Sarah K Connell1, Q Burkhart2, Anagha Tolpadi2, Layla Parast2, Courtney A Gidengil3, Steven Yung4, William T Basco5, Derek Williams6, Maria T Britto7, Mark Brittan8, Kelly E Wood9, Naomi Bardach10, Julie McGalliard11, Rita Mangione-Smith12. 1. Department of Pediatrics, University of Washington (SK Connell), Seattle, Wash; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (SK Connell and J McGalliard), Seattle, Wash. Electronic address: sarah.connell@seattlechildrens.org. 2. RAND Corporation (Q Burkhart, A Tolpadi, L Parast), Santa Monica, Calif. 3. RAND Corporation (CA Gidengil), Boston, Mass. 4. Mount Sinai Hospital (S Yung), New York, NY; Maimonides Medical Center (S Yung), Brooklyn, NY. 5. Medical University of South Carolina (WT Basco), Charleston, SC. 6. Vanderbilt University Medical Center (D Williams), Nashville, Tenn. 7. Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (MT Britto), Cincinnati, Ohio. 8. Children's Hospital Colorado (M Brittan), Aurora, Colo. 9. University of Iowa Stead Family Children's Hospital (KE Wood), Iowa City, Iowa. 10. UCSF Department of Pediatrics (N Bardach), San Francisco, Calif. 11. Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (SK Connell and J McGalliard), Seattle, Wash. 12. Kaiser Permanente Washington Health Research Institute (R Mangione-Smith), Seattle, Wash.
Abstract
OBJECTIVE: To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. METHODS: Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions. RESULTS: Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07-2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24-0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28-0.83). CONCLUSIONS: This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.
OBJECTIVE: To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. METHODS: Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions. RESULTS: Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07-2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24-0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28-0.83). CONCLUSIONS: This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.
Authors: Naomi S Bardach; Q Burkhart; Laura P Richardson; Carol P Roth; J Michael Murphy; Layla Parast; Courtney A Gidengil; Jordan Marmet; Maria T Britto; Rita Mangione-Smith Journal: Pediatrics Date: 2018-06 Impact factor: 7.124
Authors: Harold Alan Pincus; Sarah Hudson Scholle; Brigitta Spaeth-Rublee; Kimberly A Hepner; Jonathan Brown Journal: Health Aff (Millwood) Date: 2016-06-01 Impact factor: 6.301
Authors: Deborah M Stone; Thomas R Simon; Katherine A Fowler; Scott R Kegler; Keming Yuan; Kristin M Holland; Asha Z Ivey-Stephenson; Alex E Crosby Journal: MMWR Morb Mortal Wkly Rep Date: 2018-06-08 Impact factor: 17.586