353 - Trends in Avoidable Mental Behavioral Health (MBH) Hospital Days at US Children's Hospitals

Publication Number: 4346.353

Adrienne DePorre, Children's Mercy Hospitals and Clinics, prairie village, KS, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Hank Puls, Children's Mercy Kansas City, Kansas City, KS, United States; Cy Nadler, Children's Mercy Kansas City, Kansas City, MO, United States

Background: Days in which a child is hospitalized but not receiving medical services are termed avoidable days (ADs). ADs related to a mental and behavioral health condition (MBH) frequently result from poor access to inpatient psychiatric beds, delays in residential facility placement, or lack of community supports. The burden of MBH-ADs on children's hospitals is unknown. Estimating the national prevalence of MBH-ADs over time could inform high-value care delivery and population-level strategies to address unmet MBH needs.

Objective: Identify prevalence of MBH days and MBH-ADs in children's hospitals.

Design/Methods: We performed a retrospective study of hospital days of children aged 5-18 with an inpatient or observation stay from 2016-2024 across 42 children's hospitals using the Pediatric Health Information Systems database. MBH hospitalizations were identified as having a principal MBH diagnosis or a disposition to a psychiatric facility. We excluded MBH hospitalizations with inpatient psychiatric bed charges. MBH-ADs were identified using a conceptually derived and empirically validated algorithm based on billing data. We assessed longitudinal trends in MBH days and MBH-ADs over time.

Results: There was a total of 3,057,828 all-cause hospitalizations with 11,618,991 total hospital days. Of these,167,157 hospitalizations (5.5 %) and 621,380 hospital days (5.4%) were for a MBH condition. Table 1 displays hospitalization characteristics. Among the621,380 MBH days, 332,610 (53.5%) were identified as avoidable (range at individual hospitals 22.7% to 86.6%). The proportion of MBH days climbed from 3.7% in 2016 to a peak of 8.5% in 2021, before gradually declining to 4.4% in 2024 (Figure 1). Among MBH days, the proportion of MBH-ADs overall decreased from 55.7% in 2016 to 52.7% in 2024, with a nadir of 47.8% in 2020 (Figure 2).

Conclusion(s): Our results highlight sustained high proportion of MBH-ADs over the last 8 years, highlighting continued gaps in accessing the right tier of MBH care at the right time. The proportion of hospital days for a MBH reason peaked in 2021, with subsequent declines suggesting some early signs of improvements in the systems of care for youth with a MBH condition. Future studies include assessing patient and diagnostic risk-factors for experiencing MBH-ADs as well as understanding the prevalence of MBH-AD by diagnostic subgroups overtime.

Table 1. Demographic and Clinical Characteristics of Cohort Discharges
Abbreviations: MBH= mental and behavioral health; OCD= obsessive compulsive disorders.

Other MBH category includes: elimination disorders, feeding and eating disorders, personality disorders, sleep wake disorders, dissociative disorders, fetal or newborn damage related to maternal substance abuse, maternal mental illness or substance abuse, mental health symptoms, miscellaneous, sexual and gender identify disorders.


Figure 1. MBH Days Over Time


Figure 2. MBH-ADs Over Time.