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Predictors of Psychiatric Hospital Readmission for Children and Adolescents with Autism Spectrum Disorder
Previous research has shown that children and adolescents with ASD have higher rates of inpatient psychiatric hospitalizations than children with intellectual disability or other psychiatric diagnoses, and youth with ASD have longer psychiatric hospital stays on average. Though recent studies suggest that specialized inpatient units may produce positive treatment outcomes for serious behavioral problems in children and adolescents with ASD, readmissions remain a problem and contribute to the ongoing shortage of adequate psychiatric beds for this population.
Objectives:
To examine the demographic and clinical predictors of short-term hospital readmissions after an inpatient stay in a specialized inpatient psychiatry unit.
Methods:
Participants were selected from the Autism Inpatient Collection (AIC): a multi-site study enrolling children and adolescents admitted to six specialized psychiatric inpatient units. Data include demographic information, medical and psychiatric histories, parent rating scales at time of admission, discharge, and 2 months after discharge, direct assessments performed on the participants during stay, and repeated measures for those who are readmitted. The sample (n = 236; 79% male; mean age = 12.9) was divided to compare differences between participants who were re-hospitalized within 2 months of discharge(n = 59) and those who were not (n = 177). A multiple logistic regression model was applied to examine the relative contribution of different demographic and clinical factors to the likelihood of being readmitted.
Results:
No differences were found among the demographic characteristics of the two groups (age, gender, IQ, minimally verbal status, adaptive functioning, severity of autism symptoms, caregivers’ marital status, place of residence). Re-hospitalized participants had significantly more lifetime psychiatric hospitalizations (t (226) = 3.18, p = 0.002). At time of discharge, re-hospitalized participants had higher ABC-Irritability scores (t(198) = 1.9, p = 0.05) and ABC-Hyperactivity scores (t(195) = 2.1, p = 0.047). No differences were found in the type of psychiatric diagnoses given at discharge, nor number of psychotropic medications, but re-hospitalized participants had more psychiatric diagnoses overall (t(234) = 2.6, p = 0.01). A logistic regression model revealed that the total number of psychiatric diagnoses at discharge (OR = 1.66, p = 0.013) and previous psychiatric hospital admissions (OR = 1.15 , p = 0.014) independently predicted the likelihood of being re-hospitalized within 2 months of discharge.
Conclusions:
Results indicate that approximately 25% of participants admitted to one of six specialized inpatient psychiatry units across the country were re-hospitalized within 2 months of discharge. Re-hospitalized participants had a higher number of lifetime psychiatric hospitalizations, more psychiatric diagnoses at discharge, and higher irritability and hyperactivity scores at discharge. An improved understanding of patients at risk for short-term readmissions could help guide providers to better individualize plans for discharge and follow-up care, and, in turn, lead to a reduction in short-term readmissions. Further research is needed to better understand the needs of this subset of individuals and how to promote improved outcomes.