Citation

Lin MY, Kim J, Sheldrick RC, Bair-Merritt MH, Durham MP, Feinberg E, Cole MB. J. Pediatr. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.jpeds.2022.03.011

PMID

35301021

Abstract

OBJECTIVES: To evaluate temporal changes in pediatric emergency department (ED) visits for mental health problems in Massachusetts based on diagnoses and patient characteristics and to assess trends in all-cause pediatric ED visits. STUDY DESIGN: This statewide, population-based retrospective cohort study used the Massachusetts All-Payer Claims Database, which includes almost all Massachusetts residents. The study sample consisted of residents under age 21 who were enrolled in a health plan from 2013-2017. Using multivariate regressions, we examined temporal trends in mental health-related and all-cause ED visits from 2013-2017, with person-quarter as the unit of analysis; we also estimated differential trends by sociodemographic and diagnostic subgroups. The outcomes were number of mental health-related (any diagnosis, plus 14 individual diagnoses) and all-cause ED visits/1000 patients/quarter.

RESULTS: Of the 967,590 Massachusetts residents in our study (14.8 million person-quarters), mean age was 8.1 years, 48% were female, and 57% had Medicaid coverage. For this population, mental health (any) and all-cause ED visits decreased from 2013-2017 (p<0.001). Those 18-21 years experienced the largest declines in mental health-related (63.0% decrease) and all-cause (60.9% decrease) ED visits. Although mental health ED visits declined across most diagnostic subgroups, ED visits with autism spectrum disorder and suicidal-related diagnoses increased by 108% and 44%, respectively.

CONCLUSIONS: Overall rates of pediatric ED visits with mental health diagnoses in Massachusetts declined from 2013 to 2017, although ED visits with autism- and suicide-related diagnoses increased. Massachusetts' policies and care delivery models aimed at pediatric mental health may hold promise, although there are important opportunities for improvement.

Language: en

Keywords

autism spectrum disorder; all-cause ED visits; Medicaid; suicidal-related diagnoses