Hospitalization Outcomes for Rural Children with Mental Health Conditions.
Year of Publication
2020 Sep 30
<p><strong>OBJECTIVE: </strong>To identify where rural children with mental health conditions are hospitalized and to determine differences in outcomes based upon location of hospitalization.</p>
<p><strong>STUDY DESIGN: </strong>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 to 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) describe characteristics of most common hospitalizations at a rural hospital.</p>
<p><strong>RESULTS: </strong>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 aRR 1.33 (95% CI 1.25, 1.41); all P < .01]. 30-day readmission was lower at metropolitan non-children's and children's hospitals compared with rural hospitals [adjusted odds ratio (aOR) 0.73 (95% CI 0.63, 0.84) and aOR 0.59 (95% CI 0.48, 0.71); all p<0.001]. Adolescent males living in poverty with externalizing behavior disorder had the highest percentage (69.4%) of hospitalization at rural hospitals.</p>
<p><strong>CONCLUSIONS: </strong>Although hospitalizations at children's and metropolitan non-children's hospitals were longer, patient outcomes were more favorable.</p>