Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals Between 1990-200.
Brady Case.
Define the problem- Inpatient Mental Health Services use by children and adolescents in the 1980s, and early 1990s, but more recent comprehensive nationally representatitive data have not been reported.
Objective
Describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000.
o Secondary data From Nation Wide Inpatient Sample NIS of Healthcare Cost and Utilization Project for the years 1990-2000. The NIS conducted by the Agency for Healthcare Research and Quality is a nationally representative sample survey of US community hospitals defined annually as hospitals that were open during any part of the calendar year and designated as community hospitals in the American Hospital Association’s Annual Survey of Hospitals.
Exclusion is hospital units of institutions the few freestanding psychiatric hospitals and alcoholism/dependency facilities, long-term care hospitals. And beginning in 1998, short term rehabilitation hospitals.
• Data come in the forms of Nominal, Ordinal, Interval and Ratio (remember the French word NOIR for color black). Data can be either continuous or discrete.
• Both zero and unit of measurements are arbitrary in the Interval scale. While the unit of measurement is arbitrary in Ratio scale, its zero point is a natural attribute. The categorical variable is measured on an ordinal or nominal scale.
Collect the data-
Population-
Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder.
Sample- 5-8 million hospital stays from 1000 hospitals. Clinical and resource use information typically available from discharge abstracts.
NIS uses a stratified probability sample design to approximate a 20% stratified sample of all us community hospitals in each stratum. For National estimates The Agency for healthcare research and Quality provides sample weights and strata that we used in all analyses.
Limited analyses to children and adolescents aged younger than 18 years with a principal diagnosis of a mental disorder with use of International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9CM) between 1990-2000. Trend analyses used the 2 yearly end points in which there were 21450 child and adolescent mental disorder discharges in the 1990 sample, and 29590 in the 2000 sample.
Principal ICD-9 Diagnosis divided into 8 categories. 14 Co morbid secondary Diagnoses such as substance-use, intention self injuries, and general medical conditions.
• Demographic characteristics Age, sex, race/ethnicity.
• Hospital characteristics included hospital region, stat, urban/rural location, teaching statutes and bed size.
o Region coded by US Census convention into Northeast, Midwest, South, or West. Hospitals in metro areas were considered urban, and hospitals with a residency program approved by AMA with membership in Council of Teaching Hospital, or with ratio full-time equivalent interns and residents to bed of 0.25 or higher were considered teaching facilities. Urban/rural locations and teaching status were combined into a single descriptor coded as rural urban non-teaching or urban teaching.
o Bed size was coded consistent with NIS convention as small medium or large with cut points chosen so that approximately one third of the hospitals in a given region and location/teaching combination would be included in each bed size category.
o Day of admission was defined as weekday m-f or weekend s-s
o Month of admission was coded as winter dec-feb, spring, March through may, summer June through august, fall, sept. through November as well as school vacation, December July and august, or school year, defined as all other months.
o Variables are median household income in patients home; zip codes, and hospital ownership were inconsistent across study years, precluding meaningful comparison.
• Hospital stay characteristics by admission type, admission source, primary payer, day and months of admission, and discharge disposition.
Discharge and population estimates
• National population based rates of children and adolescents mental health discharges and associated charges per 100 children using US census measurements of the number of age, sex, and race/ethnicity of civilian non-institutionalized residents ages 17 years and younger for the years 1990-2000.
• Population-based discharge rates by insurance status were calculated using adjusted estimates for non-institutionalized youth from the current populations survey published by the US census bureau. Charges were calculated in constant year-2000dollars after adjustment according to the US bureau of Labor statistics annual all-urban consumer price index for medical care.
• Length of stay was calculated by subtracting the admission date from the discharge date except in cases of same-day discharges that were assigned an LOS of 0.5 days.
• Mean or median changes or differences in discharge rate, number, charges, or LOS were considered statistically significant. If the corresponding 95% confidence variable excluded zero.
• Changes in the distribution of discharge characteristics were tested for significance at 5% level using an X^2 Statistic.
• Differences in population rates between years or variable categories were considered statistically significant, if the 95% confidence variable of estimated rates did not overlap.
• These analysis were conducted with SAS=callable SIDAAM version 9.0(RIT International Research Triangle Park, NC) using programming code provided by the agency for Healthcare research and quality to accommodate complex sample design and weighting.
Quantitative- numeric and indicate either how much or how many
Distinguish
Time series- data collected over several time periods
Analyze the data
Exploratory-to discover what the data seems to be saying by using simple arithmetic, and easy to draw pictures to summarize the data
Confirmatory-ideas from probability theory in the attempt to answer specific questions
Probability provides a mechanism for measuring, expressing, and analyzing the uncertainties associated with further events.
Reporting the results
Report in the form of a table, a graph, or a set of percentages. The result must reflect the uncertainty through the use of probability statements, and intervals of values.
Define the problem- Inpatient Mental Health Services use by children and adolescents in the 1980s, and early 1990s, but more recent comprehensive nationally representatitive data have not been reported.
Objective
Describe trends in inpatient treatment of children and adolescents with mental disorders between 1990 and 2000.
o Secondary data From Nation Wide Inpatient Sample NIS of Healthcare Cost and Utilization Project for the years 1990-2000. The NIS conducted by the Agency for Healthcare Research and Quality is a nationally representative sample survey of US community hospitals defined annually as hospitals that were open during any part of the calendar year and designated as community hospitals in the American Hospital Association’s Annual Survey of Hospitals.
Exclusion is hospital units of institutions the few freestanding psychiatric hospitals and alcoholism/dependency facilities, long-term care hospitals. And beginning in 1998, short term rehabilitation hospitals.
• Data come in the forms of Nominal, Ordinal, Interval and Ratio (remember the French word NOIR for color black). Data can be either continuous or discrete.
• Both zero and unit of measurements are arbitrary in the Interval scale. While the unit of measurement is arbitrary in Ratio scale, its zero point is a natural attribute. The categorical variable is measured on an ordinal or nominal scale.
Collect the data-
Population-
Patients aged 17 years and younger discharged from US community hospitals with a principal diagnosis of a mental disorder.
Sample- 5-8 million hospital stays from 1000 hospitals. Clinical and resource use information typically available from discharge abstracts.
NIS uses a stratified probability sample design to approximate a 20% stratified sample of all us community hospitals in each stratum. For National estimates The Agency for healthcare research and Quality provides sample weights and strata that we used in all analyses.
Limited analyses to children and adolescents aged younger than 18 years with a principal diagnosis of a mental disorder with use of International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9CM) between 1990-2000. Trend analyses used the 2 yearly end points in which there were 21450 child and adolescent mental disorder discharges in the 1990 sample, and 29590 in the 2000 sample.
Principal ICD-9 Diagnosis divided into 8 categories. 14 Co morbid secondary Diagnoses such as substance-use, intention self injuries, and general medical conditions.
• Demographic characteristics Age, sex, race/ethnicity.
• Hospital characteristics included hospital region, stat, urban/rural location, teaching statutes and bed size.
o Region coded by US Census convention into Northeast, Midwest, South, or West. Hospitals in metro areas were considered urban, and hospitals with a residency program approved by AMA with membership in Council of Teaching Hospital, or with ratio full-time equivalent interns and residents to bed of 0.25 or higher were considered teaching facilities. Urban/rural locations and teaching status were combined into a single descriptor coded as rural urban non-teaching or urban teaching.
o Bed size was coded consistent with NIS convention as small medium or large with cut points chosen so that approximately one third of the hospitals in a given region and location/teaching combination would be included in each bed size category.
o Day of admission was defined as weekday m-f or weekend s-s
o Month of admission was coded as winter dec-feb, spring, March through may, summer June through august, fall, sept. through November as well as school vacation, December July and august, or school year, defined as all other months.
o Variables are median household income in patients home; zip codes, and hospital ownership were inconsistent across study years, precluding meaningful comparison.
• Hospital stay characteristics by admission type, admission source, primary payer, day and months of admission, and discharge disposition.
Discharge and population estimates
• National population based rates of children and adolescents mental health discharges and associated charges per 100 children using US census measurements of the number of age, sex, and race/ethnicity of civilian non-institutionalized residents ages 17 years and younger for the years 1990-2000.
• Population-based discharge rates by insurance status were calculated using adjusted estimates for non-institutionalized youth from the current populations survey published by the US census bureau. Charges were calculated in constant year-2000dollars after adjustment according to the US bureau of Labor statistics annual all-urban consumer price index for medical care.
• Length of stay was calculated by subtracting the admission date from the discharge date except in cases of same-day discharges that were assigned an LOS of 0.5 days.
• Mean or median changes or differences in discharge rate, number, charges, or LOS were considered statistically significant. If the corresponding 95% confidence variable excluded zero.
• Changes in the distribution of discharge characteristics were tested for significance at 5% level using an X^2 Statistic.
• Differences in population rates between years or variable categories were considered statistically significant, if the 95% confidence variable of estimated rates did not overlap.
• These analysis were conducted with SAS=callable SIDAAM version 9.0(RIT International Research Triangle Park, NC) using programming code provided by the agency for Healthcare research and quality to accommodate complex sample design and weighting.
Quantitative- numeric and indicate either how much or how many
Distinguish
Time series- data collected over several time periods
Analyze the data
Exploratory-to discover what the data seems to be saying by using simple arithmetic, and easy to draw pictures to summarize the data
Confirmatory-ideas from probability theory in the attempt to answer specific questions
Probability provides a mechanism for measuring, expressing, and analyzing the uncertainties associated with further events.
Reporting the results
Report in the form of a table, a graph, or a set of percentages. The result must reflect the uncertainty through the use of probability statements, and intervals of values.
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