse and major mental illness Severity: Estimated percentage with serious functional impairment from BH condition M, no A S: Major mental illness without alc/subst abuse A S, no M: Alc/subst abuse without major mental illness Sources: Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; FI estimation based on percentage with "serious" impairment in Kessler et al matched to ICD-9 codes in Coffey et al See text for references and details. Note: NYSDoH is not responsible for the results shown in this table. 11

12 Table 6 Behavioral Health Diagnoses among Adult Inpatients in General Community Hospitals in 2014 by New York State PHHPC Region ALL ADULT Major BH Diagnoses REGION DISCHARGES A S + M M, no A S A S, no M A S M* Adirondacks 24, % 18.4% 4.6% 28.7% Capital Region 79, % 16.5% 5.6% 28.4% Central NY 98, % 17.3% 6.1% 29.2% Finger Lakes 116, % 20.9% 5.8% 32.8% Long Island 290, % 12.5% 5.5% 21.7% Mid-Hudson 209, % 13.3% 5.6% 23.6% Mohawk Valley 26, % 16.0% 5.1% 26.4% NYC 840, % 11.8% 8.4% 26.2% Southern Tier 37, % 16.8% 5.7% 27.7% Tug Hill Seaway 23, % 18.0% 6.3% 31.6% Western NY 139, % 18.3% 7.5% 31.7% Total 2,006, % 13.9% 7.2% 26.8% A S + M: Alc/subst abuse and major mental illness M, no A S: Major mental illness without alc/subst abuse A S, no M: Alc/subst abuse without major mental illness A S M: Alc/subst abuse and/or major mental illness Columns are percentages of all adult discharges in that region. Total discharges include out-of-state discharges and records with patient county suppressed. Sources : Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; Behavioral health categories derived from AHRQ CCS codes. See text for details. Note: NYSDoH is not responsible for the results shown in this table. 12

13 Table 7 Behavioral Health and Other Factors for Adult Inpatients in General Community Hospitals in 2014 by New York State PHHPC Region ALL ADULT A S M Plus A S M DISCHARGES A S M* 2+ Chronic SIW 2+ Serious FI Adirondacks 24, % 21.2% 3.9% 13.9% Capital Region 82, % 21.0% 4.1% 14.0% Central NY 101, % 21.5% 4.1% 13.9% Finger Lakes 119, % 25.2% 4.7% 15.3% Long Island 299, % 14.9% 3.0% 10.8% Mid-Hudson 214, % 15.4% 2.8% 12.5% Mohawk Valley 26, % 19.5% 3.2% 12.6% NYC 849, % 16.6% 2.4% 14.5% Southern Tier 37, % 20.1% 3.9% 13.7% Tug Hill Seaway 24, % 20.9% 2.8% 15.8% Western NY 144, % 23.6% 5.6% 15.0% Total 2,056, % 18.3% 3.2% 13.9% * A S M: Alc/subst abuse and/or major mental illness 2+ Chronic: Diagnosed chronic conditions affecting ' or more CCS categories (beyond BH) SIW 2+: Service intensity weight (case mix) of 2 or greater Serious FI: Serious functional impairment from behavioral health condiions Total includes out-of-state discharges and records with patient county suppressed. Sources: Tabulation of data from NYS DoH SPARCS 2014 Limited Data file; FI estimation based on percentage with "serious" impairment in Kessler et al matched to ICD-9 codes in Coffey et al Chronic conditions and CCS codes from AHRQ. See text for details. Note: NYSDoH is not responsible for the results shown in this table. 13