Admissions to the state hospital: a one-year study.
Abstract: Admission to one of the state hospitals in West Virginia is gained through a legal proceeding which is initiated on a county level. It was hypothesized that involuntary psychiatric admission patterns from the Sharpe Hospital catchment area do not have a direct correlation with county population.

Methods: Sharpe Hospital admissions data for a one year period were collected and demographic data from counties within the hospital catchment area was obtained for comparison.

Results: Involuntary psychiatric admissions from the Sharpe Hospital catchment area do not correlate directly with county population, supporting the hypothesis that factors besides county population explain differences in admission patterns. Socioeconomic status, diversion of admissions to other hospitals and proximity to the state hospital do not fully explain the differences.

Conclusion: Rates of admission were found to vary widely from counties in the Sharpe Hospital catchment area. Local evaluation and treatment variables and patient-specific factors such as diagnosis, comorbid substance dependence, and psychiatric history warrant further study to guide planning
Article Type: Report
Subject: Psychiatric hospital care (Management)
Psychiatric hospitals (Management)
Mentally ill (Care and treatment)
Mental health (Planning)
Mental health (Government finance)
Hospitals (Admission and discharge)
Hospitals (Statistics)
Authors: France, Cheryl A.
Mogge, Neil L.
Pub Date: 03/01/2010
Publication: Name: West Virginia Medical Journal Publisher: West Virginia State Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 West Virginia State Medical Association ISSN: 0043-3284
Issue: Date: March-April, 2010 Source Volume: 106 Source Issue: 2
Topic: Event Code: 200 Management dynamics; 680 Labor Distribution by Employer; 220 Strategy & planning; 900 Government expenditures Computer Subject: Company business management; Company business planning
Product: Product Code: 8063000 Psychiatric Hospitals NAICS Code: 62221 Psychiatric and Substance Abuse Hospitals SIC Code: 8063 Psychiatric hospitals
Accession Number: 223908174
Full Text: Introduction

There are at present, two inpatient acute care mental health facilities operated by the West Virginia Dept of Health and Human Resources with a total of 240 beds to serve the mentally ill population of West Virginia. Each hospital has a designated catchment area with corresponding Community Mental Health Centers. William R. Sharpe, Jr. Hospital is a 150 bed facility located in Lewis County that serves 42 of West Virginia's 55 counties. Mildred Mitchell Bateman Hospital in Huntington has 90 beds and admits patients from 13 counties. All admissions to the hospital are involuntary, either through civil commitment or, in the case of forensic patients, through court order via the judicial system. Civilly committed patients are admitted along catchment area lines with few exceptions. Forensic patients from the entire state are initially admitted to the forensic program at Sharpe.

The procedure by which an involuntary psychiatric admission occurs is outlined in West Virginia Code Chapter 27 (1); in summary, the process begins with application in the community, examination by a licensed physician or mental health professional designated by the area mental health center, and a mental hygiene hearing at the county level. If "probable cause" is found that the person is mentally ill or addicted and dangerous, then an order is entered for placement at a mental health facility.

Since 2002 the census at Sharpe Hospital has nearly consistently been above its designed capacity of 150 patients. When this is the case, attempts are made to divert admissions to non-DHHR inpatient facilities willing to accept involuntary patients. The inpatient stay for these patients is funded by the state. It was evident from casual observation at Sharpe Hospital that more admissions came from some counties than others. The authors chose to quantify these observations and to study other variables related to admissions in an attempt to determine current admission patterns and to consider best practices to respond on a hospital level. However, since each patient is admitted through a county-level process, analysis of Sharpe Hospital admission patterns in light of variables within the catchment area counties would be important for state level planning for psychiatric treatment. Various patient-specific (e.g. poverty and diagnosis) and external (e.g. population and proximity to hospital) factors have been shown to positively predict rates of psychiatric admission (2) and recent data reveals a trend toward increasing forensic patient populations. (3) Additionally, admission to a public mental health facility and involuntary admission both have been associated with greater severity of illness (4) and low socioeconomic status and service quality at the local level. (5) Our initial analysis considered Sharpe Hospital catchment area demographic data to test the hypothesis that the number of involuntary admissions at Sharpe from each county does not directly correlate with the population of the county but is also impacted by other variables; therefore, rates are not constant across the catchment area.

Methods

The research project was approved by the William R. Sharpe, Jr. Hospital Research Committee. The database of information relating to admission numbers, counties from which referrals came, legal status, and diversions to other hospitals was obtained from archival sources, with the cooperation of Sharpe's Health Information Management and Admissions personnel. All admissions from April 1, 2007 through March 31, 2008 were studied. The data was transferred into S.P.S.S. (Statistical Package for the Social Sciences, Version 10, 2004, SPSS Inc.) and analyzed. Data was subsequently entered into Microsoft Office Excel 2003 (Copyright 1985-2003 Microsoft Corporation) for calculation of rates, rank sorting and graphing. Population data was obtained from the United States Census Bureau (6) for calculation of rates per 100,000 population in each county.

Results

During the year of this study, there were 840 admissions to Sharpe Hospital. Overall, 794, or 94.5%, of all involuntary admissions were from within Sharpe's catchment area, 34, or 4%, were from Bateman's catchment area and 12, or 1.4%, were from out of state. Seventy-three, or 8.7%, of the 840 admissions were court-ordered forensic patients, with 22, or 30.1%, of these coming from outside of Sharpe's catchment area.

Our hypothesis that involuntary hospitalizations do not directly correlate with county population was supported by the data. Rates of admission to Sharpe range from 0 to 168 with a mean of 69. Wood County, with the third largest population, had the highest rate of admission and admitted 145 (17.3%) of the overall total, more than double that of any other county. Taylor, Calhoun, Tyler and Pendleton Counties follow Wood County in rate of admissions; but in that their populations are small, their actual impact on Sharpe admissions is limited. In contrast to Wood County, the most populous county in the Sharpe catchment area, Berkeley County, had only 18 admissions, ranking it 37 out the 42 counties in rate.

The number of patients from Sharpe's catchment area diverted to other facilities and not admitted to the state hospital was also considered as a potentially confounding variable so this data was analyzed. There were ten hospitals that admitted patients under probable cause status as diversions; more patients were actually diverted than admitted to the state hospital. Most of the diversion hospitals accept primarily (or almost exclusively in some cases) patients from their own or nearby counties. As can be seen from Table 1, several counties diverted more patients than they admitted; there are diversion hospitals in these counties or very nearby.

The county rates of total involuntary admissions either to Sharpe or a diversion hospital were calculated as these rates actually reflect state-funded psychiatric admissions from the catchment area. These rates differ substantially for some counties from the rates of admission to Sharpe Hospital and range from 0 to 568. For example, Ohio County, the 9th most populous county, located in the Northern Panhandle, had 217 diversions with only 35 Sharpe Hospital admissions and had the highest rate of diversion as well as total involuntary admission in the catchment area. It should be noted that the local mental health center is located adjacent to a general hospital with an inpatient psychiatric unit; the majority of commitments from this catchment area were admitted to this unit. The three very populous counties in the Eastern Panhandle, Morgan, Jefferson, and Berkeley, had the lowest total rates of admission.

Graphical representation by scatterplot of the relationship between both Sharpe admissions and total involuntary admissions (Chart 1) tends to be positive overall; however, covariance is not linear over the entire range of values, the small number of admissions from some counties and the broad range of rates preclude statistically valid correlation analyses.

To further explore the disparity between admission numbers from various counties in Sharpe's catchment area, the United States Census Bureau data regarding poverty level and estimated household income for 2007 was also obtained7. Rates of poverty were calculated based on population for the 42 counties in the catchment area. To assess the relationship between involuntary admission rates, poverty rates, and median income, correlation coefficients were calculated. This relationship is graphically illustrated in Charts 2 and 3. The correlations between involuntary admission rates and median income (r= -0.10) and rate of poverty (r=0.12) were reflective of no relationship.

[GRAPHIC 1 OMITTED]

Proximity to the state hospital also appears to have a limited correlation with admission rates to Sharpe Hospital. Lewis County, the location of Sharpe Hospital, ranked sixth in rate. Wood County, first in rate, is approximately an hour and three quarters drive from Sharpe. Most of the counties with low rates of admission to Sharpe (e.g. the Eastern Panhandle) are at a considerable distance from Sharpe, but Spencer in Roane County is only fifty miles from Weston and is second to last in rate of admissions. Though all adult patients in West Virginia involuntarily hospitalized through the mental hygiene process come to the state hospital or an in-state diversion hospital, it is possible that lower rates are found, especially in border counties, due to patient evaluation and hospitalization at an out of state facility.

[GRAPHIC 2 OMITTED]

[GRAPHIC 3 OMITTED]

Discussion

The finding that variation in admission rates across the catchment area is not explained by differences in population, socioeconomic status, or proximity to the state hospital is consistent with prior studies. (5) Local mental health center staff may reasonably make the case for commitment with the mental hygiene commissioner if a patient is poor with inadequate housing, living in a remote area with limited access to outpatient treatment, and has no other access to hospitalization due to having no payer source. Study of individual characteristics of patients referred for evaluation at West Virginia mental health centers and subsequently involuntarily hospitalized may elucidate some correlative factors. It has certainly been demonstrated that the needs of remote rural patient populations pose unique challenges when attempts are made to provide ethical and adequate mental health care. (8) However, there has also been evidence to indicate that non-clinical, non-patient factors are even more likely to play significant role in involuntary treatment decisions. (9) Lorant's Belgian study determined that lack of a less restrictive alternative was the most crucial factor driving the decision for involuntary treatment; more than patient refusal, dangerousness, diagnosis, housing status, or other factors. (10) His findings are consistent with studies done in the United States. (11,12) In Lorant's study, more than half of those referred for evaluation were not committed. All of the evaluations were performed by psychiatrists at a teaching hospital psychiatric emergency room, a notable difference which may have impacted outcomes (13); in West Virginia, a mental health center nonphysician is usually the evaluator. Medical clearance, if it occurs, is done after the hearing. If the symptoms warranting commitment are found to be secondary to a medical etiology or intoxication, the patient may still be involuntarily psychiatrically hospitalized since probable cause has already been found, unless a medical condition, once discovered, justifies acute medical hospitalization. Our study was limited to patients who were involuntarily hospitalized; so the rate of patients evaluated and not committed in each county is unknown. We are currently collecting data for further study on patients admitted to Sharpe Hospital with medical conditions necessitating transfer to an acute care medical hospital.

The level and type of outpatient services, which were not examined for this study, vary greatly between mental health centers and may contribute to the differences in involuntary admission rates. Local operational norms, level of professional accountability for assessment decisions, organizational culture and support in decisions to care for a patient in the community, perceptions of conditions at the state hospital, and whether or not involuntary hospitalization is considered a "last resort" option all have been shown to influence the compulsory admission threshold. (9,14)

[ILLUSTRATION OMITTED]

Similarly, the impact of state-financed diversion admissions on readiness to petition for involuntary treatment is unknown. In theory, it is beneficial to the patient and their family, the diversion hospital with open bed space, and the Sheriff's Department transporting personnel to keep the treatment local. For a patient who wants and needs treatment but has limited resources for receiving inpatient or outpatient services, it may seem more justifiable to make the case for involuntary treatment even when a patient is actually willing to receive it and may have presented to the diverting hospital requesting it. As legislative decisions are made to address overcrowding at state psychiatric facilities, the following issues warrant consideration: data suggests a positive correlation between rates of compulsory admission and number of psychiatric beds (13), transfers of patients to state funded treatment may be economically-motivated, especially if there is no incentive to provide treatment in another setting (15), and increasing inpatient beds without developing comprehensive outpatient treatment (which is also costly) to care for discharged patients (16,17), may only serve to increase state hospital use by those who are already high users (18) or the number of long stay patients awaiting an appropriate placement.

Conclusion

Rates of admission to Sharpe Hospital and overall involuntary admission rates vary by county in the Sharpe Hospital catchment area. Further study of local evaluation and treatment variables as well as patient specific factors such as diagnosis, co morbid substance dependence, and psychiatric hospitalization history and length of stay is warranted to guide mental health planning and funding allocation.

References

(1.) West Virginia Legislature West Virginia Code Chapter 27. Mentally ill persons. http://www.legis.state.wv.us/WVCODE/Code.cfm?chap=27&art=1. Accessed December 30, 2008.

(2.) Almog M Curtis S, Copeland A, Congdon, P, Geographical variation in acute psychiatric admissions within New York City 19902000: growing inequalities in service use? Soc Sci Med. 2004;59(2):361-376.

(3.) Manderscheid RW, Atay JE, Crider RA, Changing trends in state psychiatric hospital use from 2002 to 2005. Psychiatr Serv. 2009; 60(1):29-34.

(4.) Hugo M, Comparative efficiency ratings between public and private acute inpatient facilities. Aust N Z J Psychiatry. 2000;34(4):651-657.

(5.) Bindman J, Tighe J, Thornicroft G, Leese M, Poverty, poor services, and compulsory psychiatric admission in England, Soc Psychiatry Psychiatric Epidemiol, 2002;37(7):341-345.

(6.) County-level Population Data for West Virginia. http://ers.usda.gov/Data/ Population/PopList.asp?TheState=WV%2 CWest+Virginia. Accessed October 2, 2008.

(7.) U.S. Census Bureau, Small Area Estimates Branch. 2007 Poverty and Median Income Estimates-Counties. http://www.census.gov/did/www/saipe/downloads/estmod07/est07ALL.xls. Accessed December 23, 2008.

(8.) Weiss Roberts L, Battaglia J, Epstein R S, Frontier ethics: mental health care needs and ethical dilemmas in rural communities. Psychiatr Serv. 1999;50(4):97-503.

(9.) Quirk A, Lelliott P, Audini B, Buston K, Nonclinical and extra-legal influences on decisions about compulsory admission to psychiatric hospital. J Ment Health. 2003;12(2):119-130.

(10.) Lorant V, Depuydt C, Gillain B, Guillet A, Dubois V, Involuntary commitment in psychiatric care: what drives the decision? Soc Psychiatry Psychiatr Epidemiol. 2007;42(5):360-365.

(11.) Lincoln A, Psychiatric emergency room decision-making, social control and the 'undeserving sick'. Sociol Health Illn. 2006;28:54-75.

(12.) Segal S, Laurie T, Segal M, Factors in the use of coercive retention in civil commitment evaluations in psychiatric emergency services. Psychiatr Ser. 2001;52(4):514-520.

(13.) deStephano A, Ducci G, Involuntary admission and compulsory treatment in Europe. Int J Ment Health. 2008(1);37:10-21.

(14.) Encandela JA, Korr W, Lidz CW, Mulvey EP, Slawinski T, Discretionary use of involuntary commitment by case managers of mental health clients: a case study of divergent views. Clin Soc Work J. 1999;27(4):397-411.

(15.) Schlesinger M, Dorwart R, Hoover C, Epstein S, The determinants of dumping: a national study of economically motivated transfers involving mental health care. Health Serv Res. 1997;32(5):561-590.

(16.) Bond G, Drake R, Mueser K, Latimer E, Assertive community treatment for people with severe mental illness: critical ingredients and impact on patients. Dis Manag Health Outcomes. 2001;9(3):11-159.

(17.) Joy CB, Adams CE, Rice K, Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev. 2006;4(3):CD001087.

(18.) Semke J, Kamara S, Hendryx M, Stegner B, State mental hospitals in Washington state in an era of policy change. Adm Policy Ment Health. 2001;20(1):51-65.

Cheryl A. France, M.D.

Assistant Professor, WVU Department of Behavioral Medicine, Geriatric Subspecialist

William R. Sharpe, Jr. Hospital

Neil L. Mogge, Ph.D.

Professor, WVU Department of Behavioral Medicine, Director of Psychology

William R. Sharpe, Jr. Hospital
TABLE 1: SUMMARY OF SHARPE HOSPITAL ADMISSIONS AND COUNTY
DEMOGRAPHIC DATA

                                        Sharpe       Sharpe
                            2007      Admissions   Admissions
COUNTY                   POPULATION     Total       Forensic

Barbour County              15,532           13            2
Berkeley County             99,734           18            5
Braxton County              14,639           11            0
Brooke County               23,661            9            0
Calhoun County               7,201           11            0
Doddridge County             7,262            5            1
Fayette County              46,334            8            2
Gilmer County                6,907            5            0
Grant County                11,925            6            0
Greenbrier County           34,586           30            1
Hampshire County            22,577            7            1
Hancock County              30,189            5            0
Hardy County                13,661            6            3
Harrison County             68,309           71            4
Jackson County              28,223           21            0
Jefferson County            50,832            7            1
Lewis County                17,145           19            1
Marion County               56,728           55            1
Marshall County             33,148           16            1
Mineral County              26,722            8            0
Monongalia County           87,516           50            3
Monroe County               13,537            4            1
Morgan County               16,351            0            0
Nicholas County             26,160           14            1
Ohio County                 44,398           35            6
Pendleton County             7,650            9            1
Pleasants County             7,183            5            0
Pocahontas County            8,571            7            0
Preston County              30,254           27            1
Raleigh County              79,170           53            8
Randolph County             28,292           18            2
Ritchie County              10,371            7            0
Roane County                15,295            2            0
Summers County              13,202            7            0
Taylor County               16,117           26            0
Tucker County                6,868            6            0
Tyler County                 8,952           12            0
Upshur County               23,508           15            2
Webster County               9,435            6            0
Wetzel County               16,432           11            1
Wirt County                  5,809            4            0
Wood County                 86,088          145            2
Out of State                   N/A           12            1

Bateman Catchment Area         N/A           34           21

Sharpe Catchment Area    1,176,474          794           51

TOTAL (^)                                   840           73

                          Percent         Rate
                           Sharpe        Sharpe        Sharpe
COUNTY                   Admissions   Admissions *   Diversions

Barbour County                1.5%          83.70            6
Berkeley County               2.1%          18.05           11
Braxton County                1.3%          75.14            2
Brooke County                 1.1%          38.04            6
Calhoun County                1.3%         152.76            1
Doddridge County              0.6%          68.85            0
Fayette County                1.0%          17.27           13
Gilmer County                 0.6%          72.39            0
Grant County                  0.7%          50.31            2
Greenbrier County             3.6%          86.74           16
Hampshire County              0.8%          31.01            1
Hancock County                0.6%          16.56           10
Hardy County                  0.7%          43.92            5
Harrison County               8.5%         103.94           34
Jackson County                2.5%          74.41           24
Jefferson County              0.8%          13.77            5
Lewis County                  2.3%         110.82           12
Marion County                 6.5%          96.95           54
Marshall County               1.9%          48.27           87
Mineral County                1.0%          29.94            5
Monongalia County             6.0%          57.13          142
Monroe County                 0.5%          29.55            5
Morgan County                 0.0%           0.00            0
Nicholas County               1.7%          53.52           13
Ohio County                   4.2%          78.83          217
Pendleton County              1.1%         117.65            3
Pleasants County              0.6%          69.61            2
Pocahontas County             0.8%          81.67           20
Preston County                3.2%          89.24           19
Raleigh County                6.3%          66.94          111
Randolph County               2.1%          63.62            6
Ritchie County                0.8%          67.50            2
Roane County                  0.2%          13.08            7
Summers County                0.8%          53.02            4
Taylor County                 3.1%         161.32           28
Tucker County                 0.7%          87.36            5
Tyler County                  1.4%         134.05            6
Upshur County                 1.8%          63.81            7
Webster County                0.7%          63.59            2
Wetzel County                 1.3%          66.94           56
Wirt County                   0.5%          68.86            0
Wood County                  17.3%         168.43          142
Out of State                  1.4%            N/A            0

Bateman Catchment Area        4.0%            N/A            5

Sharpe Catchment Area        94.5%          67.49        1,091

TOTAL (^)                   100.0%                       1,096

                          Percent         Rate          Total
                           Sharpe        Sharpe      Involuntary
COUNTY                   Diversions   Diversions *    Admissions

Barbour County                0.5%          38.63            19
Berkeley County               1.0%          11.03            29
Braxton County                0.2%          13.66            13
Brooke County                 0.5%          25.36            15
Calhoun County                0.1%          13.89            12
Doddridge County              0.0%           0.00             5
Fayette County                1.2%          28.06            21
Gilmer County                 0.0%           0.00             5
Grant County                  0.2%          16.77             8
Greenbrier County             1.5%          46.26            46
Hampshire County              0.1%           4.43             8
Hancock County                0.9%          33.12            15
Hardy County                  0.5%          36.60            11
Harrison County               3.1%          49.77           105
Jackson County                2.2%          85.04            45
Jefferson County              0.5%           9.84            12
Lewis County                  1.1%          69.99            31
Marion County                 4.9%          95.19           109
Marshall County               7.9%         262.46           103
Mineral County                0.5%          18.71            13
Monongalia County            13.0%         162.26           192
Monroe County                 0.5%          36.94             9
Morgan County                 0.0%           0.00             0
Nicholas County               1.2%          49.69            27
Ohio County                  19.8%         488.76           252
Pendleton County              0.3%          39.22            12
Pleasants County              0.2%          27.84             7
Pocahontas County             1.8%         233.35            27
Preston County                1.7%          62.80            46
Raleigh County               10.1%         140.20           164
Randolph County               0.5%          21.21            24
Ritchie County                0.2%          19.28             9
Roane County                  0.6%          45.77             9
Summers County                0.4%          30.30            11
Taylor County                 2.6%         173.73            54
Tucker County                 0.5%          72.80            11
Tyler County                  0.5%          67.02            18
Upshur County                 0.6%          29.78            22
Webster County                0.2%          21.20             8
Wetzel County                 5.1%         340.80            67
Wirt County                   0.0%           0.00             4
Wood County                  13.0%         164.95           287
Out of State                  0.0%            N/A           N/A

Bateman Catchment Area        0.5%            N/A           N/A

Sharpe Catchment Area        99.5%          92.73         1,885

TOTAL (^)                   100.0%                        1,936

                                                        2007
                           Percent         Rate       Poverty
                         Involuntary   Involuntary    Estimate
COUNTY                   Admissions    Admissions *   All Ages

Barbour County                 1.0%         122.33      3,476
Berkeley County                1.5%          29.08      9,936
Braxton County                 0.7%          88.80      3,137
Brooke County                  0.8%          63.40      2,777
Calhoun County                 0.6%         166.64      1,582
Doddridge County               0.3%          68.85      1,264
Fayette County                 1.1%          45.32     10,584
Gilmer County                  0.3%          72.39      1,467
Grant County                   0.4%          67.09      1,746
Greenbrier County              2.4%         133.00      6,066
Hampshire County               0.4%          35.43      3,606
Hancock County                 0.8%          49.69      3,779
Hardy County                   0.6%          80.52      1,737
Harrison County                5.4%         153.71     12,585
Jackson County                 2.3%         159.44      4,363
Jefferson County               0.6%          23.61      4,099
Lewis County                   1.6%         180.81      3,152
Marion County                  5.6%         192.14      7,854
Marshall County                5.3%         310.73      8,856
Mineral County                 0.7%          48.65      4,056
Monongalia County              9.9%         219.39     13,101
Monroe County                  0.5%          66.48      1,992
Morgan County                  0.0%           0.00      1,762
Nicholas County                1.4%         103.21      4,898
Ohio County                   13.0%         567.59      7,121
Pendleton County               0.6%         156.86      1,027
Pleasants County               0.4%          97.45        923
Pocahontas County              1.4%         315.02      1,296
Preston County                 2.4%         152.05      4,927
Raleigh County                 8.5%         207.15     12,610
Randolph County                1.2%          84.83      5,096
Ritchie County                 0.5%          86.78      1,752
Roane County                   0.5%          58.84      3,445
Summers County                 0.6%          83.32      2,860
Taylor County                  2.8%         335.05      2,801
Tucker County                  0.6%         160.16      1,102
Tyler County                   0.9%         201.07      1,655
Upshur County                  1.1%          93.59      4,510
Webster County                 0.4%          84.79      2,351
Wetzel County                  3.5%         407.74      2,667
Wirt County                    0.2%          68.86      1,078
Wood County                   14.8%         333.38     13,842
Out of State                    N/A            N/A        N/A

Bateman Catchment Area          N/A            N/A        N/A

Sharpe Catchment Area         97.4%         160.22    188,938

TOTAL (^)                    100.0%

                                      2007
                           2007      Median
                         Poverty    Household
COUNTY                    Rate *     Income

Barbour County            22,380      28,826
Berkeley County            9,963      52,566
Braxton County            21,429      31,616
Brooke County             11,737      39,601
Calhoun County            21,969      27,791
Doddridge County          17,406      34,145
Fayette County            22,843      30,312
Gilmer County             21,239      34,355
Grant County              14,642      36,361
Greenbrier County         17,539      33,163
Hampshire County          15,972      36,217
Hancock County            12,518      39,378
Hardy County              12,715      37,336
Harrison County           18,424      38,063
Jackson County            15,459      40,978
Jefferson County           8,064      61,219
Lewis County              18,384      34,223
Marion County             13,845      38,000
Marshall County           26,717      33,804
Mineral County            15,179      35,929
Monongalia County         14,970      40,889
Monroe County             14,715      35,034
Morgan County             10,776      44,162
Nicholas County           18,723      38,813
Ohio County               16,039      38,757
Pendleton County          13,425      36,019
Pleasants County          12,850      40,539
Pocahontas County         15,121      31,832
Preston County            16,285      35,567
Raleigh County            15,928      37,261
Randolph County           18,012      33,472
Ritchie County            16,893      34,329
Roane County              22,524      30,175
Summers County            21,663      27,021
Taylor County             17,379      34,804
Tucker County             16,045      32,755
Tyler County              18,487      35,271
Upshur County             19,185      34,687
Webster County            24,918      27,521
Wetzel County             16,231      36,397
Wirt County               18,557      36,850
Wood County               16,079      39,910
Out of State                 N/A         N/A

Bateman Catchment Area       N/A         N/A

Sharpe Catchment Area     16,060      36,332

TOTAL (^)

* Rates calculated per 100,000 population

A Total admissions referred through Sharpe Hospital
admissions process
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