Citation

Gay JC, Zima BT, Coker TR, Doupnik SK, Hall M, Rodean J, O'Neill M, Morse R, Rehm KP, Berry JG, Bardach NS. J. Pediatr. 2018; 193: 222-228.e1.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.jpeds.2017.09.058

PMID

29162345

Abstract

OBJECTIVES: To determine the proportion of US children hospitalized for a primary mental health condition who are discharged to postacute care (PAC); whether PAC discharge is associated with demographic, clinical, and hospital characteristics; and whether PAC use varies by state.
STUDY DESIGN: Retrospective cohort study of a nationally representative sample of US acute care hospitalizations for children ages 2-20 years with a primary mental health diagnosis, using the 2009 and 2012 Kids' Inpatient Databases. Discharge to PAC was used as a proxy for transfer to an inpatient mental health facility. We derived adjusted logistic regression models to assess the association of patient and hospital characteristics with discharge to PAC.
RESULTS: In 2012, 14.7% of hospitalized children (n = 248 359) had a primary mental health diagnosis. Among these, 72% (n = 178 214) had bipolar disorder, depression, or psychosis, of whom 4.9% (n = 8696) were discharged to PAC. The strongest predictors of PAC discharge were homicidal ideation (aOR, 24.9; 96% CI, 4.1-150.4), suicide and self-injury (aOR, 15.1; 95% CI, 11.7-19.4), and substance abuse-related medical illness (aOR, 5.0; 95% CI, 4.5-5.6). PAC use varied widely by state, ranging from 2.2% to 36.3%.
CONCLUSIONS: The majority of children hospitalized primarily for a mood disorder or psychosis were not discharged to PAC, and safety-related conditions were the primary drivers of the relatively few PAC discharges. There was substantial state-to-state variation. Target areas for quality improvement include improving access to PAC for children hospitalized for mood disorders or psychosis and equitable allocation of appropriate PAC resources across states.

Language: en

Keywords

Humans; United States; Child; Child, Preschool; Female; Male; Adolescent; Retrospective Studies; Young Adult; Hospitalization; Cohort Studies; Mental Health; suicidal ideation; depression; psychosis; Databases, Factual; Patient Discharge; mood disorders; Mental Disorders; psychiatric hospitalization; Patient Transfer; Subacute Care