Trends in the inpatient mental health treatment of children and adolescents in US community hospitals between 1990 and 2000.
BACKGROUND
Previous work has demonstrated marked changes in inpatient mental health service use by children and adolescents in the 1980s and early 1990s, but more recent, comprehensive, nationally representative data have not been reported.


OBJECTIVE
To describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000.


METHODS
Analysis of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a nationally representative sample of discharges from US community hospitals sponsored by the Agency for Healthcare Research and Quality.


METHODS
Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder.


METHODS
Changes in the number and population-based rate of discharges, total inpatient days and average length of stay, charges, diagnoses, dispositions, and patient demographic and hospital characteristics.


RESULTS
Although the total number of discharges, population-based discharge rate, and daily charges did not significantly change between 1990 and 2000, the total number of inpatient days and mean charges per visit each fell by approximately one half. Median length of stay declined 63% over the decade from 12.2 days to 4.5 days. Declines in median and mean lengths of stay were observed for most diagnostic categories and remained significant after controlling for changes in background patient and hospital characteristics. Discharge rates for psychotic and mood disorders as well as intentional self-injuries increased while rates for adjustment disorders fell. Discharges to short-term, nursing, and other inpatient facilities declined.


CONCLUSIONS
The period between 1990 and 2000 was characterized by a transformation in the length of inpatient mental health treatment for young people. Community hospitals evaluated, treated, and discharged mentally ill children and adolescents far more quickly than 10 years earlier despite higher apparent rates of serious illness and self-harm and fewer transfers to intermediate and inpatient care.
Case
Brady G
BG
Department of Psychiatry, New York University School of Medicine, New York, NY, USA. bcase@post.harvard.edu
Olfson
Mark
M
Marcus
Steven C
SC
Siegel
Carole
C
D000293:Adolescent; D000367:Age Factors; D002648:Child; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006764:Hospitals, Community / Q000191:economics / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology