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Psychiatric Disorders and Trends in Resource Use in Pediatric Hospitals
Bonnie T Zima1, Jonathan Rodean2, Matt Hall2
1Departments of Psychiatry and Biobehavioral Science, UCLA Semel Institute for Neuroscience and Human Behavior, and bzima@mednet.ucla.edu.
Insights
Pediatric hospitalizations with psychiatric diagnoses increased fivefold from 2005-2014, outpacing those without. Children with medical conditions and co-occurring psychiatric disorders drove this trend, requiring prioritized care planning.
Area of Science:
- Pediatric healthcare research
- Child and adolescent psychiatry
- Health services research
Background:
- Hospital resource utilization in children has seen significant shifts over the past decade.
- The co-occurrence of psychiatric and medical diagnoses in pediatric hospitalizations presents unique challenges.
- Understanding trends in pediatric healthcare resource use is crucial for effective planning.
Purpose of the Study:
- To analyze 10-year trends in pediatric hospital resource use.
- To compare resource use in children with and without psychiatric diagnoses.
- To examine how trends vary by co-occurring psychiatric and medical conditions.
Main Methods:
- Retrospective, longitudinal cohort analysis of US children's hospital discharge data (2005-2014).
- Inclusion of patients aged 3-17 years from 33 tertiary care children's hospitals.
- Multivariate generalized estimating equations used to assess trends in hospitalizations, days, and costs.
Main Results:
- Hospital resource use grew significantly faster for children with psychiatric diagnoses (+137.7% hospitalizations, +92.9% days, +142.7% costs) compared to those without (+26.0% hospitalizations, +5.9% days, +18.9% costs).
- The most substantial growth was seen in children with a primary medical condition and a co-occurring psychiatric diagnosis.
- In 2014, these children comprised 77.8% of hospitalizations for children with psychiatric diagnoses, with common conditions including developmental disorders, ADHD, and anxiety.
Conclusions:
- Pediatric hospitalizations in US children's hospitals rose five times more for children with psychiatric diagnoses than without over a 10-year period.
- Strategic planning for tertiary care children's hospitals must prioritize the needs of children with primary medical conditions and co-occurring psychiatric disorders.
- Addressing the rising demand for psychiatric care requires focused resource allocation and targeted interventions.
Objective:
To describe recent, 10-year trends in pediatric hospital resource use with and without a psychiatric diagnosis and examine how these trends vary by type of psychiatric and medical diagnosis cooccurrence.
Methods:
A retrospective, longitudinal cohort analysis using hospital discharge data from 33 tertiary care US children's hospitals of patients ages 3 to 17 years from January 1, 2005 through December 31, 2014. The trends in hospital discharges, hospital days, and total aggregate costs for each psychiatric comorbid group were assessed by using multivariate generalized estimating equations.
Results:
From 2005 to 2014, the cumulative percent growth in resource use was significantly (all P < .001) greater for children hospitalized with versus without a psychiatric diagnosis (hospitalizations: +137.7% vs +26.0%; hospital days: +92.9% vs 5.9%; and costs: +142.7% vs + 18.9%). During this time period, the most substantial growth was observed in children admitted with a medical condition who also had a cooccurring psychiatric diagnosis (hospitalizations: +160.5%; hospital days: +112.4%; costs: +156.2%). In 2014, these children accounted for 77.8% of all hospitalizations for children with a psychiatric diagnosis; their most common psychiatric diagnoses were developmental disorders (22.3%), attention-deficit/hyperactivity disorder (18.1%), and anxiety disorders (14.2%).
Conclusions:
The 10-year rise in pediatric hospitalizations in US children's hospitals is 5 times greater for children with versus without a psychiatric diagnosis. Strategic planning to meet the rising demand for psychiatric care in tertiary care children's hospitals should place high priority on the needs of children with a primary medical condition and cooccurring psychiatric disorders.
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