Follow-up after Pediatric Mental Health Emergency Visits

Abstract

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 yearswithMH ED discharges from January 2018 to June 2019, using the IBMWatsonMarketScanMedicaid database. Odds of nonemergent outpatient follow-up, adjusted for sociodemographic and clinical characteristics,were estimated using logistic regression. Cox proportional hazardmodelswere used to evaluate the association between timely follow-up and risk of returnMH acute care encounters (ED visits and hospitalizations). RESULTS: FollowingMH ED discharge, 31.2% and 55.8% of children had an outpatientMH visitwithin 7 and 30 days, respectively. The return ratewas 26.5%within 6months. Comparedwith children with no past-year outpatientMHvisits, thosewith 14 past-yearMHvisits had 9.53 odds of accessing follow-up carewithin 30 days (95% confidence interval [CI], 8.75-10.38). Timely follow-up within 30 dayswas associatedwith a 26%decreased risk of returnwithin 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: Connectionto outpatient carewithin7and30days of aMHEDdischarge remainspoor, andchildrenwithoutpriorMHoutpatient care are athighest risk forpoor access to care. Interventions to link to outpatientMHcare shouldprioritize follow-upwithin5 days of anMHEDdischarge.