Hospitalization Outcomes for Rural Children with Mental Health Conditions

• Published in: The Journal of pediatrics Vol. 229; pp. 240 - 246.e1
• Main Authors: Bettenhausen, Jessica L., Hall, Matt, Doupnik, Stephanie K., Markham, Jessica L., Feinstein, James A., Berry, Jay G., Gay, James C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2021
• Subjects: Adolescent; Child; Child, Preschool; Cohort Studies; Female; Hospitalization; Humans; Infant; Male; Mental Disorders - therapy; Retrospective Studies; Rural Population; United States; United States; aRR; LOS; NRD; CCC; HRISK; CART
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.09.067

To identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based on location of hospitalization.
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.
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%).
Although hospitalizations at children's and metropolitan non-children's hospitals were longer, patient outcomes were more favorable.