Evaluating the pediatric mental health care continuum at an American health system

Joshua Thariath; Rama A Salhi; Neil Kamdar; Kristian Seiler; Margaret Greenwood-Ericksen; Wilson Nham; Kaitlyn Simpson; Timothy Peterson; Mahshid Abir

doi:10.1177/20503121231181939

Evaluating the pediatric mental health care continuum at an American health system

SAGE Open Med. 2023 Jun 21:11:20503121231181939. doi: 10.1177/20503121231181939. eCollection 2023.

Authors

Joshua Thariath^{1

2}, Rama A Salhi^{2

3

4}, Neil Kamdar³, Kristian Seiler³, Margaret Greenwood-Ericksen^{2

5}, Wilson Nham^{2

4}, Kaitlyn Simpson^{1

2}, Timothy Peterson^{2

4

6

7

8}, Mahshid Abir^{2

3

4

9}

Affiliations

¹ University of Michigan Medical School, Ann Arbor, USA.
² Acute Care Research Unit, University of Michigan, Ann Arbor, USA.
³ Institute for Healthcare Policy and Innovation, Ann Arbor, USA.
⁴ Department of Emergency Medicine, University of Michigan, Ann Arbor, USA.
⁵ Department of Emergency Medicine, University of New Mexico, Albuquerque, USA.
⁶ Physician Organization of Michigan Accountable Care Organization, Ann Arbor, USA.
⁷ Center for Health and Research Transformation, Ann Arbor, USA.
⁸ Henry Ford Health, Detroit, USA.
⁹ RAND Corporation, Santa Monica, CA, USA.

Abstract

Objective: To describe trends in the pediatric mental health care continuum and identify potential gaps in care coordination.

Methods: We used electronic medical record data from October 2016 to September 2019 to characterize the prevalence of mental health issues in the pediatric population at a large American health system. This was a single institution case study. From the electronic medical record data, primary mental health discharge and readmission diagnoses were identified using International Classification of Diseases (ICD-9-CM, ICD-10-CM) codes. The electronic medical record was queried for mental health-specific diagnoses as defined by International Classification of Diseases classification, analysis of which was facilitated by the fact that only 176 mental health codes were billed for. Additionally, prevalence of care navigation encounters was assessed through electronic medical record query, as care navigation encounters are specifically coded. These encounter data was then segmented by care delivery setting.

Results: Major depressive disorder and other mood disorders comprised 49.6% and 89.4% of diagnoses in the emergency department and inpatient settings respectively compared to 9.0% of ambulatory care diagnoses and were among top reasons for readmission. Additionally, only 1% of all ambulatory care encounters had a care navigation component, whereas 86% of care navigation encounters were for mental health-associated reasons.

Conclusions: Major depressive disorder and other mood disorders were more common diagnoses in the emergency department and inpatient settings, which could signal gaps in care coordination. Bridging potential gaps in care coordination could reduce emergency department and inpatient utilization through increasing ambulatory care navigation resources, improving training, and restructuring financial incentives to facilitate ambulatory care diagnosis and management of major depressive disorder and mood disorders. Furthermore, health systems can use our descriptive analytic approach to serve as a reasonable measure of the current state of pediatric mental health care in their own patient population.

Keywords: care coordination; integrated care; mental health.