Mental health visits high in Hawaii’s hospitals

HONOLULU — A new study of Hawaii’s hospitals mandated under President Barack Obama’s sweeping health care overhaul shows more patients were hospitalized for mental health issues in 2011 than any other preventable cause.

The state’s Community Health Needs Assessment released Wednesday shows mental health causes accounted for 5,180 hospital visits in Hawaii in 2011. That’s well above the next highest cause, heart failure, with 2,954 visits.

The hospitalization rates for preventable causes are one measurement in a report designed to help the vast majority of Hawaii’s hospitals set priorities over the next few years. The assessment was required for nonprofit hospitals under the new federal law.

President George Greene of the Healthcare Association of Hawaii says the study sets benchmarks for hospitals to measure progress against every three years.

“We’re drawing a line in the sand here in 2013,” Greene said. The association’s members include all the acute care hospitals in Hawaii, plus other providers. “I’m very excited about looking forward six years from now, nine years from now, looking back on 2013 and saying that was the year that we figured out where we needed to focus our efforts and began to do that work.”

Low-income families, people in rural areas, veterans, Native Hawaiians and migrants under the Compact of Free Association have the most difficulty accessing mental health care, because of insurance coverage and others issues, the study said. The vast majority of hospital visits, more than 92 percent, came from people ages 18 to 64, a group that makes up only 63 percent of the overall population.

Heart failure hospitalization rates were highest on Oahu, likely because of higher population density compared with the availability of special needs care, the study said. But the study said hospitalizations for high blood pressure were evidence of particularly poor heart health on the Big Island. The study identified heart disease and stroke as a top issue for Hawaii in terms of populations within the state and in comparison with the rest of the country.

“The lack of healthy eating and exercise behaviors in Hawaii largely contribute to poor cardiovascular health,” the assessment said. “Those living in low-income areas are disproportionately affected, and resources are not effectively reaching those most in need.”

Loretta Fuddy, director of the Hawaii Health Department, said the assessment helps state officials and health care providers look at social factors that affect health, like access to fresh food and communities that encourage walking and other physical activity.

“We know that the social status, our economics, our environment are conditions that lead to our health conditions,” Fuddy said.

All but two of Hawaii’s 28 hospitals participated, including hospitals on all the state’s islands besides Niihau. Tripler Army Medical Center and Hawaii State Hospital were not required to do the assessment under the law. Besides measuring hospitalization rates, the assessment was built on interviews with key community members, state officials and others, and reviewed the state’s demographics and other data.

Other top health issues for Hawaii include respiratory diseases, family planning and diabetes, the study said.

Each hospital is required to come up with its own plans for how to move forward by the end of their 2012 fiscal year, Greene said.

Ginny Pressler, executive vice president for strategic business development for Hawaii Pacific Health, said hospitals have previously been focused on what happens when patients arrive, but that’s changing. Hawaii Pacific runs four hospitals, plus more than 50 clinics and service centers.

“Long gone are the days when hospitals were only responsible for what happens with patients within their four walls,” Pressler said. “Now we’re talking about taking care of patients before they’re admitted and after they’re admitted, and in fact being more and more accountable for preventing them from being hospitalized in the first place.”