Bardach NS, Burkhart Q, Richardson LP, et al. Hospital-Based Quality Measures for Pediatric Mental Health Care. Pediatrics. 2018;141(6):e20173554.
Approximately 20% of US youth meet diagnostic criteria for a mental health disorder, with inpatient and outpatient health care costs at $247 billion annually. The Center of Excellence for Children with Complex Needs developed measures to assess quality of pediatric mental health care in emergency (ED; 2 measures) and inpatient settings (6 measures). These new quality measures, when tested across >800 patients 5-19 years old at 5 non-psychiatric hospitals, identified substantial variation in care across hospitals and disparities in hospital performance on these measures by race and sex.
Depression, psychosis, and substance use are the most common inpatient mental health diagnoses for children and adolescents. The authors reviewed existing clinical practice guidelines and evidence reviews to identify best practices related to suicidality, psychosis, and substance use. Validity and feasibility of these new measures were evaluated using a multi-stakeholder panel that included clinicians of many different disciplines and also state Medicaid officials. They extracted data from medical records at 2 community hospitals and 3 children's hospitals for 817 patients. After starting with 21 measures, they worked through a consensus-building process with experts and further narrowed their set to 8 measures. Performance ranged from 95% (best) for mental health assessment for patients with suicidality before discharge from the ED to 27% (low) for communication with the outpatient clinician for inpatients with suicidality. Disparities were found by sex (caregivers of male patients admitted for suicidality were less likely than caregivers of female patients with suicidality to have received counseling before discharge about restricting access to potentially lethal means of suicide) and race (caregivers of African American patients were less likely to have been counseled about lethal means restriction than caregivers of non-Hispanic white patients).