Pediatric hospital utilization for patients with avoidant restrictive food intake disorder
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Published on: August 21, 2015
Carly E Milliren1, McGreggor Crowley2,3, Julia K Carmody2,4
1Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. carly.milliren@childrens.harvard.edu.
Insights
Inpatient admissions for Avoidant Restrictive Food Intake Disorder (ARFID) have increased in US pediatric hospitals. These hospital stays are lengthy, costly, and linked to readmissions, highlighting the need for better ARFID treatments.
Area of Science:
- Pediatric hospital utilization
- Eating disorder research
- Health services research
Background:
- Avoidant Restrictive Food Intake Disorder (ARFID) is a recognized feeding disorder in the DSM-5 and ICD-10.
- Limited research exists on ARFID-specific hospital utilization, particularly using large administrative datasets.
- This study investigates inpatient admission trends and outcomes for ARFID patients in US pediatric hospitals.
Purpose of the Study:
- To analyze the trends in inpatient admission volume for ARFID over time.
- To examine patient-level factors associated with hospital utilization for ARFID.
- To assess 30-day readmission rates and associated factors for ARFID patients.
Main Methods:
- Utilized the Pediatric Health Information System (PHIS) database for inpatient admissions with ARFID diagnosis codes (ICD-10).
- Analyzed data from October 2017 to June 2022, examining changes in ARFID volume over time.
- Employed adjusted regression models to assess associations between patient demographics, comorbidities, and hospital utilization (LOS, costs, readmissions).
Main Results:
- Inpatient ARFID volume significantly increased across 44 pediatric hospitals (β=0.36 per month).
- Median length of stay (LOS) was 7 days with median costs of $16,583; higher volume hospitals had longer stays and higher costs.
- 8.5% of patients experienced 30-day readmissions, influenced by age, insurance, malnutrition, and GI imaging.
Conclusions:
- US pediatric hospitals have seen a rise in ARFID inpatient admissions since its ICD-10 inclusion.
- ARFID inpatient stays are characterized by prolonged duration, significant costs, and notable readmission rates.
- Future research should focus on developing effective and efficient ARFID treatment strategies to improve patient outcomes and reduce healthcare burden.
Background:
Avoidant restrictive food intake disorder (ARFID) is a relatively new feeding and eating disorder added to the DSM-5 in 2013 and ICD-10 in 2018. Few studies have examined hospital utilization for patients with ARFID specifically, and none to date have used large administrative cohorts. We examined inpatient admission volume over time and hospital utilization and 30-day readmissions for patients with ARFID at pediatric hospitals in the United States.
Methods:
Using data from the Pediatric Health Information System (PHIS), we identified inpatient admissions for patients with ARFID (by principal International Classification of Diseases, 10th Revision, ICD-10 diagnosis code) discharged October 2017-June 2022. We examined the change over time in ARFID volume and associations between patient-level factors (e.g., sociodemographic characteristics, co-morbid conditions including anxiety and depressive disorders and malnutrition), hospital ARFID volume, and hospital utilization including length of stay (LOS), costs, use of enteral tube feeding or GI imaging during admission, and 30-day readmissions. Adjusted regression models were used to examine associations between sociodemographic and clinical factors on LOS, costs, and 30-day readmissions.
Results:
Inpatient ARFID volume across n = 44 pediatric hospitals has increased over time (β = 0.36 per month; 95% CI 0.26-0.46; p < 0.001). Among N = 1288 inpatient admissions for patients with ARFID, median LOS was 7 days (IQR = 8) with median costs of $16,583 (IQR = $18,115). LOS and costs were highest in hospitals with higher volumes of ARFID patients. Younger age, co-morbid conditions, enteral feeding, and GI imaging were also associated with LOS. 8.5% of patients were readmitted within 30 days. In adjusted models, there were differences in the likelihood of readmission by age, insurance, malnutrition diagnosis at index visit, and GI imaging procedures during index visit.
Conclusions:
Our results indicate that the volume of inpatient admissions for patients with ARFID has increased at pediatric hospitals in the U.S. since ARFID was added to ICD-10. Inpatient stays for ARFID are long and costly and associated with readmissions. It is important to identify effective and efficient treatment strategies for ARFID in the future.
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