Table 3.
Hospital- and system-level factors associated with Elixhauser Comorbidity Index scores in 14,458 inpatient psychiatric admissions.4
| Variable | Total N (col %) (N=14458) | ECI ≥ 1 (row %) (N=10834) | Unadjusted OR (99% CI) | Adjusted OR (99% CI) |
|---|---|---|---|---|
| Hospital-level variables | ||||
|
| ||||
| Number of hospital beds | ||||
| Small: less than 100 | 177 (1.2) | 76.3 | Reference | Reference |
| Medium: 100–499 | 7587 (52.5) | 75.1 | 0.94 (0.40–2.19) | 0.54 (0.35–0.83) |
| Large: 500 or more | 6694 (46.3) | 74.7 | 0.92 (0.39–2.15) | 0.54 (0.34–0.86) |
| Hospital ownership | ||||
| Public | 3986 (27.6) | 74.8 | Reference | Reference |
| Private not-for-profit | 10387 (71.8) | 75.2 | 1.02 (0.83–1.25) | 1.03 (0.85–1.24) |
| Private for-profit | 85 (0.6) | 52.9 | 0.38 (0.26–0.56) | 0.67 (0.38–1.16) |
| Psychiatric discharges that were Medicaid, % | ||||
| Low: less than 49% (Q1) | 1865 (12.9) | 73.3 | Reference | Reference |
| Medium: 49–71% | 7857 (54.3) | 74.4 | 1.06 (0.87–1.28) | 1.01 (0.83–1.24) |
| High: over 71% (Q3) | 4736 (32.8) | 76.5 | 1.18 (0.95–1.47) | 1.08 (0.77–1.53) |
| Teaching hospital | ||||
| No | 925 (6.4) | 72.8 | Reference | Reference |
| Yes | 13533 (93.6) | 75.1 | 1.13 (0.87–1.47) | 1.06 (0.77–1.46) |
| Population w/ ≥ 2 psych discharges, % | ||||
| Low: less than 24.5% (Q1) | 1273 (8.8) | 70.2 | Reference | Reference |
| Medium: 24.5–35% | 8021 (55.5) | 74.7 | 1.25 (0.98–1.60) | 0.93 (0.69–1.25) |
| High: over 35% (Q3) | 5164 (35.7) | 76.5 | 1.38 (1.06–1.79) | 1.00 (0.70–1.43) |
|
| ||||
| System-level variables | ||||
|
| ||||
| County population in poverty, % | ||||
| Low: less than 15% | 4552 (31.7) | 73.7 | Reference | Reference |
| Medium: 15–19% | 5666 (39.5) | 74.0 | 1.02 (0.86–1.20) | 1.00 (0.78–1.28) |
| High: 20% or higher | 4134 (28.8) | 77.5 | 1.23 (1.02–1.49) | 1.14 (0.83–1.55) |
| Urban/rural classification | ||||
| Large central metro | 8169 (56.9) | 75.6 | Reference | Reference |
| Large fringe metro | 2478 (17.3) | 72.6 | 0.86 (0.72–1.02) | 0.96 (0.74–1.24) |
| Medium metro | 1495 (10.4) | 74.8 | 0.96 (0.81–1.14) | 1.14 (0.85–1.54) |
| Small metro | 832 (5.8) | 73.3 | 0.89 (0.75–1.06) | 1.16 (0.85–1.56) |
| Micropolitan | 1072 (7.5) | 75.6 | 1.00 (0.76–1.32) | 1.24 (0.85–1.82) |
| Noncore | 306 (2.1) | 77.8 | 1.130 (0.82–1.56) | 1.25 (0.83–1.88) |
Sources: (1) Medicaid claims records and clinician data; (2) the 2012–2013 American Hospital Association Annual Survey; (3) the 2012–2013 Health Resources and Human Services Administration Area Resource File; and (4) a 2012–2013 New York State (NYS) Managed Behavioral Healthcare Organizations (MBHOs) Discharge File created during a statewide quality assurance program in which NYS contracted with five MBHOs in geographically distinct regions to review fee-for-service inpatient psychiatric admissions. Data includes patients ages 18–64 admitted to an inpatient psychiatric unit during 2012–2013 with a principal diagnosis of any mental disorder; Elixhauser Comorbidity Index (ECI) scores based on clinical diagnoses during the 12 months prior to each unique individual’s initial inpatient admission.