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Chart 10 shows that the ALOS of the Medicaid patient without a secondary diagnosis of 

 substance abuse is 4.99 days. When a patient has a secondary diagnosis of drug abuse the 

 ALOS jumps to 8.4 days. With a secondary diagnosis of alcohol abuse, the ALOS increases to 

 8.94. If the patient has a secondary diagnosis of both alcohol and drug abuse, the ALOS jumps 

 to 9.83 days, nearly double the ALOS for the patient without a secondary diagnosis of substance 

 abuse. These figures represent average lengths of stay, but as can be seen from Charts 12-14, 

 some diseases demonstrate much more significant differences. 



The ALOS was in fact shorter for some patients with a secondary diagnosis of substance abuse. 

 This does not imply that these patients benefitted from the use of alcohol or drugs. Rather, the 

 differences probably result from an aberration in the data due to the small sample of patients 

 within these diagnoses, or from the financial or social undesirability of these patients, which can 

 lead to early discharge or transfer (dumping) to another facility. More research is needed to 

 examine the disposition of such patients with respect to inadequate or incomplete medical care, 

 or a lack of sufficient attention to treating their substance abuse problem. 



Chart 11 compares the ALOS by sex and age for those with and without a secondary diagnosis 

 of substance abuse. Males stay 4.2 days longer with a substance abuse problem, and females 

 3.1 days longer. 



Much of the difference in ALOS in the under 15 age group is accounted for by the effect of 

 substance abuse on newborns (see the next chart). Note that the ALOS is greater for both 

 genders and all age levels for those with a secondary diagnosis of substance abuse with the 

 exception of males in the 15-44 age bracket. Given the fact that Medicaid covers men in much 



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