Follow-up After Pediatric Mental Health Emergency Visits


Jennifer A. Hoffmann, Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Polina Krass, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Jonathan Rodean, Children's Hospital Association, Lenexa, Kansas.
Naomi S. Bardach, Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California.
Rachel Cafferty, Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
Tumaini R. Coker, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle, Washington.
Gretchen J. Cutler, Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, Minnesota.
Matthew Hall, Children's Hospital Association, Lenexa, Kansas.
Rustin B. Morse, Department of Pediatrics, The Ohio State University, Columbus, Ohio.
Katherine A. Nash, Department of Pediatrics, New York Presbyterian Morgan Stanley Childrens Hospital, Columbia University, New York City, New York.
Kavita Parikh, Division of Hospital Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Bonnie T. Zima, Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California.

Document Type

Journal Article

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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.