(176) Implementation of Proactive Consultation-Liaison Model: Use of ICD-10 Data for Targeted Adoption in a Veteran Population

Abstract:

Background:

Multi-organ comorbidity among veterans substantially increases health care utilization and spending in this population (Zulman, 2015). CL psychiatry is well positioned to address the high burden of mental health needs of veterans with medical comorbidities given its collaborative role within healthcare. Proactive CL is an innovative model shown to be effective in caring for patients within the hospital while reducing length of stay and decreasing overall cost (Oldham, 2021). To date, though, a proactive model has not been studied within the Veteran’s Administration (VA). We examined local data to inform implementation of a proactive service in this population.



Methods:

Using the VA’s computerized patient record system (CPRS), we studied F-series ICD-10 diagnoses coded by primary teams and psychiatric consultants corresponding to dementia, delirium, psychotic disorders, bipolar affective disorders, depression, anxiety disorders, PTSD, personality disorders and substance use disorders (UD) including alcohol, opioid, cannabis, cocaine, nicotine, and stimulants in veterans admitted to the VA greater Los Angeles medical, surgical and ICU units between 01/01/2019 and 12/31/2021. Using logistic regression, we calculated the likelihood of receiving diagnoses groupings among inpatients receiving psychiatric consultation compared to admissions without consult.



Results:

The sample consisted of 4,400 veterans with relevant ICD-10 diagnoses coded without psychiatric consultation and 670 psychiatric consults. Prevalence of diagnosis groupings within medicine, surgery, and ICU, (compared with psychiatry consultation) were as follows: Dementia: 21.5% (41.1%), Delirium: 5.5% (20.4%), Alcohol UD: 25.2% (32.5%), Opioid UD: 10.2% (16.5%), Cannabis UD: 9.2% (15.1%), Cocaine UD: 9.9% (16.4%), Nicotine UD: 22.5% (25.6%), Stimulant UD: 12.9% (26.6%), Psychotic Disorders: 11.6% (31.9%), Bipolar Affective Disorders: 16.7% (33.5%), Depression: 48.5% (59.7%), Anxiety Disorders: 26.6% (34.4%), PTSD: 50.0% (54.5%), and Personality Disorders: 5.4% (17.7%). The odds of diagnosis were higher in every grouping among veterans receiving a consult (except cannabis and cocaine UDs) and all were statistically significant (except PTSD and alcohol, cannabis, cocaine, and nicotine UDs).



Discussion:

Veterans who received psychiatric consultation were 6.97 times more likely to be diagnosed with delirium, 4.17 times with psychotic disorders, 3.70 times with personality disorders and 3.42 times with dementia. These results suggest an under-recognition of delirium and highlight additional avenues of potential intervention in veterans with neurocognitive disorders, severe persistent mental illness, and personality disorders. Future directions include using existing local ICD-10 data to develop targeted proactive models to address site-specific demands at VA hospitals nationwide.



References:

(1) Zulman 2015. DOI: 10.1136/bmjopen-2015-007771.

(2) Oldham 2021. DOI: 10.1016/j.jaclp.2021.01.005.