Quality of Care for Youth Hospitalized for Suicidal Ideation and Self-Harm

To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9...

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Published inAcademic pediatrics Vol. 21; no. 7; pp. 1179 - 1186
Main Authors Connell, Sarah K., Burkhart, Q., Tolpadi, Anagha, Parast, Layla, Gidengil, Courtney A., Yung, Steven, Basco, William T., Williams, Derek, Britto, Maria T., Brittan, Mark, Wood, Kelly E., Bardach, Naomi, McGalliard, Julie, Mangione-Smith, Rita
Format Journal Article
LanguageEnglish
Published Elsevier Inc 01.09.2021
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Summary:To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions. Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07–2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24–0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28–0.83). This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.
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Dr. Mangione-Smith obtained the funding for the study, conceptualized and designed the study, supervised the primary data abstraction and analysis, and critically reviewed the manuscript for important intellectual content.
Drs. Gidengil, Yung, Basco, Williams, Britto, Brittan, Wood, and Bardach and Ms. McGalliard coordinated and supervised data collection and reviewed and revised the manuscript.
All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Dr. Connell drafted the initial manuscript, participated in data analysis interpretation and revised the manuscript based on co-author review.
Contributors Statement
Mr. Burkhart, Ms. Tolpadi, and Dr. Parast participated in the analytic design of the study, carried out the data analyses and reviewed and revised the manuscript.
ISSN:1876-2859
1876-2867
DOI:10.1016/j.acap.2021.05.019