Risk factors leading to increased rehospitalization rates among adolescents admitted to an acute care child and adolescent psychiatric hospital

McCarthy, Logan; Pullen, Lisa; Savage, Jennifer S.; Cayce, Jonathan M.

doi:10.1111/jcap.12180

Cited by 11 publications

(28 citation statements)

References 9 publications

(29 reference statements)

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“…Although few have reported on changes in LOS for pediatric mental health conditions subsequent to the ACA, 22 it has been observed that psychiatric LOS has decreased over time despite increased rates of serious illness and self-harm. 12 Given that illness severity does not seem to drive LOS and that others have found that having a managed care payer 10 was a predictor of shorter LOS, it seems plausible that administrative and insurance factors have always had a disproportionately large influence on LOS for mental health indications.…”

Section: Discussionmentioning

confidence: 99%

Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations

Connell

Rutman

Whitlock

et al. 2020

Hospital Pediatrics

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BACKGROUND: Health care reform may impact inpatient mental health services by increasing access and changing insurer incentives. We examined whether implementation of the 2014 Affordable Care Act (ACA) was associated with changes in psychiatric length of stay (LOS) and 30-day readmissions for pediatric patients. METHODS: We conducted an interrupted time-series analysis to evaluate LOS and 30-day readmissions during the 30 months before and 24 months after ACA implementation, with a 6-month wash-out period, on patients aged 4 to 17 years who were discharged from the psychiatry unit of a children's hospital. Differences by payer (Medicaid versus non-Medicaid) were examined in moderated interrupted time series. Logistic regression was used to examine the association between psychiatric LOS and 30-day readmissions. RESULTS: There were 1874 encounters in the pre-ACA period and 2186 encounters in the post-ACA period. Compared with pre-ACA implementation, post-ACA implementation was associated with LOS that was significantly decreasing over time (pre-ACA versus post-ACA slope difference: 20.10 days per encounter per month [95% confidence interval 20.17 to 20.02]; P 5 .01), especially for Medicaid-insured patients (pre-ACA versus post-ACA slope difference: 20.14 days per encounter per month [95% confidence interval 20.26 to 20.01]; P 5 .03). The overall proportion of 30-day readmissions increased significantly (pre-ACA 6%, post-ACA 10%; P , .05 for the difference). We found no association between LOS and 30-day readmissions. CONCLUSIONS: ACA implementation was associated with a decline in psychiatric inpatient LOS over time, especially for those on Medicaid, and an increase in 30-day readmissions. LOS was not associated with 30-day inpatient readmissions. Further investigation to understand the drivers of these patterns is warranted.

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Section: Discussionmentioning

confidence: 99%

Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations

Connell

Rutman

Whitlock

et al. 2020

Hospital Pediatrics

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“…Although 20 family-related risk predictors were identified across all studies, only three predictors (primary caregiver, family psychiatric history, and history of child abuse or neglect) were measured in three or more studies and thus combinable via meta-analysis (Figure 1). Youths whose primary caregiver was a parent were at lower risk of readmission, compared with those with a nonparent caretaker (6,14,19), and this relationship approached significance (OR pooled =0.63, 95% confidence interval [CI]=0.38-1.04). Heterogeneity was very low (I 2 =0.0%).…”

Section: Sociodemographic Characteristicsmentioning

confidence: 97%

“…Between 2005 and 2014, pediatric hospitalizations in U.S. children's hospitals rose five times more among children with a psychiatric diagnosis than among children without a psychiatric diagnosis (2). Recent studies suggest that one in four youths is readmitted to a psychiatric hospital within 1 year of discharge (3)(4)(5)(6), with most readmissions occurring within 3 months (7). Repeat hospitalizations disrupt social support and school performance and result in greater stigmatization for youths and their families (8,9).…”

mentioning

confidence: 99%

“…Similarly, the posited relationships between readmission and gender (13,16,19), race-ethnicity (7,13,20), guardianship status (6,16,19,21), early life stress and child abuse (6), and socioeconomic status (16,22) are multidirectional. The role of disease severity also remains unclear, with variable findings regarding primary diagnosis and symptom severity (23), comorbidity (3), self-injury, and suicidality (5,6,23,24).…”

mentioning

confidence: 99%

“…Characteristics of hospitalization may also predict readmission, such as length of stay (6,14) (LOS), access to inpatient case management services (23), and postdischarge care, including aftercare services (17), disposition to residential treatment or partial hospitalization (23), and discharge medications (21,22,25). Identifying predictors of readmission at this level can inform health policies and quality improvement interventions to mitigate cost and burden to systems and families (26).…”

mentioning

confidence: 99%

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Psychiatric Readmission of Children and Adolescents: A Systematic Review and Meta-Analysis

Edgcomb¹,

Sorter²,

Lorberg³

et al. 2020

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Objective: To investigate predictors of psychiatric hospital readmission of children and adolescents, a systematic review and meta-analysis was conducted.Methods: Following PRISMA statement guidelines, a systematic literature search of articles published between 1997 and 2018 was conducted in PubMed/MEDLINE, Google Scholar, and PsycINFO for original peer-reviewed articles investigating predictors of psychiatric hospital readmission among youths (,18 years old). Effect sizes were extracted and combined by using random-effects meta-analysis. Covariates were investigated with meta-regression and subgroup analyses.Results: Thirty-three studies met inclusion criteria, containing information on 83,361 children and adolescents, of which raw counts of readmitted vs. non-readmitted youths were available for 76,219. Of these youths, 13.2% (N=10,076) were readmitted. The mean6SD study followup was 15.9615.0 months, and time to readmission was 13.1612.8 months. Readmission was associated with, but not limited to, suicidal ideation at index hospitalization (pooled odds ratio [OR pooled ]=2.35, 95% confidence interval [CI]=1.64-3.37), psychotic disorders (OR pooled =1.87, 95% CI=1.53-2.28), prior hospitalization (OR pooled =2.51, 95% CI=1.76-3.57), and discharge to residential treatment (OR pooled =1.84, 95% CI=1.07-3.16). There was evidence of moderate study bias. Prior investigations were methodologically and substantively heterogeneous, particularly for measurement of family-level factors.

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Predicting Psychiatric Rehospitalization in Adolescents

Joyce

King

Nash

et al. 2019

Adm Policy Ment Health

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Risk factors leading to increased rehospitalization rates among adolescents admitted to an acute care child and adolescent psychiatric hospital

Abstract: Adolescent clients who are admitted to an acute psychiatric hospital with a history of self-harming behavior and extended length of stay need to be identified and individualized treatment plans implemented for preventing repeat hospitalizations.

Cited by 11 publications

References 9 publications

Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations

Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations

Psychiatric Readmission of Children and Adolescents: A Systematic Review and Meta-Analysis

Predicting Psychiatric Rehospitalization in Adolescents

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