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Use of Electronic Health Record-Based Measures to Assess Quality of Care for Pediatric Agitation
Jennifer A Hoffmann1,2, Jacqueline B Corboy1,2, Lynn Liu3
1Division of Emergency Medicine.
Insights
Evaluating pediatric acute agitation management using electronic health records (EHR) is feasible. Performance varied by patient characteristics and hospital, indicating opportunities to improve care quality for children in emergency departments (EDs).
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Health Services Research
Background:
- Acute agitation in pediatric mental health emergency department (ED) visits poses significant safety risks.
- Multidisciplinary stakeholders identified 20 quality measures for managing pediatric acute agitation.
Purpose of the Study:
- To assess the feasibility of evaluating pediatric acute agitation management quality measures using electronic health record (EHR) data.
- To examine performance variations in these quality measures across three different EDs.
Main Methods:
- Retrospective evaluation of structured EHR data for pediatric mental health ED visits (ages 5-17) from July 2020 to June 2021.
- Analysis included children presenting with mental health conditions, receiving agitation medication, or physical restraints.
- Bivariate and multivariable regression analyses were used to explore performance variations by patient characteristics and hospital.
Main Results:
- Feasible EHR-based evaluation was possible for 10 out of 20 quality measures.
- Nine measures showed variation based on patient characteristics; notably, autism spectrum disorder was associated with 4.87 times higher odds of physical restraint use.
- Four measures varied by hospital, with physical restraint use ranging from 0.5% to 3.3% across the studied EDs.
Conclusions:
- Quality of care for pediatric acute agitation management can be evaluated using EHR-derived quality measures.
- Observed variations in performance highlight critical opportunities for improving care quality for agitated pediatric patients in ED settings.
Objectives:
Acute agitation during pediatric mental health emergency department (ED) visits presents safety risks to patients and staff. We previously convened multidisciplinary stakeholders who prioritized 20 proposed quality measures for pediatric acute agitation management. Our objectives were to assess feasibility of evaluating performance on these quality measures using electronic health record (EHR) data and to examine performance variation across 3 EDs.
Methods:
At a children's hospital and 2 nonchildren's hospitals, we assessed feasibility of evaluating quality measures for pediatric acute agitation management using structured EHR data elements. We retrospectively evaluated measure performance during ED visits by children 5 to 17 years old who presented for a mental health condition, received medication for agitation, or received physical restraints from July 2020 to June 2021. Bivariate and multivariable regression were used to examine measure performance by patient characteristics and hospital.
Results:
We identified 2785 mental health ED visits, 275 visits with medication given for agitation, and 35 visits with physical restraints. Performance was feasible to measure using EHR data for 10 measures. Nine measures varied by patient characteristics, including 4.87 times higher adjusted odds (95% confidence interval 1.28-18.54) of physical restraint use among children with versus without autism spectrum disorder. Four measures varied by hospital, with physical restraint use varying from 0.5% to 3.3% of mental health ED visits across hospitals.
Conclusions:
Quality of care for pediatric acute agitation management was feasible to evaluate using EHR-derived quality measures. Variation in performance across patient characteristics and hospitals highlights opportunities to improve care quality.
