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Health Services Research & Development

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2005 HSR&D National Meeting Abstract

1068 — The Undiagnosed Substance Use Disorder Patient in VA Nursing Homes

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Research shows that substance use disorder (SUD), a significant chronic mental health problem, is often underdiagnosed in older patients seeking medical care. This study aimed to determine the extent to which known SUDs are documented among patients entering VA nursing homes (VANHs) and to identify patient and program characteristics related to accuracy of SUD diagnoses in the VANH record.

A 20% random sample of VANH admissions in FY02 was identified (n = 5820) from the National Patient Care Database (NPCD). Recent diagnoses and patient demographic characteristics were obtained from NPCD files covering inpatient, outpatient, and extended care episodes in FY02 and FY01. Chi-square, analysis of variance, and logistic regressions were used to examine factors related to documentation of SUD diagnoses in the NH record.

Approximately 17% of FY02 VANH admissions had a SUD diagnosis in the current or prior year; fewer than half the patients with a recent SUD diagnosis had this diagnosis recorded during their VANH stay. Accuracy of SUD diagnoses was independent of demographic characteristics, except that older patients were more likely than younger patients to have SUD diagnoses missing from their VANH record. With age controlled, the numbers of medical and of mental health problems in the patient’s NH record were not related to accuracy of SUD diagnoses. Diagnostic accuracy varied markedly between NHs but was not related to facility size or SUD prevalence.

This study found that many of the older patients who enter VANHs with recent SUD diagnoses do not have these diagnoses recorded during their NH stay and that older age seems to interfere with detecting and documenting SUDs in VANHs. Some VANHs appear to systematically assess patients for SUDs, whereas others essentially ignore this aspect of patient functioning.

Failure to diagnose SUDs in VANH patients may diminish quality of care and treatment effectiveness in relation to both medical comorbidities and substance use problems. Educational efforts to increase awareness of SUDs in VANH may result in improved detection, documentation, and treatment effectiveness. Researchers also need to be aware of underreporting of SUDs in extended care databases.

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