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Perspectives of Parents and Providers on Reasons for Mental Health Readmissions: A Content Analysis Study

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Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Pediatric hospitalizations for mental health conditions are rapidly increasing, with readmission rates for mental health conditions surpassing those for non-mental health conditions. The objective of this study was to identify reasons for pediatric mental health readmissions from the perspectives of parents and providers. We performed a retrospective content analysis of surveys administered to parents and providers of patients with a 14-day readmission to an inpatient pediatric psychiatry unit between 5/2017 and 8/2018. Open-ended survey items assessed parent and provider perceptions of readmission reasons. We used deductive coding to categorize survey responses into an a priori coding scheme based on prior research. We used inductive coding to identify and categorize responses that did not fit into the a priori coding scheme. All data were recoded using the revised schema and reliability of the coding process was assessed using kappa statistics and consensus building. We had completed survey responses from 89 (64%) of 138 readmission encounters (56 parent surveys; 61 provider surveys). The top three readmission reasons that we identified from parent responses were: discordant inpatient stay expectations with providers (41%), discharge hesitancy (34%), and treatment plan failure (13%). Among providers, the top readmission reasons that we identified were: access to outpatient care (30%), treatment adherence (13%), and a challenging home (11%) and social environment (11%). We identified inpatient stay expectations, discharge hesitancy, and suboptimal access to outpatient care as the most prominent reasons for mental health readmissions, which provide targets for future quality improvement efforts.

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Acknowledgements

We thank Anu Asnani for her assistance in helping us obtain our dataset and for providing a detailed account of the survey process.

Funding

This study was funded by the University of Washington/Seattle Children’s Hospital Health Services and Quality of Care Research Fellowship Program. Dr. Desai’s time was supported by the Agency for Healthcare Research and Quality, Grant K08 HS024299 (PI Desai). Research reported in this publication was also supported by the Institute of Translational Health Science (ITHS) under award number UL1 TR002319 NCATS/NIH. The authors have no financial relationships relevant to this article to disclose.

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Authors and Affiliations

  1. Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Research Institute, 2001 8th Ave., Seattle, WA, USA

    Sarah K. Connell & Arti D. Desai

  2. Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA

    Sarah K. Connell, Tony To, Jessica Ramos, Miriam J. Haviland & Arti D. Desai

  3. Psychiatry and Behavioral Medicine, Seattle Children’s Hospital, Seattle, WA, USA

    Kashika Arora

Authors
  1. Sarah K. Connell
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  2. Tony To
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  3. Kashika Arora
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  4. Jessica Ramos
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  5. Miriam J. Haviland
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  6. Arti D. Desai
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Contributions

Dr Connell conceptualized and designed the study, supervised the primary data abstraction, analyzed the data, and drafted the initial manuscript. Mr To and Ms Arora analyzed the data, and reviewed and revised the manuscript. Ms Ramos designed the data collection instrument, coordinated and supervised data collection and reviewed and revised the manuscript. Dr Haviland carried out the data analyses, and reviewed and revised the manuscript. Dr Desai participated in conceptualizing the study design, participated in data analysis, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sarah K. Connell.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Informed Consent

The Institutional Review Board approved a waiver of consent as this study posed minimal risk to study participants and utilized retrospective data that was previously obtained for the purpose of local quality improvement efforts.

Research Involving Human and Animal Rights

The study was approved by Seattle Children’s Hospital Institutional Review Board.

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Connell, S.K., To, T., Arora, K. et al. Perspectives of Parents and Providers on Reasons for Mental Health Readmissions: A Content Analysis Study. Adm Policy Ment Health 48, 830–838 (2021). https://doi.org/10.1007/s10488-021-01134-6

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