Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition.

Autor: Gay JC; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN., Zima BT; UCLA Semel Institute for Neuroscience and Human Behavior, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA., Coker TR; University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA., Doupnik SK; Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA., Hall M; Children's Hospital Association, Lenexa, KS., Rodean J; Children's Hospital Association, Lenexa, KS., O'Neill M; Department of Pediatrics, Boston Children's Hospital, Boston, MA., Morse R; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX., Rehm KP; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN., Berry JG; Department of Pediatrics, Boston Children's Hospital, Boston, MA., Bardach NS; Department of Pediatrics and Philip R. Lee Institute of Health Policy Studies, UCSF School of Medicine, San Francisco, CA.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2018 Feb; Vol. 193, pp. 222-228.e1. Date of Electronic Publication: 2017 Nov 20.
DOI: 10.1016/j.jpeds.2017.09.058
Abstrakt: 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.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: