Factors Associated With a Six-Month Return to Emergency Services Among Child and Adolescent Psychiatric Patients

Goldstein, Amy B.; Frosch, Emily; Davarya, B.S. Sarah; Leaf, Philip J.

doi:10.1176/ps.2007.58.11.1489

Cited by 58 publications

(69 citation statements)

References 4 publications

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“…Although previous research showed that current involvement in and access to MH services predicted repeat ED use 14,16,33,34 , our study demonstrated that patients connected with previous resources were more likely to repeat earlier and more frequently to the PED when controlling for other variables. Past research on pediatric and adult samples shows that lack of availability from primary care during weekend and evening hours and those dissatisfied with primary care were more likely to visit the ED.…”

Section: Service Use Determinantscontrasting

confidence: 97%

“…Past research on pediatric and adult samples shows that lack of availability from primary care during weekend and evening hours and those dissatisfied with primary care were more likely to visit the ED. 32,35 Also consistent with previous research 16,20 , our results indicated that patients were more likely to return to the PED if they had a history of previous psychiatric hospitalization. Previous psychiatric hospitalization also predicted earlier repeat presentations.…”

Section: Service Use Determinantssupporting

confidence: 91%

“…Contrary to previous research, suicide risk and self-injuring behavior were not significant predictors of repeat PED use. Although, these variables were significant predictors or associated with repeat use in previous research 16,18,20 , our study showed that when other demographic, service use and clinical variables are considered, they were not significant.…”

Section: Clinical Determinantscontrasting

confidence: 87%

“…There have been mixed findings pointing to a link between geographical region and repeat PED use. [14][15][16] This study showed that youth living closer to the PED were more likely to revisit, repeat sooner and more frequently. Studies conducted in general EDs 30-32 also found that metropolitan patients were more likely to have repeat presentations.…”

Section: Demographic Determinantsmentioning

confidence: 64%

“…7,13 Repeat presentations represent a large proportion of PED MH presentations with estimates ranging from 12% to 36%. [14][15][16] This may be the result of a lack of availability or difficulty accessing MH services that effectively meet this patient population's needs. 14,17 Findings on predictors of repeat PED for MH issues are inconsistent.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Cloutier

Thibedeau

Barrowman

et al. 2016

CJEM

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ObjectivesDespite documented increases in emergency department (ED) mental health (MH) presentations, there are inconsistent findings on the characteristics of patients with repeat presentations to pediatric EDs (PEDs) for MH concerns. Our study sought to explore the characteristics of MH patients with repeat PED visits and determine predictors of return visits, of earlier repeat visits, and of more frequent repeat visits.MethodsWe examined data collected prospectively in a clinical database looking at MH presentations to a crisis intervention program housed within a PED from October 2006 to December 2011. Predictive models based on demographic and clinical variables were constructed using logistic, Cox, and negative binomial regression.ResultsA total of 4,080 presentations to the PED were made by the 2,900 children and youth. Repeat visits accounted for almost half (45.8%) of all presentations. Multivariable analysis identified five variables that independently predicted greater odds of having repeat presentations, greater risk of earlier repeat presentations, and greater risk of frequent repeat presentations. The five variables were: female, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances.ConclusionsRepeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently. Further research is needed to examine interventions targeting this patient group to ensure appropriate MH patient management.

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Section: Service Use Determinantscontrasting

confidence: 97%

Section: Service Use Determinantssupporting

confidence: 91%

Section: Clinical Determinantscontrasting

confidence: 87%

Section: Demographic Determinantsmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Cloutier

Thibedeau

Barrowman

et al. 2016

CJEM

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Mental Health Revisits at US Pediatric Emergency Departments

et al. 2023

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ImportancePediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts.ObjectiveTo describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits.Design, Setting, and ParticipantsIn this cohort study, data were obtained from 38 US children’s hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit.ExposuresCharacteristics of patients, encounters, hospitals, and communities.Main Outcomes and MeasuresThe primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression.ResultsThere were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit.Conclusions and RelevanceMarkers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.

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Medical Practice Variations in Mental Health and Addictions Care

Lin¹,

Or²,

Coldefy³

et al. 2015

Medical Practice Variations

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International audienceThis chapter provides an overview of the practice variations in care delivery for mental health and addictive disorders and some of the system-level funding and structural factors that contribute to such variation. Practice variations are described for five populations, along with their expected clinical picture and service needs:Children and adolescentsThe elderlySevere mental illnessMild/moderate illnessSubstance use disordersThese variations occur in a system-level climate which has been transformed over the past decades because of a fundamental change in how appropriate care is defined. Specifically, Western countries have been shifting from institutional to more community-based care – a process labeled “deinstitutionalization.” National differences in how services are funded and organized in light of deinstitutionalization are described. Pending gold-standard outcome indicators such descriptions allow more in-depth examination of what the potential drivers for system change are and how different funding and structure configurations might be compared and evaluated

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Factors Associated With a Six-Month Return to Emergency Services Among Child and Adolescent Psychiatric Patients

Cited by 58 publications

References 4 publications

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program

Mental Health Revisits at US Pediatric Emergency Departments

Medical Practice Variations in Mental Health and Addictions Care

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