The Influence of Mental Health Condi4ons on Pediatric Medical and Surgical Hospital U4liza4on
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1 The Influence of Mental Health Condi4ons on Pediatric Medical and Surgical Hospital U4liza4on Stephanie Doupnik, MD John Lawlor, MHS Bonnie Zima, MD, MPH Tumaini Coker, MD, MBA Naomi Bardach, MD, MAS Hall, PhD Jay Berry, MD, MPH 1
2 Disclosures The authors have no financial relaeonships or conflicts of interest to disclose. 2
3 Background Hospitals report difficulty ensuring adequate resources to meet inpaeents mental health needs. In certain medical condieons, mental health condieons are associated with more inpaeent uelizaeon. 3
4 ObjecEve Measure the influence of having a comorbid mental health condieon on hospital length of stay in common medical and surgical condieons. 4
5 Methods Design: RetrospecEve cross-seceonal study Data source: 2012 Kids InpaEent Database NaEonally representaeve sample of pediatric hospitalizaeons Includes a primary discharge diagnosis and up to 24 comorbid hospital diagnoses 5
6 Methods Sample: HospitalizaEons of 3-20 yo paeents 10 common medical condieons 10 common surgical condieons Excluding: Psychiatric hospitalizaeons, Obstetric hospitalizaeons, Transfers 6
7 Methods Sample: HospitalizaEons of 3-20 yo paeents 10 common medical condieons 10 common surgical condieons Excluding: Psychiatric hospitalizaeons, Obstetric hospitalizaeons, Transfers Selected medical and surgical condieons with largest number of children affected by mental health condieons 7
8 Methods Comorbid mental health condi4ons IdenEfied in discharge ICD-9 codes for comorbid condieons Classified into mental health diagnosis categories: ADHD Bipolar Disorder Depression Substance Abuse Psychosis Anxiety Disorder AuEsm ReacEon Disorder 8
9 Outcomes Methods Length of stay (measured in whole days) EsEmate of cost of addieonal hospital days 9
10 Methods Length of stay modeled using adjusted generalized linear models with exponeneal distribueons Adjusted for sociodemographic, clinical, and hospital factors Cost of increased length of stay esemated using mean daily charges x cost-to-charge raeos 10
11 Sample 670,161 hospitalizaeons 48.5% of hospitalizaeons of 3-20 yo children & adolescents in
12 Sample 670,161 hospitalizaeons 48.5% of hospitalizaeons of 3-20 yo children & adolescents in 2012 Prevalence of comorbid mental health condieons: In study sample: 13.2% In all hospitalizaeons of 3-20 yo paeents: 15.0% 12
13 Most Common Comorbid Mental Health CondiEons Condi4on Prevalence Any mental health condieon 13.2% Substance Abuse 4.2% ADHD 3.8% Anxiety Disorders 2.6% Depression 2.0% AuEsm 1.7% 13
14 Mental Health CondiEons and Hospital Resource Use HospitalizaEons with an associated mental health condieon are longer & more costly 31,729 addieonal hospital days $90 million addieonal hospital costs 14
15 Impact of Mental Health CondiEons (MHC) on Length of Stay in Medical Admissions (days)
16 Impact of Mental Health CondiEons (MHC) on Length of Stay in Medical Admissions (days) Average LOS Increase: 9%
17 Impact of Mental Health CondiEons (MHC) on Length of Stay in Medical Admissions (days) One additional hospital day in 1 in 4 patients with a mental health condition
18 Length of Stay & Costs: Medical CondiEons
19 Impact of Mental Health CondiEons (MHC) on Length of Stay in Surgical Admissions (days)
20 Impact of Mental Health CondiEons (MHC) on Length of Stay in Surgical Admissions (days) Average LOS Increase: 17%
21 Impact of Mental Health CondiEons (MHC) on Length of Stay in Surgical Admissions (days) additional hospital day in 1 in 2 patients with a mental health condition
22 Length of Stay & Costs: Surgical CondiEons
23 Mental health condieon drivers Associated with >10% increase in length of stay Depression, Anxiety Having >1 mental health condieon Substance abuse, in surgical condieons only Not associated with increased length of stay ADHD, AuEsm Substance abuse, in medical condieons 23
24 Main Findings Mental health condieons are associated with longer hospital stay in most common medical and surgical condieons. Depression, anxiety, muleple mental health comorbidiees, and substance abuse are major drivers of longer hospital stay. 24
25 LimitaEons Length of stay measured in days (not hours). SensiEvity of administraeve discharge data for idenefying comorbid mental health condieons. 25
26 Future DirecEons IdenEfy factors driving differences in length of stay: Low value? Avoidable medical complicaeons High value? Necessary psychiatric consultaeon 26
27 Thank you! 27
abstract ARTICLE NIH OBJECTIVE: Mental health conditions are prevalent among children hospitalized for
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