![]() Those with ≥4 mental health comorbidities had a higher follow-up percentage compared with those without these comorbidities (66.4% vs 59.0% at 7 days and 85.6% vs 78.4% at 30 days Table 2). Fewer non-Hispanic or non-Latino black patients compared with white patients had follow-up at both 7 and 30 days after discharge (57.9% vs 63.2% at 7 days and 77.4% vs 84.1% at 30 days). However, those discharged from general medical or surgical units were substantially less likely to have follow-up at both time points (47.2% at 7 days and 73.2% at 30 days) compared with patients discharged from psychiatric units within general hospitals (61.1% at 7 days and 81.3% at 30 days) or freestanding psychiatric hospitals (63.8% at 7 days and 84.1% at 30 days Table 2). Follow-up rates were similar across most patient characteristics ( Table 2), with <6-percentage-point differences in follow-up between categories (although most met statistical significance because of large sample size). ![]() Sixty-two percent of patients had follow-up within 7 days, and 82.3% had follow-up within 30 days. Psychiatric unit within a general hospital We chose the 2 follow-up windows (7 and 30 days) because they are consistent with the HEDIS quality measure of follow-up after hospitalization for mental illness. The visit was defined as any Medicaid-reimbursed visit with one or more of the following: (1) a mental health diagnosis defined by using the International Classification of Diseases code definitions noted above 10, 11 (2) a visit defined by using the “standard providers” variable in the database, by using values for psychiatry, psychology, therapy (excluding physical, occupational, or speech), and mental health facility or (3) a visit defined by using Truven’s proprietary binary variable indicating a service subcategory of mental health (see Supplemental Table 5 for the distribution of these definitions and Supplemental Table 6 for the most common Current Procedural Terminology codes associated with these visits). Our predictors of interest were whether the patient had a mental health outpatient follow-up visit within 7 or 30 days after discharge from the index admission. Finally, to ensure consistent measurement of outpatient use, patients who were not discharged from the hospital to home (eg, those discharged to a partial hospitalization program) were excluded. Transfers from one inpatient setting to another (eg, general hospital to inpatient psychiatric facility) were treated as one episode. 9, 12 To ensure completeness of use estimates after hospitalization, only children with continuous Medicaid enrollment for 6 months after discharge were included. This age range is consistent with previous claims-based studies of the mental health diagnoses of focus, reflecting the low prevalence in young patients and, therefore, small sample size in this group. 11 We restricted the population to patients aged 6 to 17 years at the time of their hospitalization. 10, 11 The ICD-9-CM codes were aligned with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition main diagnostic groups, 10 and, subsequently, the ICD-10-CM codes were mapped from the ICD-9-CM and tested by using a national administrative database after the switch to the ICD-10-CM. ![]() We identified these patients using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes, as done previously. 9 Our study cohort consisted of patients with a hospitalization (the index admission) for one of these as a primary diagnosis between January 2015 and June 2016. We focused on mental health diagnoses that were found in our previous work to be common and costly diagnoses for pediatric inpatient mental health use: depression, bipolar disorder, psychosis, and anxiety.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |