Factors related to length of stay, referral on discharge and hospital readmission for children and adolescents with anorexia nervosa.

Publisher: Wiley Country of Publication: United States NLM ID: 8111226 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-108X (Electronic) Linking ISSN: 02763478 NLM ISO Abbreviation: Int J Eat Disord Subsets: MEDLINE

Publication: <2005-> : Hoboken, NJ : Wiley
Original Publication: [New York, N.Y. : Van Nostrand Reinhold Co., c1981-

Anorexia Nervosa*/epidemiology ; Anorexia Nervosa*/therapy ; Patient Readmission*; Adolescent ; Child ; Humans ; Length of Stay ; Male ; Patient Discharge ; Referral and Consultation

Objective: This study examined factors related to hospital length of stay (LOS), reported referral on discharge, and hospital readmission, for children and adolescents (C&A) admitted to public hospitals for anorexia nervosa (AN), in a large health jurisdiction in Australia.
Method: Sociodemographic, illness, treatment, and hospital factors associated with LOS, reported referral to post-hospital treatment, and readmission within 28 days were analyzed for C&A with AN admitted to all New South Wales public hospitals in 2017, using median, multinomial logit and logit models. The sample comprised 289 admissions by 200 C&A aged 9-18 years with a primary or secondary diagnosis of AN.
Results: AN as a primary diagnosis and the presence of some physical and mental co-occurring conditions (e.g., malnutrition and obsessive-compulsive disorders) conferred a longer LOS. The majority of admissions were recorded being referred to primary care physicians (59.86%) and relatively small numbers to outpatient mental health services (5.54%) or outpatient eating disorder services (8.30%), with age, area socioeconomic status, and illness factors related to referral type. Male, low socioeconomic status, the presence of some co-occurring illnesses (e.g., adjustment disorder and viral infection), and rural or remote locations increased the likelihood of readmission.
Discussion: The findings have implications for service design, in particular the pathway to care from hospital into community for AN. Targeted interventions should consider recognizing and treating physical co-occurring illnesses at presentation to the health system, ensuring appropriate referral to community services, and providing services in socioeconomically disadvantaged and rural or remote areas.
(© 2020 Wiley Periodicals LLC.)

Agostino, H., Erdstein, J., & Di Meglio, G. (2013). Shifting paradigms: Continuous nasogastric feeding with high caloric intakes in anorexia nervosa. Journal of Adolescent Health, 53(5), 590-594. https://doi.org/10.1016/j.jadohealth.2013.06.005.
Agras, W. S. (2001). The consequences and costs of the eating disorders. Psychiatric Clinics of North America, 24(2), 371-379. https://doi.org/10.1016/S0193-953X(05)70232-X.
Aisbett, D., Boyd, C., Francis, K., & Newnham, K. (2007). Understanding barriers to mental health service utilization for adolescents in rural Australia. Rural Remote Health, 7(1), 624. https://doi.org/10.22605/RRH624.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Association.
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724-731. https://doi.org/10.1001/archgenpsychiatry.2011.74.
Castro, J., Gila, A., Puig, J., Rodriguez, S., & Toro, J. (2004). Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa. International Journal of Eating Disorders, 36(1), 22-30. https://doi.org/10.1002/eat.20009.
Demmler, J. C., Brophy, S. T., Marchant, A., John, A., & Tan, J. O. (2020). Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: National data linkage study. The British Journal of Psychiatry, 216(2), 105-112. https://doi.org/10.1192/bjp.2019.153.
Druss, B. G. (2007). Improving medical care for persons with serious mental illness: Challenges and solutions. The Journal of Clinical Psychiatry, 68(Suppl 4), 40-44. https://pubmed.ncbi.nlm.nih.gov/17539699/.
Golden, N. H., Katzman, D. K., Kreipe, R. E., Stevens, S. L., Sawyer, S. M., Rees, J., … Rome, E. S. (2003). Eating disorders in adolescents: Position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33(6), 496-503. https://doi.org/10.1016/j.jadohealth.2003.08.004.
Golden, N. H., Keane-Miller, C., Sainani, K. L., & Kapphahn, C. J. (2013). Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome. Journal of Adolescent Health, 53(5), 573-578. https://doi.org/10.1016/j.jadohealth.2013.05.014.
House, J., Schmidt, U., Craig, M., Landau, S., Simic, M., Nicholls, D., … Eisler, I. (2012). Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders. International Journal of Eating Disorders, 45(8), 949-956. https://doi.org/10.1002/eat.22065.
Jordan, J., Joyce, P. R., Carter, F. A., Horn, J., McIntosh, V. V., Luty, S. E., … Bulik, C. M. (2008). Specific and nonspecific comorbidity in anorexia nervosa. International Journal of Eating Disorders, 41(1), 47-56. https://doi.org/10.1002/eat.20463.
Katzman, D. K. (2005). Medical complications in adolescents with anorexia nervosa: A review of the literature. International Journal of Eating Disorders, 37(S1), S52-S59. https://doi.org/10.1002/eat.20118.
Katzman, D. K., Golden, N. H., Neumark-Sztainer, D., Yager, J., & Strober, M. (2000). From prevention to prognosis: Clinical research update on adolescent eating disorders. Pediatric Research, 47(6), 709-712. https://doi.org/10.1203/00006450-200006000-00005.
Lawrence, D., & Kisely, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology, 24(4_suppl), 61-68. https://doi.org/10.1177/1359786810382058.
Lay, B., Jennen-Steinmetz, C., Reinhard, I., & Schmidt, M. H. (2002). Characteristics of inpatient weight gain in adolescent anorexia nervosa: Relation to speed of relapse and re-admission. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 10(1), 22-40. https://doi.org/10.1002/erv.432.
Lievers, L. S., Curt, F., Wallier, J., Perdereau, F., Rein, Z., Jeammet, P., & Godart, N. (2009). Predictive factors of length of inpatient treatment in anorexia nervosa. European Child & Adolescent Psychiatry, 18(2), 75-84. https://doi.org/10.1007/s00787-008-0706-8.
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le Grange, D., … Hay, P. (2015). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychological Medicine, 45(2), 415-427. https://doi.org/10.1017/S0033291714001573.
Madden, S., Morris, A., Zurynski, Y., Kohn, M., & Elliott, E. (2008). Early-onset eating disorders (EOED) in young children: An overview of the findings of the Australian Paediatric Surveillance Unit (APSU) study. The Australian and New Zealand Journal of Psychiatry, 42, A28.
Maguire, S., Li, A., Cunich, M., & Maloney, D. (2019). Evaluating the effectiveness of an evidence-based online training program for health professionals in eating disorders. Journal of Eating Disorders, 7(1), 14. https://doi.org/10.1186/s40337-019-0243-5.
Maguire, S., Surgenor, L. J., Abraham, S., & Beumont, P. (2003). An international collaborative database: Its use in predicting length of stay for inpatient treatment of anorexia nervosa. Australian and New Zealand Journal of Psychiatry, 37(6), 741-747. https://doi.org/10.1080/j.1440-1614.2003.01257.x.
Meads, C., Gold, L., & Burls, A. (2001). How effective is outpatient care compared to inpatient care for the treatment of anorexia nervosa? A systematic review. European Eating Disorders Review: The Professional Journal of the Eating Disorders Association, 9(4), 229-241. https://doi.org/10.1002/erv.406.
Nicholls, D. E., Lynn, R., & Viner, R. M. (2011). Childhood eating disorders: British national surveillance study. The British Journal of Psychiatry, 198(4), 295-301. https://doi.org/10.1192/bjp.bp.110.081356.
Nozoe, S.-I., Soejima, Y., Yoshioka, M., Naruo, T., Masuda, A., Nagai, N., & Tanaka, H. (1995). Clinical features of patients with anorexia nervosa: Assessment of factors influencing the duration of in-patient treatment. Journal of Psychosomatic Research, 39(3), 271-281. https://doi.org/10.1016/0022-3999(94)00141-Q.
NSW Health. (2016). NSW hospital peer groups 2016. Information Bulletin.
NSW Health. (2018). Key performance indicators and improvement measures. NSW: NSW Government.
Pinhas, L., Morris, A., Crosby, R. D., & Katzman, D. K. (2011). Incidence and age-specific presentation of restrictive eating disorders in children: A Canadian paediatric surveillance program study. Archives of Pediatrics & Adolescent Medicine, 165(10), 895-899. https://doi.org/10.1001/archpediatrics.2011.145.
Smink, F. R., Van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406-414. https://doi.org/10.1007/s11920-012-0282-y.
Steinhausen, H. C., Grigoroiu-Serbanescu, M., Boyadjieva, S., Neumärker, K. J., & Winkler Metzke, C. (2008). Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study. International Journal of Eating Disorders, 41(1), 29-36. https://doi.org/10.1002/eat.20414.
Striegel-Moore, R. H., Leslie, D., Petrill, S. A., Garvin, V., & Rosenheck, R. A. (2000). One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: Evidence from a national database of health insurance claims. International Journal of Eating Disorders, 27(4), 381-389. https://doi.org/10.1002/(SICI)1098-108X(200005)27:4<381::AID-EAT2>3.0.CO;2-U.

Keywords: anorexia nervosa; children and adolescents; co-occurring illnesses; eating disorder; hospital referrals on discharge; length of stay; readmission; risk factors; socioeconomic status

Date Created: 20201116 Date Completed: 20211004 Latest Revision: 20211004

20231215

10.1002/eat.23399

33191499