Toward Effective Utilization of the Pediatric Emergency Department: The Case of ADHD

Lynch, Seán; Bautista, María A.; Freer, Cecilia; Kalynych, Colleen; Cuffe, Steven P.; Hendry, Phyllis L.

doi:10.1080/19371918.2015.1087909

Cited by 5 publications

(9 citation statements)

References 25 publications

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“…Medicaid data collected in Florida from 2011 to 2012 highlighted the prevalence of ADHD as a presenting problem for children and youth seen in EDs (Lynch et al, 2016 ). Of the 28,001 mental health or substance use ED visits during the study year, 24% were for ADHD-related evaluation and treatment.…”

Section: Categories Of Informationmentioning

confidence: 99%

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

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

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There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors’ interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.

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Section: Categories Of Informationmentioning

confidence: 99%

“…Ninety-seven percent of this latter group were discharged home from the ED and the authors estimated that at least 30% of the visits for that subgroup were unnecessary. EDs were used more frequently by the individuals with ADHD who lived in counties that had a mental health professional shortage (Lynch et al, 2016 ).…”

Section: Categories Of Informationmentioning

confidence: 99%

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

Hoge

Vanderploeg

Paris

et al. 2022

Community Ment Health J

View full text Add to dashboard Cite

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“…21 Finally, related to the third possibility, the ED can be a source of emergent behavioral health care for some families when they cannot access care in the community in either primary or specialty care settings when they need it. [22][23][24][25] For example, consider the anecdotal case of a caregiver who took his/her child to the ED for care because the child was sent home from school for attention-deficit/hyperactivity disorder-related behaviors and was advised that the child would not be permitted to return to class until his/her behavior avoided disrupting the class. These terms may have led the caregiver to go to the ED in order to seek a prescription for stimulants for his/her child that had perhaps lapsed or expired, possibly because he/she had no regular relationship with a primary care provider.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…For this analysis, we collapsed the MMA age ranges into a single group. These measures were chosen because they represent conditions that result in frequent presentation in hospital emergency departments for disease-specific care that is often treatable in primary care settings [ 42 , 43 ]. Both measures were also chosen because they have a strong association with social vulnerability and residing in economically deprived areas and may be part of expanded risk factor adjustment metrics [ 55 ].…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we assessed whether geographic proximity to health care providers modified the association between medical home attendance and risk of avoidable and potentially avoidable ED visits among pediatric Medicaid recipients in South Carolina (SC) having a pre-existing diagnosis of asthma or attention-deficit/hyperactivity disorder, each of which are chronic illnesses that often result in ED visits for disease-specific care that is often treatable in primary care settings [ 42 , 43 ]. Each condition was defined using the National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS ® ) process measures, thus reflecting a measurement standard commonly used for risk adjustment and performance tracking by state Medicaid agencies.…”

Section: Introductionmentioning

confidence: 99%

Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures

et al. 2022

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Importance Previous studies have found a mixed association between Patient-Centered Medical Home (PCMH) designation and improvements in primary care quality indicators, including avoidable pediatric emergency department (ED) encounters. Whether these associations persist after accounting for the geographic locations of providers relative to where patients reside is unknown. Objective To examine the association between geographic proximity to primary care providers versus hospitals and risk of avoidable and potentially avoidable ED visits among children with pre-existing diagnosis of attention-deficit/hyperactivity disorder or asthma. Methods Retrospective cohort study of a panel of pediatric Medicaid claims data from the South Carolina from 2016–2018 for 2,959 beneficiaries having a pre-existing diagnosis of attention-deficit/hyperactivity disorder (ADD, ages 6–12) and 6,390 beneficiaries with asthma (MMA, ages 5–18), as defined using Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. We calculated differences in avoidable and potentially avoidable ED visits by the beneficiary’s PCMH attribution type and in relation to differences in proximity to their primary care providers versus hospitals. Outcomes were defined using the New York University Emergency Department Algorithm (NYU-EDA). Differences in ED visit risk were assessed using generalized estimation equations and compared using marginal effects models. Results The 2.4 percentage point reduction in risk of avoidable ED visits among children in the ADD cohort who attended a PCMH versus those who did not increased to 3.9 to 7.2 percentage points as relative proximity to primary care providers versus hospitals improved (p < 0.01). Children in the ADD and MMA cohorts that were enrolled in a medical home, but did not attend one for primary care services exhibited a 5.4 and 3.0 percentage point increase in avoidable ED visit compared to children who were unenrolled and did not attend medical homes (p < 0.05), but these differences were only observed when geographic proximity to hospitals was more convenient than primary care providers. Mixed findings were observed for potentially avoidable visits. Conclusions In several health care performance evaluations, patient-centered medical homes have not been found to reduce differences in hospital utilization for conditions that are treatable in primary care settings among children with chronic illnesses. Analytical approaches that also consider geographic proximity to health care services can identify performance benefits of medical homes. Expanding risk-adjustment models to also include geographic data would benefit ongoing quality improvement initiatives.

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Toward Effective Utilization of the Pediatric Emergency Department: The Case of ADHD

Cited by 5 publications

References 25 publications

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

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

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

Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures

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