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American Academy of Pediatrics
Research Articles

Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations

Sarah K. Connell, Lori E. Rutman, Kathryn B. Whitlock, Miriam J. Haviland, Shannon Simmons, Kelly Schloredt, Jessica Ramos, Kathy Brewer, Marie Augustine and K. Casey Lion
Hospital Pediatrics March 2020, 10 (3) 238-245; DOI: https://doi.org/10.1542/hpeds.2019-0197
Sarah K. Connell
aDepartment of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;
bCenter for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington;
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Lori E. Rutman
aDepartment of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;
cPediatric Emergency Medicine and
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Kathryn B. Whitlock
bCenter for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington;
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Miriam J. Haviland
bCenter for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington;
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Shannon Simmons
dPsychiatry and Behavioral Medicine, Seattle Children’s Hospital, Seattle, Washington
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Kelly Schloredt
dPsychiatry and Behavioral Medicine, Seattle Children’s Hospital, Seattle, Washington
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Jessica Ramos
bCenter for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington;
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Kathy Brewer
dPsychiatry and Behavioral Medicine, Seattle Children’s Hospital, Seattle, Washington
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Marie Augustine
dPsychiatry and Behavioral Medicine, Seattle Children’s Hospital, Seattle, Washington
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K. Casey Lion
aDepartment of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;
bCenter for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington;
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Abstract

BACKGROUND: Health care reform may impact inpatient mental health services by increasing access and changing insurer incentives. We examined whether implementation of the 2014 Affordable Care Act (ACA) was associated with changes in psychiatric length of stay (LOS) and 30-day readmissions for pediatric patients.

METHODS: We conducted an interrupted time-series analysis to evaluate LOS and 30-day readmissions during the 30 months before and 24 months after ACA implementation, with a 6-month wash-out period, on patients aged 4 to 17 years who were discharged from the psychiatry unit of a children’s hospital. Differences by payer (Medicaid versus non-Medicaid) were examined in moderated interrupted time series. Logistic regression was used to examine the association between psychiatric LOS and 30-day readmissions.

RESULTS: There were 1874 encounters in the pre-ACA period and 2186 encounters in the post-ACA period. Compared with pre-ACA implementation, post-ACA implementation was associated with LOS that was significantly decreasing over time (pre-ACA versus post-ACA slope difference: −0.10 days per encounter per month [95% confidence interval −0.17 to −0.02]; P = .01), especially for Medicaid-insured patients (pre-ACA versus post-ACA slope difference: −0.14 days per encounter per month [95% confidence interval −0.26 to −0.01]; P = .03). The overall proportion of 30-day readmissions increased significantly (pre-ACA 6%, post-ACA 10%; P < .05 for the difference). We found no association between LOS and 30-day readmissions.

CONCLUSIONS: ACA implementation was associated with a decline in psychiatric inpatient LOS over time, especially for those on Medicaid, and an increase in 30-day readmissions. LOS was not associated with 30-day inpatient readmissions. Further investigation to understand the drivers of these patterns is warranted.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (3)
Hospital Pediatrics
Vol. 10, Issue 3
1 Mar 2020
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Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations
Sarah K. Connell, Lori E. Rutman, Kathryn B. Whitlock, Miriam J. Haviland, Shannon Simmons, Kelly Schloredt, Jessica Ramos, Kathy Brewer, Marie Augustine, K. Casey Lion
Hospital Pediatrics Mar 2020, 10 (3) 238-245; DOI: 10.1542/hpeds.2019-0197

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Health Care Reform, Length of Stay, and Readmissions for Child Mental Health Hospitalizations
Sarah K. Connell, Lori E. Rutman, Kathryn B. Whitlock, Miriam J. Haviland, Shannon Simmons, Kelly Schloredt, Jessica Ramos, Kathy Brewer, Marie Augustine, K. Casey Lion
Hospital Pediatrics Mar 2020, 10 (3) 238-245; DOI: 10.1542/hpeds.2019-0197
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