Graduation Date

Spring 5-5-2018

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Health Services Research, Administration, and Policy

First Advisor

Fernando A. Wilson

Abstract

The main goal of this dissertation was to estimate national-level inpatient readmissions and state-level hospital-based emergency department (ED) visits with behavioral health (BH) conditions in the states of Nebraska and New York. The dissertation aims to assess the impact of the policy mandates under the Patient Protection and Affordable Care Act on these state and national estimates. The Nationwide Readmissions Database and the State Emergency Department databases maintained by the Healthcare Cost and Utilization Project were used for this dissertation. US Adult population with high-risk of readmissions in the inpatient departments for alcohol-related disorders (ARD) and of visiting ED for BH conditions were identified. Prediction of economic burden due to 30-day readmissions, specifically for recurrences of ARD, patient and hospital-level rates, costs, and predictors of 30-day readmissions were derived at the national level. Region-level data on ED facilities and BH workforce in Nebraska were obtained from the Health Professionals Tracking Services. In addition, the location of substance abuse treatment centers and ED facilities in New York were procured from the National Survey of Substance Abuse Treatment Services and the National Emergency Department Inventory, respectively. To identify BH conditions, International Classification of Diseases, Ninth Revision, Clinical Modification codes were used. Estimates of total charges for ED visits in Nebraska and New York were performed along with an assessment of the availability of substance abuse treatment centers, BH workforce, and EDs. The dissertation underlines the need for integrated behavioral health services at a primary level and development of preventative health programs tailored specifically for high-risk populations.

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