title: Health care utilization in dementia patients with psychiatric comorbidity.
abstract: OBJECTIVE
  The purpose of this research was to determine if differences in service use exist between dementia patients with and without psychiatric comorbidity.
  
  
  METHODS
  A retrospective cohort study was conducted on all Veterans Affairs (VA) beneficiaries seen at the Houston Veterans Affairs Medical Center with a VA Outpatient Clinic File diagnosis of dementia in 1997. The primary dependent measure was amount of Houston VA health service use from study entry until the end of fiscal year 1999 or until death.
  
  
  RESULTS
  Of the 864 dementia patients in the identified cohort, two thirds had a comorbid psychiatric diagnosis. Examination of 2-year health service use revealed that, after adjusting for demographic and medical comorbidity differences, dementia patients with psychiatric comorbidity had increased medical and psychiatric inpatient days of care and more psychiatric outpatient visits compared with patients without psychiatric comorbidity.
  
  
  CONCLUSIONS
  Further understanding of the current health service use of dementia patients with psychiatric comorbidity may help to establish a framework for considering change in the current system of care. A coordinated system of care with interdisciplinary teamwork may provide both cost-effective and optimal treatment for dementia patients.
authors.affiliation: VAMC, Houston, TX 77030, USA. mkunik@bcm.tmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.forename: Victor A
authors.initials: VA
authors.lastname: Molinari
authors.forename: Terri J
authors.initials: TJ
authors.lastname: Menke
authors.forename: Julianne
authors.initials: J
authors.lastname: Souchek
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.forename: Carol M
authors.initials: CM
authors.lastname: Ashton
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013781:Texas / Q000453:epidemiology; D014728:Veterans