Common and Costly Hospitalizations for Pediatric Mental Health Disorders

Abstract

BACKGROUND AND OBJECTIVES: Inpatient pediatric mental health is a priority topic for national quality measurement and improvement, but nationally representative data on the patients admitted or their diagnoses are lacking. Our objectives were: to describe pediatric mental health hospitalizations at general medical facilities admitting children nationally; to assess which pediatric mental health diagnoses are frequent and costly at these hospitals; and to examine whether the most frequent diagnoses are similar to those at free-standing children’s hospitals. METHODS: We examined all discharges in 2009 for patients aged 3 to 20 years in the nationally representative Kids’ Inpatient Database (KID) and in the Pediatric Health Information System (free-standing children’s hospitals). Main outcomes were frequency of International Classification of Diseases, Ninth Revision, Clinical Modification–defined mental health diagnostic groupings (primary and nonprimary diagnosis) and, using KID, resource utilization (defined by diagnostic grouping aggregate annual charges). RESULTS: Nearly 10% of pediatric hospitalizations nationally were for a primary mental health diagnosis, compared with 3% of hospitalizations at free-standing children’s hospitals. Predictors of hospitalizations for a primary mental health problem were older age, male gender, white race, and insurance type. Nationally, the most frequent and costly primary mental health diagnoses were depression (44.1% of all mental health admissions; $1.33 billion), bipolar disorder (18.1%; $702 million), and psychosis (12.1%; $540 million). CONCLUSIONS: We identified the child mental health inpatient diagnoses with the highest frequency and highest costs as depression, bipolar disorder, and psychosis, with substance abuse an important comorbid diagnosis. These diagnoses can be used as priority conditions for pediatric mental health inpatient quality measurement.

Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

“…32,33 Our fi ndings are consistent with other studies showing that complex chronically ill children at freestanding children's hospitals have a relatively high burden of mental health comorbidities. 4 As hospitals develop budgets and place greater emphasis on revenue-generating ser vices, the effect of PCLS on pediatric inpatient care should not be under estimated. These services are typically not part of the larger profit producers in hospital settings; therefore, demonstrating cost-offset through shortened hospital stays and decreased health care charges is an important way to demonstrate the value of PCLS at pediatric institutions.…”

“…8 One of the 2 most frequent diagnostic categories in our study was depressive disorders (29%), consistent with a recent study which found that depression is the most common mental health diagnosis in freestanding children's hospitals for patients aged 3 to 20 years. 4 Studies have shown that patients with less overt psychiatric symptoms such as depression are at risk for delayed identifi cation and assistance and, therefore, have a more protracted hospital course. 21,24 Hospital initiatives that can expedite referral to PCLS, such as nursing screens for depression and suicide risk and in-service programs for hospital staff by PCLS, can be benefi cial in promptly addressing the needs of depressed youth with medical problems.…”

Medically Hospitalized Patients With Eating Disorders and Somatoform Disorders in Pediatrics: What Are Their Similarities and Differences and How Can We Improve Their Care?

“…Studies have revealed that close to 10% of pediatric hospitalizations within the United States are for primary mental health diagnoses, 1 and that inpatient admissions for mental health problems among youth increased 24% from 2007 to 2010, 2 thus highlighting the substantial burden of pediatric mental illness. Eating disorders (ED) are one of the most common causes of hospitalizations due to a primary mental health diagnosis seen in free-standing children' s hospitals in the United States 1 and accounted for 5.5% of the pediatric hospitalizations with a primary mental health diagnosis at free-standing children' s hospitals in 2009.…”

“…Eating disorders (ED) are one of the most common causes of hospitalizations due to a primary mental health diagnosis seen in free-standing children' s hospitals in the United States 1 and accounted for 5.5% of the pediatric hospitalizations with a primary mental health diagnosis at free-standing children' s hospitals in 2009. 1 Patients with ED, particularly anorexia nervosa, have the highest mortality rate of any psychiatric disorder 3 and tend to have medical hospitalizations as a result of complications from their illness, such as cardiac dysrhythmias, malnutrition, hypotension, and hypokalemia. 4 Similarly, patients with somatoform disorders (SFD) are at risk for frequent hospitalizations because of their physical symptoms and place a significant burden on the health care delivery system, with twice the inpatient medical care use and twice the medical care costs of nonsomatizing patients.…”

“…7 Admission to the hospital is associated with greater functional impairment compared with the outpatient setting, 4,6 and inpatient pediatric mental health has been identified as a priority area for national quality measurement and improvement. 1,8 Understanding the characteristics of patients with primary psychiatric disorders like ED and SFD, who are often medically hospitalized in pediatric settings, is the first step toward establishing foundational knowledge to guide future quality improvement and integrated care efforts. Although it is well documented that patients with ED and SFD have higher rates of health care use across multiple health care settings compared with the general population 5,9 and that psychological factors, such as denial, poor motivation, alexithymia (ie, difficulty identifying and verbally expressing feelings), and limited insight affect their health care use, [10][11][12][13] it is not known if they use services with the same rates and patterns.…”