Inpatient Utilization of Mental Health Care among Service Members: 2005-2017
The visualizations here describe trends in utilization of inpatient services in the Military Health System (MHS) among active duty service members (ADSM) diagnosed with mental health disorders within either direct or purchased care settings (depicted separately in the two dashboards below). To assess inpatient utilization for each mental health condition, we calculated three metrics of interest:
- Total hospitalizations with a diagnosis
- Bed days per hospitalization (BDPH)
- Hospitalization rates for each disorder of interest
Interpreting Purchased Care Graphs
Purchased care settings include civilian facilities that accept TRICARE. Providers are civilian providers and are neither directly employed nor managed by the MHS.
ADSMs are prioritized for care in direct care settings and therefore receive the vast majority of their care there. With that in mind, we can expect more utilization metrics for Service members within the purchased care realm (immediately above) to be much lower than those seen in the direct care setting.
Insomnia is rarely a diagnosed condition during inpatient hospitalization visits among this population. As a precaution, all inpatient insomnia metrics have been completely suppressed from this page to protect individual privacy.
In 2017, the average length of time a Service member spent in the hospital when admitted with an adjustment disorder was about 8 days before being discharged.
Bed days per hospitalization and hospitalization rates help to understand the severity of cases for a given condition. Higher hospitalization rates suggest that more patients who are diagnosed actually end up in the hospital for the condition, and higher bed days per hospitalization suggest that hospitalizations for that condition are more severe.
Hospitalizations are included if they were coded with a diagnosed mental health disorder in the first or second diagnostic position. Care is delivered in the MHS in two settings: direct care (i.e., military treatment facilities) and purchased care (i.e., civilian facilities). To understand where ADSMs are hospitalized for mental health disorders, the first two inpatient utilization metrics are separated by setting: direct care in the first set of graphs and purchased care in the second set of graphs. However, to understand the likelihood (or risk) of hospitalization associated with particular psychological health conditions, hospitalization rates combine data from both direct and purchased care to describe the total number of hospitalizations with a diagnosis of interest per 100 diagnosed patients. Diagnosis codes for each disorder were identified using the Armed Forces Health Surveillance Branch case definitions which use International Classification of Diseases (ICD) codes. Of note, hospitalizations for insomnia are so rare that all insomnia hospitalization metrics are suppressed to protect individual privacy.
Utilization metrics reported here are derived from raw counts of mental health hospitalizations in the MHS. All metrics are represented by crude numbers and unadjusted rates. Comparison between services or components should be made with caution.
Administrative health care data only captures information when medical services are used and its accuracy is limited by how providers record medical encounters. The utilization estimates only describe patients who both seek care and receive a diagnosis for a given condition. Patients who seek care but do not receive a particular diagnosis, as well as those patients who do not seek care at all, are not represented in these estimates. Consequently, the true impact of a particular condition on both patients and the MHS is likely underestimated by the data shown here.
Psychological Health Center of Excellence (2018, December). Psychological Health by the Numbers: Inpatient Utilization of Mental Health Care among Active Duty Service Members, 2005-2017. Available at: https://www.pdhealth.mil/utilization_inpatient. Defense Health Agency: Falls Church, VA.
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