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Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition - 31/01/18

Doi : 10.1016/j.jpeds.2017.09.058 
James C. Gay, MD, MMHC 1, Bonnie T. Zima, MD, MPH 2, Tumaini R. Coker, MD, MBA 3, Stephanie K. Doupnik, MD, MS 4, 5, Matthew Hall, PhD 6, Jonathan Rodean, MS 6, Margaret O'Neill, BS 7, Rustin Morse, MD, MMM 8, Kris P. Rehm, MD 1, Jay G. Berry, MD, MPH 7, Naomi S. Bardach, MD, MAS 9
1 Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 
2 UCLA Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 
3 University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA 
4 Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 
5 The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA 
6 Children's Hospital Association, Lenexa, KS 
7 Department of Pediatrics, Boston Children's Hospital, Boston, MA 
8 Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX 
9 Department of Pediatrics and Philip R. Lee Institute of Health Policy Studies, UCSF School of Medicine, San Francisco, CA 

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.

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Keywords : suicidal ideation, depression, psychosis, mood disorders, psychiatric hospitalization

Abbreviations : ICD-9-CM, KID, PAC


Plan


 N.B. received research support from the Agency for Healthcare Research and Quality (U18HS025291). J.B. received research support from the Agency for Healthcare Research and Quality (R21 HS023092-01). S.D. received research support from the a National Research Service Award (T32-HP010026-11). B.Z. received research support from the Mental Health Centers of Excellence for California (SB852). The authors declare no conflicts of interest.


© 2017  Elsevier Inc. Tous droits réservés.
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Vol 193

P. 222 - février 2018 Retour au numéro
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