Acute Inpatient Admission Research Articles

Rate of Acute Hospital Admissions Before and After Roux-en-Y Gastric Bypass Surgery: A Population-based Cohort Study.

To examine rates of acute inpatient hospital admissions patients undergoing Roux-en-Y gastric bypass (RYGB) surgery and a matched population-based comparison cohort. Little is known about the admission rates before and after RYGB. Nationwide population-based cohort study, including all 9985 patients undergoing RYGB in Denmark during 2006 to 2010, and 247,375 matched general population comparisons. We calculated cumulative incidence of surgical complications after RYGB and incidence rate ratios (RRs) of hospital admission in RYGB patients versus comparisons before and after RYGB. Admissions for surgical complications occurred in 3.3% (n = 328) of RYGB patients <30 days after surgery and in 23.9% (n = 2367) during entire follow-up (median 4.2 yrs). Fifteen percent (n = 1486) were admitted with abdominal pain, 5.2% (n = 518) with intestinal obstruction during follow-up. Overall admission rates in RYGB patients versus comparisons were 11.5 versus 5.9 per 100 person-years before RYGB [RR = 1.95 (95% confidence interval (CI): 1.89-2.01)], increasing to 24.9 versus 7.1 per 100 person-years after RYGB [RR = 3.38 (95% CI; 3.30, 3.47)]. RRs of cardiovascular and chronic pulmonary disease admissions decreased considerably. RRs increased for alcohol abuse [0.59 (95% CI; 0.39-0.88) to 2.17 (95% CI; 1.72-2.72)], self-harm (suicide attempts, medication overuse) [1.72 (95% CI; 1.32-2.25) to 3.61 (95% CI; 2.88-4.52)], anemia [0.84 (95% CI; 0.39-1.78) to 17.92 (95% CI; 14.94-21.48)], and osteoporosis [1.19 (95% CI; 0.93-1.53) to 1.65 (95% CI; 1.35-2.02)]. Short-term surgical complications occurred in 3% and long-term complications in one-fourth of RYGB patients. Compared with the general population, the RR for any inpatient admission increased after RYGB.

Evaluation of the Present-on-Admission Indicator among Hospitalized Fee-for-Service Medicare Patients with a Pressure Ulcer Diagnosis: Coding Patterns and Impact on Hospital-Acquired Pressure Ulcer Rates.

To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). Retrospective cross-sectional study. We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011. Admissions were categorized as follows: (1) no pressure ulcer diagnosis, (2) new pressure ulcer diagnosis, and (3) previously documented pressure ulcer diagnosis. HAPU rates were calculated by varying patient exclusion criteria. Among admissions with a pressure ulcer diagnosis, we observed a large discrepancy in the proportion of admissions with a HAPU based on hospital-reported POA data (5.2 percent) and the proportion with a new pressure ulcer diagnosis based on patient history in billing claims (49.7 percent). Applying quality measure exclusion criteria resulted in removal of 91.2 percent of admissions with a pressure injury diagnosis from HAPU rate calculations. As payers and health care organizations expand the use of quality measures, it is important to consider how the measures are implemented, coding revisions to improve measure validity, and the impact of patient exclusion criteria on provider performance evaluation.

PO016 Audit of neurological examinations in acute admissions

Background It is noticed clinically that for acute inpatient admissions, neurological examinations are often incomplete or omitted in initial assessment. Hence we audited how often neurological examinations are performed on admission. Thereafter we propose the Glasgow Neuroscreen – a quick neurological screening examination especially in patients with non-neurological presenting complaints to exclude important neurological signs and improve examination rates. The efficacy of the Glasgow Neuroscreen will be evaluated. Methods Consented patients’ clerk-in notes were audited to evaluate how often various components of the neurological examination were performed. Glasgow Neuroscreen was tested on these patients using either of 2 algorithms- ambulant/non ambulant patients. The normal examination findings were used as standard for comparison against Neuroscreen findings to evaluate its reliability. Results Of 30 patients, 17 (56.67%) had some documentation of neurological examination. Only 48% of patients with non-neurological presenting complaints were examined neurologically. Analysis of Neuroscreen showed a sensitivity of 80% and specificity of 33.3%. The positive predictive value stands at 33.3% whereas the negative predictive value is 80%. Discussion For general or non- neurological presenting complaints, neurological examinations are often omitted possibly due to time constraints hence the Neuroscreen could be useful as a quick screening tool in these patients.

Psychiatric disorders as main discharge diagnosis by the Portuguese oldest old from 2000 to 2014: exploring national acute inpatient admissions.

Exploratory descriptive analyses of data regarding the number of episodes and coded diagnosis on admission were performed. From a total of 1,837,613 inpatient episodes, 16,430 (0.9%) correspond to episodes having a psychiatric disorder as a primary discharge diagnosis. Delirium, dementia and amnestic and other cognitive disorders (60.1%), alcohol-related disorders (17.7%) and mood disorders (8.6%) were the most common diagnosis. An analysis by age group revealed that among octogenarians and nonagenarians delirium, dementia, and amnestic and other cognitive disorders were the most common diagnosis; in the centenarian group; however, these were outweighed by alcohol-related disorders. Findings from this study document the importance of neurocognitive disorders as a primary reason for hospitalization in the oldest old, but also highlights the need of paying attention to other mental disorders among this age group. Further studies should examine the prevalence of medical comorbidities in patients with mental disorders.

Differences in Pre- and Post-dischcarge Methicillin-resistant Staphylococcus aureus (MRSA) infection rates by colonization status in US Department of Veterans Affairs (VA) hospitals

BackgroundLittle is known about how MRSA infection rates differ between patients who are colonized on admission compared with those who acquire colonization during an inpatient stay. In addition, most studies focus on MRSA infections that are diagnosed prior to discharge while ignoring those that are identified post-discharge. The VA implemented an active surveillance program for MRSA in 2007 in which all inpatients are tested for MRSA on admission. This surveillance data along with the ability to follow patients longitudinally allowed us to estimate the difference in infection rates for those who import vs. those who acquire MRSA colonization during their stay and to characterize post-discharge MRSA infections.MethodsWe constructed a dataset of 3,659,911 acute care inpatient admissions to 125 VA hospitals nationwide between January 1, 2008 and December 31/2015 who had surveillance tests performed for MRSA carriage. Admissions were restricted to individuals with at least 365 days of VA activity prior to admission. We categorized these admissions into 3 groups: no colonization, importation, and acquisition based on MRSA test results throughout the admission. We then captured MRSA infections in these individuals prior to discharge and at 30 and 90 days post-discharge. Infections were defined as positive MRSA cultures taken from sterile sites (including blood, catheter site, or bone).ResultsDuring the 8-year period, we identified 4,037 total pre-discharge MRSA infections, 2,793 MRSA infections at 30 days post-discharge, and 7,018 infections at 90 days post-discharge. During the pre-discharge time period, patients who acquired MRSA carriage were more likely to progress to an infection prior to discharge than those who imported the pathogen (RR = 2.6, P < 0.001). For patients who acquired MRSA carriage, the percentage who progressed to infection prior to discharge decreased from 2.0% in 2010 to 1.4% in 2015. The results from our analyses can be found in Figures 1–3.ConclusionWe found that roughly half of post-discharge infections were in patients who acquired the organism pre-discharge. These may be preventable with optimal infection control. In addition, there were nearly twice as many post-discharge MRSA infections at 90 days than during the pre-discharge period.Disclosures All authors: No reported disclosures.

Phenomenography: Alignment with personal recovery in mental health nursing

For more than four decades, people with lived experience of mental health concerns have been redefining the concept of recovery. No longer just synonymous with cure, recovery is understood in contemporary terms as a personal journey; a process. This process is known as personal recovery. A desire to work in alignment with the principles of personal recovery, while exploring the ways in which the phenomenon of safety is understood by people who have experienced acute mental health inpatient admission, led the authors to apply the research approach known as phenomenography. The aim of this paper is to propose the ways in which phenomenography and the principles of personal recovery align. The philosophy, characteristics and processes of phenomenography and of personal recovery are compared.

Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data.

ObjectiveTo describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data.MethodsPatients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System’s electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models.ResultsA total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19–24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period.ConclusionOpioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.

Physical exam in mental health: implementation of a form to guide medical assessment of acute psychiatric inpatients

Physical exam in mental health: implementation of a form to guide medical assessment of acute psychiatric inpatients Tariq Munshi,1,2 M Selim Asmer,1,2 Sarah Penfold,1,2 Jennifer Pikard,1,2 Dane Mauer-Vakil,1 Emma Banwell1 1School of Medicine, Queen&rsquo;s University, 2Department of Psychiatry,&nbsp;Queen&rsquo;s University, Kingston, ON, Canada Abstract: The physical health of individuals suffering from mental illness is known to be diminished compared to the general population, with worse health outcomes and shortened life expectancy. This places a great burden on health care systems around the world. Due to stigma and clinician attitudes, it may be difficult for physicians to engage with mentally ill patients to screen for physical disease and implement physical health interventions. Engaging with these patients during acute inpatient admission is an ideal time to identify any specific problems that may be the focus of medical attention. The Canadian Government mandates that all patients admitted to hospital receive routine physical assessment as part of their care. Our study aimed to implement a form to guide physical screening for all psychiatric patients admitted to an acute inpatient Psychiatric Unit in Kingston, ON, Canada; the patients underwent two cycles of clinical audit between 2014 and 2015 to measure completion of forms. Although the completion rate decreased, the frequency of consultation with the hospitalist increased significantly between the two cycles. There was no relationship found between patient age, psychiatric diagnosis, and day of admission during the week did not affect completion of physical health screening. Further education and advocacy is needed to ensure appropriate screening of physical problems in patients admitted for psychiatric reasons. Future studies are needed to study the effectiveness of these forms and whether or not they are effective in improving health outcomes in the long term. Keywords: physical examination, audit, health form

Who experiences seclusion? An examination of demographics and duration in a public acute inpatient mental health service

ABSTRACTRestrictive interventions such as seclusion may occur during an acute mental health crisis. Such interventions are experienced by people as traumatic and counter to recovery. The current study aimed to investigate the use of seclusion and who was secluded amongst patients presenting with psychotic symptomology. All acute inpatient admissions were examined across a 12-month period January–December 2013. Electronic and paper records were accessed and audited for all 655 admissions. There were 91 admissions that included a seclusion and 200 seclusion events. There were 79 unique patients who experienced seclusion. For those experiencing seclusion: two-thirds were male, 49% were either homeless or had no fixed abode, 32% received case management in the community prior to their inpatient stay, and 56% were unemployed or not in the workforce. The median and mode duration of seclusion was 4 h. By understanding seclusion interventions better, changes can be made to enhance practice. This descriptive research into seclusion has clarified the demographics of who is most likely to experience seclusion, for how long, and the implications for reducing restrictive interventions. How the social work role could contribute to reforms to protect and enhance the rights and well-being of marginalized members of our communities, at their most vulnerable, is considered.

Metadichol, A Novel ROR Gamma Inverse Agonist and Its Applications in Psoriasis

Background: There is limited information regarding changes in functional outcome among trauma patients during acute inpatient rehabilitation and the factors associated with such changes. Examining the factors associated with functional outcome changes can provide a meaningful way to predict and prognosticate the needs of trauma patients during post-acute care rehabilitation. Objective: The objective of this study was to evaluate the association between changes in functional mobility and factors such as age and gender among trauma patients admitted to an acute Inpatient rehabilitation facility. Design: The retrospective study consisted of a 330 patients treated in a Level I academic trauma center who were discharged to an acute inpatient rehabilitation facility. Admission- and discharge-acute inpatient rehabilitation functionality was measured using Functional Independence Measure (FIM) scores. Methods: Information from the hospital’s trauma database on patients admitted to the level 1 trauma center and subsequently discharged to the hospital’s inpatient acute rehabilitation was retrospectively extracted and analyzed. Main outcome Measure: FIM scores. Mean/proportion comparison tests were used to investigate whether admission- and discharge-FIM scores statistically differed by age and gender. Multivariate regression analyses were estimated to examine whether age and gender were associated with differences between patients admission- and discharge-acute inpatient rehabilitation FIM scores while controlling for confounding factors. Results: Improvements in patients’ FIM scores during acute inpatient rehabilitation (FIM-gains) were statistically higher (p ≤ 0.05) among patients under 65 years old (FIM-gains: 21.3) relative to patients aged 65 years and older (FIM-gains: 18.13) despite the younger age group’s higher injury severity scores and longer hospital length of stays. Increased age and admission-acute inpatient rehabilitation FIM scores were both associated with lower FIM score improvements during acute inpatient rehabilitation admissions. FIM-gains score was estimated to be 6.34 points (p=0.00) lower in patients aged 65 years and older relative to patients under the age of 65; while a one-unit increase in patients’ admission-acute inpatient rehabilitation FIM score was associated with a 0.36 decrease (p=0.00) in their FIM-gains score. No gender based differences in patients’ FIM-gains scores were found. Conclusion: Patients under 65 years of age had a greater improvement in FIM-gains scores relative to patients aged 65 years and older. Besides age, we also found that patients with a higher admission-acute inpatient rehabilitation FIM score had a lower improvement in their FIM-gains score. No gender differences were noted.

Acute Hospital Admissions of Individuals with a Known Parkinson's Disease Diagnosis in Ireland 2009-2012: A Short Report.

The rate of people with Parkinson's disease (PD) is predicted to double by 2030 resulting in an even greater burden to an already struggling Irish health care system. There is a paucity of information regarding hospital utilisation among the PD population in an Irish context. To examine trends of acute hospital in-patient admissions of patients admitted with a secondary diagnosis of PD between 2009 and 2012 in Ireland. Data concerning patients, aged over and under 65 years with a previously existing diagnosis of Parkinson's Disease were requested from the HIPE database for the years 2009-2012. Primary categories of interest were the top 10 principal diagnoses on admission, the top 10 principal procedures conducted, admission source and route, and final discharge destination. 12,437 discharges were recorded for people with PD over the age of 65 years and 1,223 in those under 65 years in Republic of Ireland between 2009 and 2012. A steady rise in acute hospital admissions was noted in the over 65 group. The number of patients requiring long stay accommodation more than doubled across both age categories from admission to discharge status. The most common reasons for admission in all age ranges were acute lower respiratory infection; disorders of urinary system; pneumonia (organism unspecified); and pneumonitis due to solids and liquids (aspiration pneumonia). This report highlights a worrying trend towards increased rates of hospital admissions for pneumonia and infections for people living with PD in Republic of Ireland.

Mindfulness-Based Crisis Interventions for patients with psychotic symptoms on acute psychiatric wards (amBITION study): Protocol for a feasibility randomised controlled trial.

BackgroundInpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. People often need to go to a hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings.Methods/designThe amBITION study is a feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention (MBCI)). Inpatients on acute psychiatric wards are eligible for the study if they report at least one positive psychotic symptom and are willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants will be randomly allocated to receive either MBCI or a control intervention (social activity therapy (SAT)) which will be based on doing activities on the ward with the therapist. The primary objective of the study is to find out whether it is possible to carry out this kind of trial successfully within UK inpatient settings and to find out whether patients and staff find it an acceptable intervention. The secondary objective is to collect pilot data on primary and secondary outcome measures, including re-admission rates at 6-month follow-up. This will provide information on the appropriateness of re-admission as the primary outcome measure for future efficacy trials, as well as data on the acceptability and utility of the clinical self-report measures.DiscussionThe results of the feasibility trial will indicate whether a subsequent efficacy pilot trial is warranted and, if so, will provide vital information for the planning of such a trial (e.g. pilot data on expected effect sizes). If future research finds that MBCI is an effective and safe intervention, then patients will benefit from access to better treatment within inpatient care which would reduce re-admission rates. This trial therefore addresses an area of urgent concern for service users, clinicians and the wider NHS.Trial registrationCurrent controlled trials ISRCTN37625384

Innovative Strength-Based Care in Child and Adolescent Inpatient Psychiatry.

Child and adolescent psychiatric units serve the highest risk, most vulnerable populations in the mental health delivery system. This article describes the integration of a strength-based approach with a traditional, medical model of psychiatric care on an acute inpatient unit. A strength-based framework allows for increased focus on exploring patients' goals, strengths, relationships, skills, and family communication within the hospital setting. The process of integration of strength-based care is described, followed by discussion of the implementation and evaluation of interventions, including mindfulness, family movie, narrative, and animal-assisted therapies. Innovative interventions led to improvement in patient symptoms, unit culture, and patient, family, and staff satisfaction. A strong emphasis on strength-based, multidisciplinary treatment has enhanced patient care, as the goals of acute inpatient admission are broadened to include more than diagnosis and medication management.

Refining Stroke Prediction in Atrial Fibrillation Patients by Addition of African-American Ethnicity to CHA2DS2-VASc Score

BackgroundPrior studies show that African-American patients have a higher risk of stroke compared with Caucasians. ObjectivesThis study hypothesized addition of African-American ethnicity to CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke, vascular disease, age 65 to 74, and female sex) score might improve stroke prediction in patients with atrial fibrillation (AF). MethodsMedicare claims from January 2010 to December 2012 identified patients with newly diagnosed AF. The CHA2DS2-VASc was calculated on the basis of diagnoses in claims incurred during 12 months before first AF diagnosis. Ethnicity was identified from the Beneficiary Summary File. CHA2DS2-VASc-R score was calculated by giving 1 additional point for African-American ethnicity. The primary outcome was stroke, defined by primary diagnosis on acute inpatient admissions after the initial AF diagnosis. We used proportional hazards regression to determine the relationship between stroke and the CHA2DS2-VASc or a revised CHA2DS2-VASc-R score. ResultsOf 460,417 patients with AF, 390,590 (85%) were non-Hispanic whites, 31,702 (7%) were non-Hispanic African Americans, and the remainder were other non-white ethnicities. Mean age was 79.2 ± 8.0 years, with 60% females. Overall, 16,703 stroke events occurred, and 151,441 (32.7%) patients died during a mean follow-up period of 18.0 months. Compared with CHA2DS2-VASc, CHA2DS2-VASc-R score improved the fit of the model significantly as measured by the log likelihood ratio statistic (p < 0.001). Among individual risk factors in CHA2DS2-VASc-R score, only prior stroke, age ≥75 years, and female sex had a stronger association with incident stroke than African-American ethnicity. ConclusionsIn patients >65 years of age with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score significantly improved stroke prediction.

A retrospective observational study of the effectiveness of paliperidone palmitate on acute inpatient hospitalization rates.

This retrospective mirror-image observational study aimed to establish the effects of the long-acting antipsychotic injection paliperidone palmitate (PP) on acute inpatient hospitalization rates. We utilized routinely collected clinical data to compare the number and length of acute patient admissions 1 year before and 1 year after initiation of PP. A single cohort of 66 patients with a diagnosis of schizophrenia and who had received monthly injections of PP for at least 1 year were included in the analysis. The mean number of acute inpatient admissions fell from 0.86 in the year before PP initiation to 0.23 in the following year (P=0.001), and there was a numerical but nonsignificant decrease in the number of bed days from 32.48 to 31.22 over the study duration. The median number of bed days in the year before PP initiation was 20, and in the year after initiation it was 0. The median number of admissions also fell from 1 to 0 during the same period. The results of the study should be treated cautiously because of the limitations of the study design but suggest that patients with a diagnosis of schizophrenia who continue treatment with PP over 12 months experience a significant reduction in hospital admissions compared with the previous year.

Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

Treatment of Attention Deficit in a Patient with Intractable Daily Seizures: A Case Report

Individuals with epilepsy often demonstrate a diminished capacity for sustained attention, whether from the underlying process or their medications. Some consider the use of stimulants such as Methylphenidate, controversial due to concerns they may lower convulsive threshold. This case report describes a patient with daily intractable seizures despite multiple anti-epileptic agents, with severe impairments in attention, cognition and communication. During an acute inpatient rehabilitation admission, this patient was treated with Methylphenidate and decreased anti-epileptic medication with clinically demonstrated improvements in attention, communication and command following. There were no adverse effects demonstrated in seizure frequency.

Age before acuity: the drivers of demand for emergency department services in the Greater Sydney Area

ObjectiveTo contrast long-term population-based trends in general practice (GP) presentations and acute inpatient admissions from the emergency department (ED) in the elderly population within the Greater Sydney Area.MethodsThis was a...

Predictors of mental health-related acute service utilisation and treatment costs in the 12 months following an acute psychiatric admission.

A key step in informing mental health resource allocation is to identify the predictors of service utilisation and costs. This project aims to identify the predictors of mental health-related acute service utilisation and treatment costs in the year following an acute public psychiatric hospital admission. A dataset containing administrative and routinely measured outcome data for 1 year before and after an acute psychiatric admission for 1757 public mental health patients was analysed. Multivariate regression models were developed to identify patient- and treatment-related predictors of four measures of service utilisation or cost: (a) duration of index admission; and, in the year after discharge from the index admission (b) acute psychiatric inpatient bed-days; (c) emergency department (ED) presentations; and (d) total acute mental health service costs. Split-sample cross-validation was used. A diagnosis of psychosis, problems with living conditions and prior acute psychiatric inpatient bed-days predicted a longer duration of index admission, while prior ED presentations and self-harm predicted a shorter duration. A greater number of acute psychiatric inpatient bed-days in the year post-discharge were predicted by psychosis diagnosis, problems with living conditions and prior acute psychiatric inpatient admissions. The number of future ED presentations was predicted by past ED presentations. For total acute care costs, diagnosis of psychosis was the strongest predictor. Illness acuity and prior acute psychiatric inpatient admission also predicted higher costs, while self-harm predicted lower costs. The development of effective models for predicting acute mental health treatment costs using existing administrative data is an essential step towards a workable activity-based funding model for mental health. Future studies would benefit from the inclusion of a wider range of variables, including ethnicity, clinical complexity, cognition, mental health legal status, electroconvulsive therapy, problems with activities of daily living and community contacts.

Predictors of admission to acute inpatient psychiatric care among children enrolled in Medicaid.

This study examined acute inpatient psychiatric admissions among child Medicaid recipients with a mental health diagnosis in one Midwestern state. The authors used multivariable logistic regression to determine the demographic, clinical, and service factors associated with admissions among 51,233 Medicaid enrolled children 3-17years old who were identified as having a mental health diagnosis. Compared to available data from other states, the overall acute admission rate was low (2.5%). Clinical factors were the strongest predictors of hospitalization. Youths with mood, disruptive and psychotic disorder diagnoses were 14.1, 6.2, and 5.8 times more likely than other mental health beneficiaries to experience one or more acute inpatient psychiatric admissions. Other predictors of acute admission included prior hospitalization, receipt of two or more concurrent psychotropic medications, older age, and urban residence. A low rate of acute inpatient admissions may indicate successful delivery of community-based mental health services; conversely, it may suggest underservice to youths with mental health need, particularly those in rural areas. Implications for publicly funded children's mental health care are discussed.