1. Behavioral health effects inpatient costs and utilization of diabetes related lower extremity complications Zachary Gustin and Jonathan Labovitz, DPM Western University of Health Sciences, College of Podiatric Medicine
INTRODUCTION
RESULTS
Integrating behavioral health into overall medical care is a method of improving patient well-being since psychological disorders and addiction significantly impacts clinical outcomes. Other than the effect of alcohol addiction on the cost of diabetes mellitus (DM) management, the impact of behavioral health conditions on cost of care and resource utilization is unknown.1
In addition, cognitive deficits frequent in DM negatively impact self-care and elevate the risk of ulcers and amputations. Meanwhile, depression increases the risk of ulcers, non-healing ulcers and amputations.2-5 However, the effect specific behavioral health conditions have on cost and utilization involving DM related lower extremity (LE) complications is lacking.
Purpose: To determine the economic impact of behavioral health conditions on DM LE complications to improve value-based care.
Acute Care Costs
Condition Present
Condition Absent
Anxiety
$ 18,910
$ 15,277
Depression
$ 16,008
$ 15,620
Major Depression
$ 14,180
$ 15,695
Bipolar Disorder
$ 13,434
$ 15,712
Alcohol Abuse
$ 16,226
$ 15,636
Drug Abuse
$ 14,797
$ 15,715
Anxiety
Depression
Alcohol abuse
Increased Cost
Bipolar disorder
Drug abuse
Increased LOS
P < 0.01
P < 0.05
Major depression
Decreased Cost
Decreased LOS
Length of Stay
Condition Present
Condition Absent
Anxiety
6.8
5.1
Depression
6.5
5.2
Major Depression
4.9
5.3
Bipolar Disorder
6.6
Alcohol Abuse
5.9
Drug Abuse
5.8
METHODS
CONCLUSIONS
Patients with Type 2 DM, LE complications and behavioral health conditions identified by ICD-9 codes in the CA Office of Statewide Health Planning and Development public discharge files using CUPID 2.0 software (SpeedTrack, Inc., Placentia, CA).
DM and complications were primary diagnosis or first five secondary diagnoses.
Adjusted cost to 2014 US dollar; cost and length of stay (LOS) by Elixhauser comorbidity measures
Significance of behavioral health conditions using t-test (p< 0.05)
Most behavioral health disorders and addictions examined significantly increased utilization in DM related LE complications. Cost and resource consumption in acute care settings reinforces integrating behavioral health to improve value-based care in DM related lower extremity complications.
OBJECTIVES
REFERENCES
French M, Mundt M, Fleming M, Zavala S. The cost of medical care for patients with diabetes, hypertension and both conditions: does alcohol use play a role? Journal of Internal Medicine [serial online]. n.d.;258(1): Available from: Science Citation Index, Ipswich, MA. Accessed April 22, 2017.
Natovich R, Kushnir T, Harman-Boehm I, et al. Cognitive Dysfunction: Part and Parcel of the Diabetic Foot. Diabetes Care 2016; 39(7):
Tseng CL, Sambamoorthi U, Helmer D, et al. The association between mental health functioning and nontraumatic lower extremity amputations in veterans with diabetes. General Hospital Psychiatry 2007; 59(6):
Williams, Lisa H., et al. "Depression and incident diabetic foot ulcers: a prospective cohort study." The American Journal of Medicine 2010; 123(8):
Williams, Lisa H., et al. "Depression and incident lower limb amputations in veterans with diabetes." Journal of Diabetes and its Complications 2011; 25(3):