Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO; Children's Hospital Association, Lenexa, KS.
J Pediatr. 2021 Feb;229:240-246.e1. doi: 10.1016/j.jpeds.2020.09.067. Epub 2020 Oct 1.
To identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based on location of hospitalization.
This is a retrospective cohort analysis of US rural children aged 0-18 years with a mental health hospitalization between January 1, 2014, and November 30, 2014, using the 2014 Agency for Healthcare Research and Quality's Nationwide Readmissions Database. Hospitalizations for rural children were categorized by children's hospitals, metropolitan non-children's hospitals, or rural hospitals. Associations between hospital location and outcomes were assessed with logistic (readmission) and negative binomial regression (length of stay [LOS]) models. Classification and regression trees (CART) were used to describe the characteristics of most common hospitalizations at a rural hospital.
Of 21 666 mental health hospitalizations of rural children, 20.6% were at rural hospitals. After adjustment for clinical and demographic characteristics, LOS was higher at metropolitan non-children's and children's hospitals compared with rural hospitals (LOS: adjusted rate ratio [aRR], 1.35 [95% CI 1.29-1.41] and 1.33 [95% CI, 1.25-1.41]; P < .01 for all). The 30-day readmission was lower at metropolitan non-children's and children's hospitals compared with rural hospitals (aOR, 0.73 [95% CI, 0.63-0.84] and 0.59 [95% CI, 0.48-0.71]; P < .001 for all). Adolescent males living in poverty with externalizing behavior disorder had the highest percentage of hospitalization at rural hospitals (69.4%).
Although hospitalizations at children's and metropolitan non-children's hospitals were longer, patient outcomes were more favorable.
确定患有心理健康问题的农村儿童的住院地点，并根据住院地点确定结果差异。
这是一项在美国农村地区年龄在 0-18 岁的患有心理健康住院治疗的儿童（2014 年 1 月 1 日至 2014 年 11 月 30 日）的回顾性队列分析，使用 2014 年医疗保健研究与质量机构的全国再入院数据库。根据儿童医院、大都市非儿童医院或农村医院对农村儿童的住院情况进行分类。使用逻辑（再入院）和负二项回归（住院时间[LOS]）模型评估医院位置与结果之间的关联。分类回归树（CART）用于描述农村医院最常见的住院情况的特征。
在 21666 例农村儿童心理健康住院治疗中，有 20.6%在农村医院。在调整了临床和人口统计学特征后，与农村医院相比，大都市非儿童医院和儿童医院的 LOS 更高（LOS：调整后的比率比[ARR]，1.35[95%CI 1.29-1.41]和 1.33[95%CI，1.25-1.41]；所有 P<.01）。与农村医院相比，大都市非儿童医院和儿童医院的 30 天再入院率较低（aOR，0.73[95%CI，0.63-0.84]和 0.59[95%CI，0.48-0.71]；所有 P<.001）。居住在贫困地区且存在外在行为障碍的青少年男性在农村医院的住院比例最高（69.4%）。
尽管儿童医院和大都市非儿童医院的住院时间更长，但患者的预后更好。
