Hospital-based quality measures for pediatric mental health care

Naomi S. Bardach, Q. Burkhart, Laura P. Richardson, Carol P. Roth, J. Michael Murphy, Layla Parast, Courtney A. Gidengil, Jordan Marmet, Maria T. Britto, Rita Mangione-Smith

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

BACKGROUND AND OBJECTIVES: Patients with a primary mental health condition account for nearly 10% of pediatric hospitalizations nationally, but little is known about the quality of care provided for them in hospital settings. Our objective was to develop and test medical record–based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings. METHODS: We drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings. We used the modified Delphi method to prioritize measures; 2 ED and 6 inpatient measures were operationalized and field-tested in 2 community and 3 children’s hospitals. Eligible patients were 5 to 19 years old and diagnosed with psychosis, suicidality, or substance use from January 2012 to December 2013. We used bivariate and multivariate models to examine measure performance by patient characteristics and by hospital. RESULTS: Eight hundred and seventeen records were abstracted with primary diagnoses of suicidality (n = 446), psychosis (n = 321), and substance use (n = 50). Performance varied across measures. Among patients with suicidality, male patients (adjusted odds ratio: 0.27, P < .001) and African American patients (adjusted odds ratio: 0.31, P = .02) were less likely to have documentation of caregiver counseling on lethal means restriction. Among admitted suicidal patients, 27% had documentation of communication with an outside provider, with variation across hospitals (0%–38%; P < .001). There was low overall performance on screening for comorbid substance abuse in ED patients with psychosis (mean: 30.3). CONCLUSIONS: These new pediatric mental health care quality measures were used to identify sex and race disparities and substantial hospital variation. These measures may be useful for assessing and improving hospital-based pediatric mental health care quality.

Original languageEnglish (US)
Article numbere20173554
JournalPediatrics
Volume141
Issue number6
DOIs
StatePublished - Jun 2018

Bibliographical note

Funding Information:
FUNDING: Funded by a cooperative agreement with the Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services, grant U18HS020506, part of the Children’s Health Insurance Program Reauthorization Act Pediatric Quality Measures Program. Dr Bardach was funded by the National Institute of Child Health and Human Development (K23HD065836). Funded by the National Institutes of Health (NIH).

Funding Information:
Funded by a cooperative agreement with the Agency for Healthcare Research and Quality and Centers for Medicare and Medicaid Services, grant U18HS020506, part of the Children’s Health Insurance Program Reauthorization Act Pediatric Quality Measures Program. Dr Bardach was funded by the National Institute of Child Health and Human Development (K23HD065836). Funded by the National Institutes of Health (NIH).

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