Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Hosp Med. 2018 Jul;13(7):445-452. doi: 10.12788/jhm.2910.
Mental health conditions (MHCs) are prevalent among hospitalized children and could influence the success of hospital discharge. We assessed the relationship between MHCs and 30-day readmissions.
This retrospective, cross-sectional study of the 2013 Nationwide Readmissions Database included 512,997 hospitalizations of patients ages 3 to 21 years for the 10 medical and 10 procedure conditions with the highest number of 30-day readmissions. MHCs were identified by using the International Classification of Diseases, 9th Revision-Clinical Modification codes. We derived logistic regression models to measure the associations between MHC and 30-day, all-cause, unplanned readmissions, adjusting for demographic, clinical, and hospital characteristics.
An MHC was present in 17.5% of medical and 13.1% of procedure index hospitalizations. Readmission rates were 17.0% and 6.2% for medical and procedure hospitalizations, respectively. In the multivariable analysis, compared with hospitalizations with no MHC, hospitalizations with MHCs had higher odds of readmission for medical admissions (adjusted odds ratio [AOR], 1.23; 95% confidence interval [CI], 1.19-1.26] and procedure admissions (AOR, 1.24; 95% CI, 1.15-1.33). Three types of MHCs were associated with higher odds of readmission for both medical and procedure hospitalizations: depression (medical AOR, 1.57; 95% CI, 1.49-1.66; procedure AOR, 1.39; 95% CI, 1.17-1.65), substance abuse (medical AOR, 1.24; 95% CI, 1.18-1.30; procedure AOR, 1.26; 95% CI, 1.11-1.43), and multiple MHCs (medical AOR, 1.43; 95% CI, 1.37-1.50; procedure AOR, 1.26; 95% CI, 1.11-1.44).
MHCs are associated with a higher likelihood of hospital readmission in children admitted for medical conditions and procedures. Understanding the influence of MHCs on readmissions could guide strategic planning to reduce unplanned readmissions for children with cooccurring physical and mental health conditions.
精神健康状况（MHCs）在住院儿童中普遍存在，可能会影响出院的成功率。我们评估了 MHCs 与 30 天再入院之间的关系。
本研究对 2013 年全国再入院数据库进行了回顾性、横断面研究，纳入了 512997 例年龄在 3 至 21 岁的患者，这些患者因 10 种医疗和 10 种程序条件住院，这些条件的 30 天再入院率最高。MHCs 通过使用国际疾病分类，第 9 版临床修订版代码来确定。我们得出逻辑回归模型来衡量 MHCs 与 30 天、全因、非计划再入院之间的关系，调整了人口统计学、临床和医院特征。
17.5%的医疗索引住院和 13.1%的程序索引住院存在 MHC。医疗住院的再入院率为 17.0%，程序住院的再入院率为 6.2%。在多变量分析中，与没有 MHC 的住院相比，存在 MHC 的住院有更高的再入院几率，包括医疗入院（调整后的优势比[OR]，1.23；95%置信区间[CI]，1.19-1.26]）和程序入院（OR，1.24；95% CI，1.15-1.33）。三种 MHC 与医疗和程序住院的再入院几率增加有关：抑郁症（医疗 OR，1.57；95% CI，1.49-1.66；程序 OR，1.39；95% CI，1.17-1.65）、药物滥用（医疗 OR，1.24；95% CI，1.18-1.30；程序 OR，1.26；95% CI，1.11-1.43）和多种 MHC（医疗 OR，1.43；95% CI，1.37-1.50；程序 OR，1.26；95% CI，1.11-1.44）。
MHCs 与儿童因医疗条件和程序入院后的再入院可能性增加有关。了解 MHCs 对再入院的影响，可以指导战略规划，以减少患有精神和身体共病儿童的非计划再入院。
