Stories written by Alan Shafer

Inpatient Psychiatric Hospitalization in Texas 1999 to 2010 - 09/03/2019

The primary purpose of the study was to examine the role public sector payers (Medicare and Medicaid) and providers (Texas state mental health hospitals) play in psychiatric hospitalization, using Texas annual hospital discharge files from 1999 to 2010. Psychiatric hospitalization, as defined by a primary behavioral health diagnosis (ICD-9 diagnoses 290-314.99) averaged 146,876 discharges per year, approximately 5.24% of all hospitalizations in the state. Children younger than 18 years accounted for 27,035 discharges per year. The top 4 diagnostic groups were depression (29%), bipolar disorder (22%), schizophrenia (18%), and alcohol-drug disorders (14%). More patients with schizophrenia or other psychotic disorders were served by the public sector, while more patients with depression or alcohol-drug disorders were served by private insurance. Interestingly, patients with bipolar disorder were distributed relatively evenly across both payment groups and ages. Length of stay decreased fr...


Cancer Incidence Among Texas Publicly Funded Substance Abuse Treatment Clients - 10/08/2018

In this study, the authors examine the incidence of cancer among a large cohort of patients receiving Texas Department of State Health Services publicly funded substance abuse treatment services between 2005 and 2009. We hypothesized that substance abuse patients would have an increased incidence of cancer, especially cancers associated with alcohol misuse, tobacco use, and opiate dependence. We compared cancer incidence among 119,237 substance abuse patients with those in the Texas general population as reported to the Texas Cancer Registry. The cohort was 60% male; and 50% white, 30% Hispanic, and 20% black. Mean age at the start of follow-up was 47.6 years (SD, 10.5 years), with mean follow-up time of 2.4 years (SD, 1.5 years). Primary drug dependency was 30% alcohol; 25% cocaine; 15% opiate; 13% amphetamine or methamphetamine; and 17% marijuana or other drugs. Almost 75% of the patients used tobacco regularly. The overall age-adjusted incidence rate was lower for substance abusers ...


The Journal of Texas Medicine: March 2013 - 05/13/2016

We explored the characteristics of general medical hospital admissions for patients in state mental health hospitals. Data were extracted from a statewide database of all hospital discharges for 5 years identified as general medical hospital admissions that occurred during the stay of patients at state mental health hospitals. Across the 9 mental health hospitals in the state system, rates of admission to general medical hospitals varied significantly from 0.7% to 3.7%. On average, of the 1.9% of all state mental health inpatients who had a general hospital admission, 25% occurred within 4 days of admission to the mental hospital. The average general hospitalization lasted 5.7 days. The reported total charge for all stays was $34 million. Dehydration (15%), hypertension (10%), and diabetes (10%) were the most frequent diagnoses. Thirteen percent of diagnoses met preventable hospitalization criteria. Given the variability among hospitals in admission rates and the number of preventable ...