Postacute Care after Pediatric Hospitalizations for a Primary Mental Health Condition

Area of Science:

• Pediatric mental health services research
• Health services research
• Child and adolescent psychiatry

Background:

• Millions of children experience acute mental health crises requiring hospitalization annually.
• Understanding postacute care (PAC) utilization is crucial for optimizing treatment pathways and resource allocation.
• Disparities in PAC access may exist based on clinical and demographic factors.

Purpose of the Study:

• To determine the proportion of US children hospitalized for primary mental health conditions discharged to PAC.
• To identify demographic, clinical, and hospital characteristics associated with PAC discharge.
• To examine state-level variations in PAC utilization for pediatric mental health hospitalizations.

Main Methods:

• Retrospective cohort study utilizing the 2009 and 2012 Kids' Inpatient Databases.
• Analysis of a nationally representative sample of US acute care hospitalizations for children aged 2-20 years with primary mental health diagnoses.
• Adjusted logistic regression models to assess predictors of PAC discharge.

Main Results:

• In 2012, 4.9% of 8,696 children hospitalized for bipolar disorder, depression, or psychosis were discharged to PAC.
• Homicidal ideation, suicide/self-injury, and substance abuse-related medical illness were strong predictors of PAC discharge.
• PAC utilization varied widely across states, from 2.2% to 36.3%.

Conclusions:

• The majority of children hospitalized for mood disorders or psychosis did not receive PAC.
• Safety-related conditions were the primary drivers for the limited PAC discharges.
• Improving PAC access for specific mental health conditions and ensuring equitable state-level resource allocation are critical quality improvement targets.