Naomi S Bardach1,2, Stephanie K Doupnik3, Jonathan Rodean4, Bonnie T Zima5, James C Gay6, Carol Nash7, Yasas Tanguturi8, Tumaini R Coker9. 1. Department of Pediatrics and naomi.bardach@ucsf.edu. 2. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California. 3. Department of Pediatrics, University of Pennsylvania and Division of General Pediatrics, PolicyLab, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 4. Children's Hospital Association, Lenexa, Kansas. 5. Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California. 6. Departments of Pediatrics and. 7. Department of Research, Franciscan Children's, Boston, Massachusetts; and. 8. Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee. 9. Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Research Institute, Seattle, Washington.
Abstract
OBJECTIVES: A national quality measure in the Child Core Set is used to assess whether pediatric patients hospitalized for a mental illness receive timely follow-up care. In this study, we examine the relationship between adherence to the quality measure and repeat use of the emergency department (ED) or repeat hospitalization for a primary mental health condition. METHODS: We used the Truven MarketScan Medicaid Database 2015-2016, identifying hospitalizations with a primary diagnosis of depression, bipolar disorder, psychosis, or anxiety for patients aged 6 to 17 years. Primary predictors were outpatient follow-up visits within 7 and 30 days. The primary outcome was time to subsequent mental health-related ED visit or hospitalization. We conducted bivariate and multivariate analyses using Cox proportional hazard models to assess relationships between predictors and outcome. RESULTS: Of 22 844 hospitalizations, 62.0% had 7-day follow-up, and 82.3% had 30-day follow-up. Subsequent acute use was common, with 22.4% having an ED or hospital admission within 30 days and 54.8% within 6 months. Decreased likelihood of follow-up was associated with non-Hispanic or non-Latino black race and/or ethnicity, fee-for-service insurance, having no comorbidities, discharge from a medical or surgical unit, and suicide attempt. Timely outpatient follow-up was associated with increased subsequent acute care use (hazard ratio [95% confidence interval]: 7 days: 1.20 [1.16-1.25]; 30 days: 1.31 [1.25-1.37]). These associations remained after adjusting for severity indicators. CONCLUSIONS: Although more than half of patients received follow-up within 7 days, variations across patient population suggest that care improvements are needed. The increased hazard of subsequent use indicates the complexity of treating these patients and points to potential opportunities to intervene at follow-up visits.
OBJECTIVES: A national quality measure in the Child Core Set is used to assess whether pediatric patients hospitalized for a mental illness receive timely follow-up care. In this study, we examine the relationship between adherence to the quality measure and repeat use of the emergency department (ED) or repeat hospitalization for a primary mental health condition. METHODS: We used the Truven MarketScan Medicaid Database 2015-2016, identifying hospitalizations with a primary diagnosis of depression, bipolar disorder, psychosis, or anxiety for patients aged 6 to 17 years. Primary predictors were outpatient follow-up visits within 7 and 30 days. The primary outcome was time to subsequent mental health-related ED visit or hospitalization. We conducted bivariate and multivariate analyses using Cox proportional hazard models to assess relationships between predictors and outcome. RESULTS: Of 22 844 hospitalizations, 62.0% had 7-day follow-up, and 82.3% had 30-day follow-up. Subsequent acute use was common, with 22.4% having an ED or hospital admission within 30 days and 54.8% within 6 months. Decreased likelihood of follow-up was associated with non-Hispanic or non-Latino black race and/or ethnicity, fee-for-service insurance, having no comorbidities, discharge from a medical or surgical unit, and suicide attempt. Timely outpatient follow-up was associated with increased subsequent acute care use (hazard ratio [95% confidence interval]: 7 days: 1.20 [1.16-1.25]; 30 days: 1.31 [1.25-1.37]). These associations remained after adjusting for severity indicators. CONCLUSIONS: Although more than half of patients received follow-up within 7 days, variations across patient population suggest that care improvements are needed. The increased hazard of subsequent use indicates the complexity of treating these patients and points to potential opportunities to intervene at follow-up visits.
Authors: Alison R Carroll; Matt Hall; Charlotte M Brown; David P Johnson; James W Antoon; Heather Kreth; My-Linh Ngo; Whitney Browning; Maya Neeley; Alison Herndon; Swati B Chokshi; Gregory Plemmons; Jakobi Johnson; Sarah R Hart; Derek J Williams Journal: J Pediatr Date: 2021-09-01 Impact factor: 4.406
Authors: Reham Shalaby; Pamela Spurvey; Michelle Knox; Rebecca Rathwell; Wesley Vuong; Shireen Surood; Liana Urichuk; Mark Snaterse; Andrew J Greenshaw; Xin-Min Li; Vincent I O Agyapong Journal: Int J Environ Res Public Health Date: 2022-03-23 Impact factor: 3.390