Lohr W David, Jawad Kahir S, Wood Nichole, Le Jennifer F, Stevenson Michelle D, Feygin Yana B, Davis Deborah Winders
Division of Child & Adolescent Psychiatry and Pediatric Psychology, University of Louisville School of Medicine, Louisville, Kentucky.
Child and Adolescent Health Research Design and Support Unit, Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky.
JAACAP Open. 2023 Dec 18;2(3):170-179. doi: 10.1016/j.jaacop.2023.12.001. eCollection 2024 Sep.
To describe and identify factors associated with mental health (MH) readmission rates for youth ages 5 to 17 years discharged between January 2019 and November 2019.
This retrospective, cross-sectional analysis using the 2019 Nationwide Readmissions Database identified hospitalizations for patients with a primary diagnosis of an MH condition using the Clinical Classification Software groupings, which are based on codes. Various patient characteristics including comorbidities were included in univariate and multivariate analysis to study their association with psychiatric readmission.
A 30-day readmission rate of 7.8% was found for the overall sample with significantly higher rates for youth younger than age 15 years. MH comorbidity was a factor in readmission rates; having ≥3 primary MH conditions was associated with higher rates of readmission (adjusted odds ratio [aOR] = 1.20). Significantly higher rates of readmission were noted for several diagnostic groupings including schizophrenia spectrum and other psychotic disorders (aOR = 1.95); bipolar and related disorders (aOR = 1.42); other specified and unspecified mood disorders (aOR = 1.42); disruptive, impulse-control, and conduct disorders (aOR = 1.32); and neurodevelopmental disorders (aOR = 1.23). Having public insurance (aOR=1.28) and a longer length of stay (AOR = 1.71 for ≥15 days) were associated with significantly higher odds of an MH readmission.
A concerning number of children admitted for MH conditions in 2019 were readmitted within 30 days (7.8%). Younger children, children with specific MH diagnoses, children with public health insurance, and children with a long initial length of stay have higher odds for readmission and represent a target for prevention and intervention.
DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.
描述并确定与2019年1月至2019年11月期间出院的5至17岁青少年心理健康（MH）再入院率相关的因素。
这项回顾性横断面分析使用了2019年全国再入院数据库，通过临床分类软件分组（基于代码）确定了以MH疾病为主要诊断的患者的住院情况。在单变量和多变量分析中纳入了包括合并症在内的各种患者特征，以研究它们与精神科再入院的关联。
总体样本的30天再入院率为7.8%，15岁以下青少年的再入院率明显更高。MH合并症是再入院率的一个因素；患有≥3种原发性MH疾病与更高的再入院率相关（调整后的优势比[aOR]=1.20）。在几个诊断分组中，再入院率明显更高，包括精神分裂症谱系及其他精神病性障碍（aOR=1.95）；双相情感障碍及相关障碍（aOR=1.42）；其他特定和未特定的情绪障碍（aOR=1.42）；破坏性行为、冲动控制和品行障碍（aOR=1.32）；以及神经发育障碍（aOR=1.23）。拥有公共保险（aOR=1.28）和住院时间较长（住院≥15天的aOR=1.71）与MH再入院的显著更高几率相关。
2019年因MH疾病入院的儿童中有相当数量（7.8%）在30天内再次入院。年龄较小的儿童、患有特定MH诊断的儿童、拥有公共医疗保险的儿童以及初次住院时间较长的儿童再入院几率更高，是预防和干预的目标人群。
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