Hospital Discharges for Mental Illness in the Veterans Health Administration

In order to better understand the nature of inpatient care in the Veterans Health Administration (VHA), we compared the 10 most common discharge diagnoses for fiscal year 2008 with the top 10 discharge diagnoses in United States community hospitals in 2007. Using the principal discharge diagnosis, we identified the 10 most common discharge diagnoses in VHA and the Nationwide Inpatient Sample (NIS). Because VHA does not provide labor and delivery services or hospital care for children, we eliminated hospitalizations for labor and delivery as well as those for individuals < 18 years of age from the NIS data. There were 588,856 hospital discharges from VHA hospitals, and 30.6 million in the NIS. In VHA, 3 major categories of conditions accounted for about one third each of the 10 most common discharges: cardiac (34%), pulmonary (30%), and mental illness (30%), including affective psychoses, schizophrenia, and alcohol dependence syndrome. Compared with community hospitals, proportionally more VHA hospitalizations were due to mental illness and/or alcohol use disorders (9.1% versus 3.3%). In VHA, hospital discharges with a principal diagnosis of mental illness were among the 10 most common discharges, with affective psychoses ranking first. As a percentage of all discharges for adults, these 3 diagnoses accounted for almost 3 times the proportion of similar hospitalizations in United States community hospitals.