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Open Access Research article

Schizophrenia and potentially preventable hospitalizations in the United States: a retrospective cross-sectional study

Elizabeth Khaykin Cahoon1, Emma E McGinty2, Daniel E Ford3 and Gail L Daumit3*

Author Affiliations

1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

2 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

3 Johns Hopkins Medical Institutions, Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 East Monument Street, Room 2-513, Baltimore, MD, USA

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BMC Psychiatry 2013, 13:37  doi:10.1186/1471-244X-13-37

Published: 25 January 2013

Abstract

Background

Persons with schizophrenia may face barriers to high quality primary care due to communication difficulties, cognitive impairment, lack of social support, and fragmentation of healthcare delivery services. As a result, this group may be at high risk for ambulatory care sensitive (ACS) hospitalizations, defined as hospitalizations potentially preventable by timely primary care. The goal of this study was to determine if schizophrenia is associated with overall, acute, and chronic ACS hospitalizations in the United States (US).

Methods

We conducted a retrospective cross-sectional study. Hospitalization data for the US were obtained from the Nationwide Inpatient Sample for years 2003–2008. We examined 15,275,337 medical and surgical discharges for adults aged 18–64, 182,423 of which had a secondary diagnosis of schizophrenia. ACS hospitalizations were measured using the Agency for Healthcare Research and Quality’s Prevention Quality Indicators (PQIs). We developed logistic regression models to obtain nationally-weighted odds ratios (OR) for ACS hospitalizations, comparing those with and without a secondary diagnosis of schizophrenia after adjusting for patient, hospitalization, and hospital characteristics.

Results

Schizophrenia was associated with increased odds of hospitalization for acute ACS conditions (OR = 1.34; 95% CI: 1.31, 1.38), as well as for chronic ACS conditions characterized by short-term exacerbations. Schizophrenia was associated with decreased odds of hospitalization for diabetes mellitus long-term complications and diabetes-related lower extremity amputation, conditions characterized by long-term deterioration.

Conclusions

Additional research is needed to determine which individual and health systems factors contribute to the increased odds of hospitalization for acute PQIs in schizophrenia.

Keywords:
Schizophrenia; Ambulatory care-sensitive condition; Preventable hospitalization; Primary care; United States