Association Between Comorbid Psychiatric Disorders and Hospital Resource Use in Physically Ill Pediatric Inpatients: A Case-Matched Analysis - 22/02/21
Abstract |
Objective |
To understand differences in hospital length of stay and costs associated with the presence of a comorbid psychiatric disorder among physically ill inpatients within a publicly funded pediatric hospital.
Method |
This was a retrospective observational design using administrative data on physically ill inpatients 2 to 18 years old who were admitted over a 5-year period (n = 54,316 admissions). Records with (n = 4,953) and without (n = 49,363) documented comorbid psychiatric disorder were compared for differences in baseline characteristics. To optimize the balance of measured covariates, individuals with comorbid psychiatric disorders were matched on propensity score, case mix group, and Elixhauser comorbidities, resulting in 4,371 pairs of inpatients with and without a comorbid psychiatric disorder. Differences in length of stay and total hospital costs were assessed using generalized estimating equation models on matched patients.
Results |
Unmatched analyses demonstrated that inpatient admissions with comorbid psychiatric disorders were associated with higher occurrence of previous hospitalizations (69.2% versus 55.0%), unscheduled admissions (66.9% versus 60.9%), medical admissions (75.6% versus 52.7%), urgent admissions (62.5% versus 56.2%), and Elixhauser comorbidities (69.0% versus 39.0%), with standardized differences > |0.1|. Matched analyses demonstrated a 9.6% longer length of stay (95% CI = 5.7−13.7; p < .001) and 9.6% higher costs per admission (95% CI = 5.9−13.4; p < .001) in inpatients with comorbid psychiatric disorders compared to those without.
Conclusion |
The complexity of inpatients with a comorbid psychiatric disorder, in conjunction with the approximate 10% increase in hospital resource use, highlights the need for innovative models of clinical care and research directed at improving patient outcomes and reducing hospital costs.
Le texte complet de cet article est disponible en PDF.Key words : propensity score, case mix, length of stay, pediatric hospitals, mental disorders
Plan
| This work was supported by the Medical Psychiatry Alliance, a collaborative partnership between The Centre for Addiction and Mental Health, The Hospital for Sick Children, Trillium Health Partners, The University of Toronto and funded by the Ontario Ministry of Health and Long-Term Care and an anonymous donor. The funding sources did not have any involvement in conducting the research, and/or preparation of the manuscript. |
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| Ms. Santiago-Jiménez served as the statistical expert for this research. |
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| Author Contributions |
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| Conceptualization: Ansari, Saab |
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| Data curation: Ansari, Santiago-Jiménez |
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| Formal analysis: Ansari, Santiago-Jiménez |
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| Methodology: Ansari, Santiago-Jiménez, Saab, De Souza, Szatmari, Monga |
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| Project administration: Saab, Monga |
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| Resources: Monga |
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| Supervision: Szatmari, Monga |
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| Validation: Ansari, Santiago-Jiménez, Monga |
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| Writing – original draft: Ansari, Monga |
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| Writing – review and editing: Ansari, Santiago-Jiménez, Saab, De Souza, Szatmari, Monga |
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| ORCID |
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| Hina Ansari, MSc: 0000-0002-8048-656X |
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| María Santiago-Jiménez, MSc: 0000-0003-3288-5109 |
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| Hana Saab, PhD: 0000-0001-7274-9473 |
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| Claire De Souza, MD, FRCPC: 0000-0002-5930-1217 |
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| Peter Szatmari, MD, FRCPC: 0000-0002-1763-067X |
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| Suneeta Monga, MD, FRCPC: 0000-0002-1068-3920 |
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| Disclosure: Dr. Szatmari has received grant funding support from the Canadian Institutes of Health Research (CIHR) and support from the Patsy and Jamie Anderson Chair in Child and Youth Mental Health. He has received royalties from Guilford Press for his book A Mind Apart: Understanding Children with Autism and Asperger Syndrome and from Simon and Schuster Canada for his book Start Here—A Parent’s Guide to Helping Children and Teens Through Mental Health Challenges. Dr. Monga has received grant funding support from the Canadian Institutes of Health Research (CIHR) and the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health. She has received support from the SickKids Chair in Child and Youth Medical Psychiatry. She has received royalties from Springer for her book Assessing and Treating Anxiety Disorders in Young Children: The Taming Sneaky Fears Program. Drs. Saab and De Souza, Mss. Ansari and Santiago-Jiménez have reported no biomedical financial interests or potential conflicts of interest. |
Vol 60 - N° 3
P. 346-354 - mars 2021 Retour au numéro
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