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Hospitalization Outcomes for Rural Children with Mental Health Conditions
Jessica L Bettenhausen1, Matt Hall2, Stephanie K Doupnik3
1Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Insights
Rural children with mental health conditions experience longer hospital stays but better outcomes at children's and metropolitan hospitals compared to rural facilities. This highlights disparities in pediatric mental healthcare access and quality.
Area of Science:
- Pediatric mental health services research
- Healthcare access and disparities
- Rural health outcomes
Background:
- Understanding hospitalization patterns for rural children with mental health conditions is crucial for improving care.
- Existing research often overlooks specific outcomes associated with different hospital settings for this vulnerable population.
Purpose of the Study:
- To pinpoint the locations where rural children with mental health conditions are hospitalized.
- To compare patient outcomes, including length of stay and readmission rates, based on hospitalization location.
Main Methods:
- Retrospective cohort analysis of US rural children (0-18 years) with mental health hospitalizations from January 1, 2014, to November 30, 2014.
- Utilized the 2014 Agency for Healthcare Research and Quality's Nationwide Readmissions Database.
- Compared outcomes across children's hospitals, metropolitan non-children's hospitals, and rural hospitals using logistic and negative binomial regression models.
Main Results:
- 20.6% of 21,666 mental health hospitalizations for rural children occurred at rural hospitals.
- Longer lengths of stay (LOS) were observed at metropolitan non-children's and children's hospitals compared to rural hospitals (aRR 1.35 and 1.33, respectively).
- Lower 30-day readmission rates were found at metropolitan non-children's and children's hospitals versus rural hospitals (aOR 0.73 and 0.59, respectively).
Conclusions:
- Despite longer hospitalizations, children's and metropolitan non-children's hospitals offered more favorable patient outcomes for rural youth with mental health conditions.
- Findings suggest potential disparities in care quality and access based on hospital location for pediatric mental health services.
Objective:
To identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based on location of hospitalization.
Study Design:
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.
Results:
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%).
Conclusions:
Although hospitalizations at children's and metropolitan non-children's hospitals were longer, patient outcomes were more favorable.
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