Follow-up After Pediatric Mental Health Emergency Visits

Author:

Hoffmann Jennifer A.1,Krass Polina23,Rodean Jonathan4,Bardach Naomi S.5,Cafferty Rachel6,Coker Tumaini R.7,Cutler Gretchen J.8,Hall Matthew4,Morse Rustin B.910,Nash Katherine A.11,Parikh Kavita12,Zima Bonnie T.13

Affiliation:

1. aDivision of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois

2. bDepartment of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

3. cNational Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania

4. dChildren’s Hospital Association, Lenexa, Kansas

5. eDepartment of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California

6. fDivision of Emergency Medicine, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado

7. gDepartment of Pediatrics, University of Washington School of Medicine and Seattle Children’s Research Institute, Seattle, Washington

8. hChildren’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, Minnesota

9. iDepartment of Pediatrics, The Ohio State University, Columbus, Ohio

10. jNationwide Children’s Hospital, Center for Clinical Excellence, Columbus, Ohio

11. kDepartment of Pediatrics, New York Presbyterian Morgan Stanley Childrens Hospital, Columbia University, New York City, New York

12. lDivision of Hospital Medicine, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

13. mCenter for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California

Abstract

OBJECTIVES To examine how outpatient mental health (MH) follow-up after a pediatric MH emergency department (ED) discharge varies by patient characteristics and to evaluate the association between timely follow-up and return encounters. METHODS We conducted a retrospective study of 28 551 children aged 6 to 17 years with MH ED discharges from January 2018 to June 2019, using the IBM Watson MarketScan Medicaid database. Odds of nonemergent outpatient follow-up, adjusted for sociodemographic and clinical characteristics, were estimated using logistic regression. Cox proportional hazard models were used to evaluate the association between timely follow-up and risk of return MH acute care encounters (ED visits and hospitalizations). RESULTS Following MH ED discharge, 31.2% and 55.8% of children had an outpatient MH visit within 7 and 30 days, respectively. The return rate was 26.5% within 6 months. Compared with children with no past-year outpatient MH visits, those with ≥14 past-year MH visits had 9.53 odds of accessing follow-up care within 30 days (95% confidence interval [CI], 8.75-10.38). Timely follow-up within 30 days was associated with a 26% decreased risk of return within 5 days of the index ED discharge (hazard ratio, 0.74; 95% CI, 0.63-0.91), followed by an increased risk of return thereafter. CONCLUSIONS Connection to outpatient care within 7 and 30 days of a MH ED discharge remains poor, and children without prior MH outpatient care are at highest risk for poor access to care. Interventions to link to outpatient MH care should prioritize follow-up within 5 days of an MH ED discharge.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference35 articles.

1. Trends in pediatric emergency department visits for mental health conditions and disposition by presence of a psychiatric unit;Cutler;Acad Pediatr,2019

2. Escalating mental health care in pediatric emergency departments;Rogers;Clin Pediatr (Phila),2017

3. National trends in mental health-related emergency department visits by children and adults, 2009-2015;Santillanes;Am J Emerg Med,2020

4. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau . Critical Crossroads: Pediatric Mental Health Care in the Emergency Department. A Care Pathway Resource Toolkit. 2019. Available at: https://www.hrsa.gov/sites/default/files/hrsa/critical-crossroads/critical-crossroads-tool.pdf. Accessed September 30, 2019

5. Why don’t patients attend their appointments? Maintaining engagement with psychiatric services;Mitchell;Adv PsychiatrTreat,2007

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