Layla Parast1, Q Burkhart2, Naomi S Bardach3, Robert Thombley4, William T Basco5, Greg Barabell6, Derek J Williams7, Ed Mitchel8, Edison Machado9, Priya Raghavan10, Anagha Tolpadi2, Rita Mangione-Smith9. 1. RAND Corporation, Statistics Group (L Parast, Q Burkhart, A Tolpadi), Santa Monica, Calif. Electronic address: parast@rand.org. 2. RAND Corporation, Statistics Group (L Parast, Q Burkhart, A Tolpadi), Santa Monica, Calif. 3. University of California San Francisco (NS Bardach), San Francisco, Calif. 4. UCSF, Institute for Health Policy Studies (R Thombley), San Francisco, Calif. 5. The Medical University of South Carolina (WT Bosco), Charleston, SC. 6. Clear Bell Solutions (G Barabell), Charleston, SC. 7. Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr. Children's at Vanderbilt (DJ Williams), Nashville, Tenn. 8. Department of Health Policy, Vanderbilt University School of Medicine (E Mitchel), Nashville, Tenn. 9. Kaiser Permanente Washington Health Research Institute (E Machado, R Mangione-Smith), Seattle, Wash. 10. IPRO (P Raghavan), Lake Success, NY.
Abstract
OBJECTIVE: To develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. METHODS: Based on a conceptual framework, evidence review, and a modified Delphi process, we developed a quality measure assessing whether youth 5 to 17 years old evaluated for suicidal ideation or self-harm in the ED and discharged to home had a follow-up mental health care visit within 7 days. The measure was tested in 4 geographically dispersed states (California, Pennsylvania, South Carolina, Tennessee) using Medicaid administrative data. We examined measure feasibility of implementation, variation, reliability, and validity. To test validity, adjusted regression models examined associations between quality measure scores and subsequent all-cause and same-cause hospital readmissions/ED return visits. RESULTS: Overall, there were 16,486 eligible ED visits between September 1, 2014 and July 31, 2016; 53.5% of eligible ED visits had an associated mental health care follow-up visit within 7 days. Measure scores varied by state, ranging from 26.3% to 66.5%, and by youth characteristics: visits by youth who were non-White, male, and living in an urban area were significantly less likely to be associated with a follow-up visit within 7 days. Better quality measure performance was not associated with decreased reutilization. CONCLUSIONS: This new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, future work is needed to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
OBJECTIVE: To develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. METHODS: Based on a conceptual framework, evidence review, and a modified Delphi process, we developed a quality measure assessing whether youth 5 to 17 years old evaluated for suicidal ideation or self-harm in the ED and discharged to home had a follow-up mental health care visit within 7 days. The measure was tested in 4 geographically dispersed states (California, Pennsylvania, South Carolina, Tennessee) using Medicaid administrative data. We examined measure feasibility of implementation, variation, reliability, and validity. To test validity, adjusted regression models examined associations between quality measure scores and subsequent all-cause and same-cause hospital readmissions/ED return visits. RESULTS: Overall, there were 16,486 eligible ED visits between September 1, 2014 and July 31, 2016; 53.5% of eligible ED visits had an associated mental health care follow-up visit within 7 days. Measure scores varied by state, ranging from 26.3% to 66.5%, and by youth characteristics: visits by youth who were non-White, male, and living in an urban area were significantly less likely to be associated with a follow-up visit within 7 days. Better quality measure performance was not associated with decreased reutilization. CONCLUSIONS: This new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, future work is needed to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
Authors: Gregory K Brown; Thomas Ten Have; Gregg R Henriques; Sharon X Xie; Judd E Hollander; Aaron T Beck Journal: JAMA Date: 2005-08-03 Impact factor: 56.272
Authors: Layla Parast; Naomi S Bardach; Q Burkhart; Laura P Richardson; J Michael Murphy; Courtney A Gidengil; Maria T Britto; Marc N Elliott; Rita Mangione-Smith Journal: Acad Pediatr Date: 2017-10-31 Impact factor: 3.107