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

Abstract

OBJECTIVES\nTo examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization.\n\n\nMETHODS\nRetrospective observational eight hospital study of patients [N=1090] aged 5-17 years hospitalized for suicidal ideation/self-harm between 9/1/14-8/31/16. 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.\n\n\nRESULTS\nMedical record documentation revealed that, depending on hospital site, 17% - 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0-51% 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 (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).\n\n\nCONCLUSIONS\nThis 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.