1. Development and Testing of an Emergency Department Quality Measure for Pediatric Suicidal Ideation and Self-Harm
- Author
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Parast, Layla, Burkhart, Q, Bardach, Naomi S, Thombley, Robert, Basco, William T, Barabell, Greg, Williams, Derek J, Mitchel, Ed, Machado, Edison, Raghavan, Priya, Tolpadi, Anagha, and Mangione-Smith, Rita
- Subjects
Paediatrics ,Biomedical and Clinical Sciences ,Prevention ,Health Services ,Brain Disorders ,Emergency Care ,Serious Mental Illness ,Mental Health ,Behavioral and Social Science ,Suicide ,Pediatric ,Clinical Research ,Mental health ,Good Health and Well Being ,Adolescent ,Child ,Child ,Preschool ,Emergency Service ,Hospital ,Humans ,Male ,Quality Indicators ,Health Care ,Reproducibility of Results ,Self-Injurious Behavior ,Suicidal Ideation ,United States ,emergency department ,follow-up care ,quality measure ,self-harm ,suicidal ideation ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
ObjectiveTo 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.MethodsBased 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.ResultsOverall, 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.ConclusionsThis 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.
- Published
- 2022