Follow-up After Pediatric Mental Health Emergency Visits
Jennifer A Hoffmann1, Polina Krass2,3, Jonathan Rodean4
1Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Outpatient mental health (MH) follow-up after pediatric emergency department (ED) discharge is poor. Prioritizing timely follow-up within 5 days can reduce return visits for children needing MH care.
Area of Science:
- Pediatric mental health
- Healthcare access
- Emergency medicine
Background:
- Pediatric mental health (MH) emergency department (ED) encounters are common.
- Effective follow-up care is crucial for preventing readmissions and improving outcomes.
- Understanding factors influencing follow-up is essential for optimizing care pathways.
Purpose of the Study:
- To investigate outpatient mental health (MH) follow-up patterns after pediatric MH ED discharge.
- To identify patient characteristics associated with follow-up care access.
- To evaluate the impact of timely follow-up on subsequent acute care encounters.
Main Methods:
- Retrospective study of 28,551 children (6-17 years) discharged from MH EDs (Jan 2018-June 2019).
- Data sourced from IBM Watson MarketScan Medicaid database.
- Logistic regression and Cox proportional hazard models analyzed follow-up and return encounter risks.
Main Results:
- Only 31.2% and 55.8% of children had outpatient MH visits within 7 and 30 days post-discharge, respectively.
- Children with ≥14 prior MH visits had significantly higher odds (9.53) of 30-day follow-up.
- Timely 30-day follow-up decreased short-term return risk by 26% but increased later return risk.
Conclusions:
- Access to outpatient mental health care within 7-30 days of ED discharge is insufficient.
- Children with no prior outpatient MH care face the greatest access barriers.
- Interventions should focus on facilitating follow-up within 5 days of MH ED discharge to improve outcomes.
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.
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