Katherine A Nash1,2, Bonnie T Zima3, Craig Rothenberg4, Jennifer Hoffmann5, Claudia Moreno6, Marjorie S Rosenthal7,2, Arjun K Venkatesh4,8. 1. National Clinician Scholars Program, katherine.nash@yale.edu. 2. Departments of Pediatrics and. 3. UCLA-Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California. 4. Emergency Medicine, and. 5. Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and. 6. Yale Child Study Center, School of Medicine, Yale University, New Haven, Connecticut. 7. National Clinician Scholars Program. 8. Center for Outcomes Research & Evaluation, New Haven, Connecticut.
Abstract
BACKGROUND AND OBJECTIVES: Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS: We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS: From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type. CONCLUSIONS: The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.
BACKGROUND AND OBJECTIVES: Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS: We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS: From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type. CONCLUSIONS: The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.
Authors: Shireen Cama; Monica Malowney; Anna Jo Bodurtha Smith; Margaret Spottswood; Elisa Cheng; Louis Ostrowsky; Jose Rengifo; J Wesley Boyd Journal: Int J Health Serv Date: 2017-05-05 Impact factor: 1.663
Authors: Heather B Conrad; Kathryn A Hollenbach; Daniel L Gehlbach; Karen L Ferran; Tiffani A Barham; Keri L Carstairs Journal: Pediatr Emerg Care Date: 2018-08 Impact factor: 1.454