Factors Related to Psychiatric Hospital Readmission Among Children and Adolescents in State Custody

Romansky, Jill; Lyons, John S.; Lehner, Renanah K.; West, Courtney M.

doi:10.1176/appi.ps.54.3.356

Cited by 90 publications

(129 citation statements)

References 61 publications

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“…Children with ASD or other developmental disabilities may be at greater risk for psychiatric hospitalization than children with other disorders (Gallaher et al 2002;Romansky et al 2003;Saeed et al 2003;Walsh et al 1997). Studies have found that a quarter of children with ASD served in community mental health settings have been psychiatrically hospitalized and that children with ASD have five times the Medicaid-reimbursed expenditures for inpatient psychiatric care of children with mental retardation and 20 times that of children with other psychiatric diagnoses (Croen et al 2006;Mandell et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric Hospitalization Among Children with Autism Spectrum Disorders

Mandell

2007

J Autism Dev Disord

155

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This study examined predictors of psychiatric hospitalization among children with autism spectrum disorders (ASD). Data were collected from 760 caregivers of children with ASD. Cox regression was used to determine factors associated with hospitalization. Almost 11% were hospitalized. Youth in single parent homes were more likely to be hospitalized (OR = 2.54), as were youth diagnosed at a later age (OR = 1.10). Engaging in self-injurious behavior (OR = 2.14), aggressive behavior (OR = 4.83), and being diagnosed with depression (OR = 2.48) or obsessive compulsive disorder (OR = 2.35) increased the odds of hospitalization. Risk for hospitalization increased with age and over time. The results suggest early diagnosis and community-based interventions for aggressive and selfinjurious behaviors may reduce hospitalizations.

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Section: Introductionmentioning

confidence: 99%

Psychiatric Hospitalization Among Children with Autism Spectrum Disorders

Mandell

2007

J Autism Dev Disord

155

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“…As hospitals continue to adapt to a changing health care environment where resources are limited and pressures to reduce lengths of stay are great, more information is needed about effective strategies to reduce readmissions. Understanding factors that contribute to readmission is essential not only for continued quality improvement, but also for the development of targeted prevention programs aimed at those at greatest risk.The few existing studies (Arnold et al, 2003;Blader, 2004;Romansky, Lyons, Lehner, & West, 2003) that have examined predictors of readmission among children and adolescents vary considerably with regard to design (retrospective versus prospective), data source (hospital records versus administrative data), operational definition of readmission (to the same hospital versus any hospital in the state or managed care network), population (publicly insured versus privately insured), and type of predictor variables examined. Consequently, methodological differences across studies make it difficult to integrate findings or draw definitive conclusions about factors that lead to readmissions.…”

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confidence: 99%

“…Some investigators (e.g., Arnold et al, 2003;Foster, 1999;Pavkov, Goerge, & Lee, 1997) have found an association between child's age and readmission, while others (e.g., Blader, 2004; Cornsweet-Barber & Evans, 1999;Romansky et al, 2003) have not. Neither race nor gender has been found to consistently predict readmission (Arnold et al, 2003;Blader, 2004;Foster, 1999;Pavkov et al, 1997;Romansky et al, 2003).The strong association between various clinical factors and readmission, particularly diagnosis and severity of symptoms, is well documented in the research literature; youths diagnosed with affective, behavioral disorders and/or psychoses with more severe symptoms are at greater risk for readmission (Arnold et al, 2003;Blader, 2004;Foster, 1999;Pavkov et al, 1997). The influence of other clinical factors such as suicidal and homicidal behavior, history of abuse, and comorbidity is less clear and has not been consistently examined by researchers.…”

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The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Fontanella

2008

American Journal of Orthopsychiatry

103

124

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This study examined predictors of readmission for a sample of 522 adolescents enrolled in Medicaid and admitted to three inpatient psychiatric hospitals in Maryland. Comprehensive data on clinical, treatment, and health care system characteristics were collected from archival sources (medical records, Medicaid claims, and Area Resource File). Predictors of readmission were examined with bivariate (Kaplan Meier) and multivariate (Cox Regression) survival techniques. One year readmission rates were 38% with the majority occurring within 3 months after discharge. Adolescent demographic (age and gender), clinical (severity of symptoms, comorbidity, suicidality) and family characteristics (level of family risk) were associated with readmission. However, treatment factors including type of aftercare, post-discharge living environment, medication noncompliance, and hospital provider were among the strongest predictors of readmission. Study findings underscore the importance of careful discharge planning and linkage to appropriate aftercare. The differing rates of readmission across hospitals also suggest that organizational level factors may play a vital role in determining treatment outcomes. Keywords inpatient psychiatric hospitalization; adolescents; readmissionIt is estimated that 24% to 37% of youths will be readmitted to a psychiatric hospital within one year after discharge, and latest data suggest that rates of readmission are increasing despite cost-containment efforts and emphasis on community-based treatment alternatives (Blader, 2004;Fontanella, Zuravin, & Burry, 2006;Pavkov, Goerge, Lee, & Howard, 1994; Soloman, Evans, & Delaney, 1993). In the United States, inpatient services account for about 33% ($3.9 billion) of the total mental health expenditures for children and adolescents; across age groups adolescents are the highest users of inpatient services (Ringel & Sturm, 2001).Some researchers speculate that the increased readmission rates can be attributed to premature discharges resulting from shortened lengths of stay (Appley, Desai, Luchins, Gibbons, & Hedeker, 1993;Lien, 2002;Wickizer, Lessler, & Boyd-Wickizer, 1999). In fact, studies on Medicaid populations (Callahan, Shepard, Beinecke, Larson, & Cavanaugh, 1995;Dickey, Normand, Norton, Rupp, & Azeni, 2001;Saunders & Heflinger, 2003) have shown increasesCorrespondence concerning this article should be addressed to Cynthia A. Fontanella, College of Social Work, The Ohio State University, 1947 College Road, Columbus, Ohio 43210. E-mail: fontanella.4@osu.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. ...

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“…Two prior studies of rehospitalization risk included a significant number of preadolescents in cohorts that combined children and adolescents (mean age 13 years), but the samples comprised dependents of military personnel (Foster, 1999) and children in state custody (Romansky et al, 2003). Another study followed a predominantly adolescent sample discharged from longterm state hospitals (mean age 14.5 years) (Pavkov et al, 1997); this group may not generalize to the majority of hospitalized children, who are admitted to acute-care units (Pottick et al, 2000).…”

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confidence: 99%

Symptom, Family, and Service Predictors of Children's Psychiatric Rehospitalization Within One Year of Discharge

Blader

2004

Journal of the American Academy of Child & Adolescent Psych

123

135

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Objective-To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization.Method-One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via the Cox proportional hazards model, were symptom and family factors assessed at admission, aspects of psychiatric treatment, and demographic variables.Results-The Kaplan-Meier rehospitalization risk within 1 year of discharge, taking into account known readmissions and censored observations, was 0.37. Most readmissions (81%) occurred within 90 days of discharge. Four variables contributed simultaneously to predicting readmission risk. More severe conduct problems, harsh parental discipline, and disengaged parent-child relations conferred a higher risk for rehospitalization; these risks were attenuated when parents disclosed higher stress in their parenting roles. Conclusions-Findingsshowed that psychiatric rehospitalization of children is common, most likely in the trimester after discharge, and highly related to both child symptoms and family factors measurable at admission. Results suggest that efforts to improve postdischarge outcomes of children should target the initial period following inpatient care, address vigorously the complex treatment needs of those with severe conduct problems, and aim to improve parent-child relations.

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Factors Related to Psychiatric Hospital Readmission Among Children and Adolescents in State Custody

Cited by 90 publications

References 61 publications

Psychiatric Hospitalization Among Children with Autism Spectrum Disorders

Psychiatric Hospitalization Among Children with Autism Spectrum Disorders

The influence of clinical, treatment, and healthcare system characteristics on psychiatric readmission of adolescents.

Symptom, Family, and Service Predictors of Children's Psychiatric Rehospitalization Within One Year of Discharge

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