Priority conditions could help pediatric mental health inpatient quality measurement

Priority conditions such as depression, bipolar disorder and psychosis could be used for pediatric mental health inpatient quality measurement, according to recent study findings published in Pediatrics.

Naomi S. Bardach, MD, MAS, of the department of pediatrics at the University at San Francisco, and colleagues evaluated hospital discharge data from 2009 of children aged 3 to 20 years to compare mental health hospitalizations at general medical facilities with free-standing children’s hospitals and determine the associated costs of the most frequent mental health diagnoses.

Naomi S. Bardach

The researchers used data extrapolated from the Kids’ Inpatient Database (KID), used in US general medical centers, and the Pediatric Health Information System (PHIS), used in free-standing children’s hospitals. According to KID data, 9.6% of patients were primarily diagnosed with a mental disorder and 3.3% of patients had a primary diagnosis of a mental disorder based on the PHIS data.

Nationally, depression (44.1%) was the most common and costly primary mental health diagnosis, followed by bipolar disorder (18.1%) and psychosis (12.1%). Among children from the PHIS hospitalizations, depression (42.2%) was the most common primary mental health diagnosis, followed by externalizing disorder (10.8%) and bipolar disorder (10.6%). Eating disorders as a primary diagnosis were more commonly found in the PHIS group (5.5%) compared with the national group (1.1%).

Nationally, for all patients with any mental health diagnosis (either as a primary or comorbid diagnosis), depression (35.9%) was the most common mental health diagnosis that led to hospitalization, followed by substance abuse (34%) and attention-deficit/hyperactivity disorder (19.4%). Among PHIS hospitalizations with primary or comorbid diagnosis, developmental disorder (32.7%) was the most common diagnosis followed by depression (23.9%) and ADHD (22.9%).

Substance abuse as a primary or comorbid diagnosis was common for the nationally (34%) compared with the PHIS group (8.9%); however, the PHIS group was more likely to have hospitalizations for developmental disorder (32.7%) compared with the national group (11.8%) and autism (10.7%) compared with for the national group (5.1%).

“Mental health hospitalizations are common and costly nationally, with nearly one in 10 pediatric admissions having a primary diagnosis of a mental health condition,” Bardach told Infectious Diseases in Children. “This finding exceeds national estimates of hospitalizations for asthma (7.1% for 1- to 17-year-olds). Aggregate charges for depression along ($1.33 billion) are comparable to the $1.50 billion in aggregate charges for asthma in 2009. Mental health hospitalizations are less common at tertiary care referral hospitals compared to all hospitals admitting children nationally, so academic pediatricians may underestimate the degree to which mental health is a pediatric issue.” — by Amber Cox

Naomi S. Bardach, MD, MAS, can be reached at bardachn@peds.ucsf.edu.

Disclosure: The study was funded in part by the Agency for Healthcare Research and Quality, the National Institute for Children’s Health and Human Development and the NIH. The researchers report no relevant financial disclosures.