Care Coordination in Emergency Departments for Children and Adolescents With Behavioral Health Conditions

Abstract

Background: Increasing numbers of children are receiving care for behavioral health conditions in emergency departments (EDs). However, studies of mental health-related care coordination between EDs and primary and/or specialty care settings are limited. Such coordination is important because ED care alone may be insufficient for patients' behavioral health needs. Methods:We analyzed claims during the year 2014 from Truven Health Analytics MarketScan Medicaid and Commercial databases for outpatient services and prescription drugs for youth 2 to 18 years old with continuous enrollment. We applied a standard care coordination measure to insurance claims data in order to examine whether youth received a primary care or specialty follow-up visit within 7 days following an ED visit with a psychiatric diagnosis. We calculated descriptive statistics to evaluate differences in care coordination by enrollees' demographic, insurance, and healthrelated characteristics. In addition, we constructed a multivariate logistic regression model to detect the factors associated with the receipt of care coordination. Results:The total percentages of children who received care coordination were 45.8% (Medicaid) and 46.6% (private insurance). Regardless of insurance coverage type, children aged 10 to 14 years had increased odds of care coordination compared with youth aged 15 to 18 years. Children aged 2 to 5 years and males had decreased odds of care coordination. Conclusions:It is of concern that fewer than half of patients received care coordination following an ED visit. Factors such as behavioral health workforce shortages, wait times for an appointment with a provider, and lack of reimbursement for care coordination may help explain these results.

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

“…They noted, however, that follow-up with these adolescents is infrequent and that, even when outpatient services are offered, engagement after ED discharge is poor. An analysis of claims data in the U.S. from 2014 found that approximately 46% of individuals aged 2 to 18 seen in an ED with a psychiatric diagnosis had a follow-up visit with a primary care provider or a specialty mental health provider within 7 days of ED discharge (Lynch et al, 2021). Frosch et al (2011) examined repeat pediatric psychiatric ED visits in an urban general hospital to determine why youth were seeking care and if their ED visits led to increased outpatient connections.…”

Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers

“…This study shows some of the factors that are associated with high levels of repeat ED visits made by youth with BH conditions from low income families. The implementation of medical homes (Monti & Rosner, 2015) and regular follow-up after an ED visit (Lynch et al, 2018) may support improvements in population health by improving access to BH care outside of the ED, possibly reducing ED visits by youth (Moore et al, 2016). Improvements in ED providers' access to community-based BH resources related to treatment of substance use and ADHD are urgently needed so that quality of care improves, health care costs are controlled, and youth experience fewer BH crises.…”

Investigating characteristics of patients with mental disorders to predict out-patient physician follow-up within 30 days of emergency department discharge

“…Overall, few studies have measured prompt emergency department follow-up for patients with a mental disorder, and even fewer were longitudinal studies using diverse clinical administrative databases. 8 Most studies have evaluated specific populations, such as youth with mental disorders 9 and patients with depression, 5 mood disorders 10 or self-harm behaviours. 7 More prompt emergency department follow-up was identified among patients with serious mental disorders such as bipolar disorders 3 or those who engaged in self-harm; 7 unlike patients with depression, mood disorders 8 or substance-related disorders, 3 for whom follow-up was delayed.…”

“…7 More prompt emergency department follow-up was identified among patients with serious mental disorders such as bipolar disorders 3 or those who engaged in self-harm; 7 unlike patients with depression, mood disorders 8 or substance-related disorders, 3 for whom follow-up was delayed. Women, 8,9 patients residing in areas other than medium-to-high poverty neighbourhoods 11 or urban areas, 12 patients integrated in out-patient programmes with low wait times 4 and those who previously used out-patient mental health services 13 also had greater access to prompt emergency department follow-up. However, prior service use as a predictor of prompt emergency department follow-up has been understudied, especially in terms of the type and intensity of services provided or continuity of care.…”