Evaluation and Disposition of Medicaid-Insured Children and Adolescents With Suicide Attempts

Abstract Objective Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aim of this study...

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Veröffentlicht in:Academic pediatrics 2015-01, Vol.15 (1), p.36-40
Hauptverfasser: Williams, Candice L., MD, Cooper, William O., MD, MPH, Balmer, Leanne S., RN, Dudley, Judith A., BS, Gideon, Patricia S., RN, DeRanieri, Michelle M., RN, Stratton, Shannon M., BS, Callahan, S. Todd, MD, MPH
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container_end_page 40
container_issue 1
container_start_page 36
container_title Academic pediatrics
container_volume 15
creator Williams, Candice L., MD
Cooper, William O., MD, MPH
Balmer, Leanne S., RN
Dudley, Judith A., BS
Gideon, Patricia S., RN
DeRanieri, Michelle M., RN
Stratton, Shannon M., BS
Callahan, S. Todd, MD, MPH
description Abstract Objective Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aim of this study was to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior. Methods We conducted a large cohort study of youth, aged 7 to 18, enrolled in Tennessee Medicaid from 1995 to 2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal on the basis of external cause-of-injury codes (E codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization, and discharge instructions. Results Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (adjusted odds ratio [AOR] 0.72; 95% confidence interval [CI] 0.55–0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39–2.65). Female subjects were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41–0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01–2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date. Conclusions In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.
doi_str_mv 10.1016/j.acap.2014.04.005
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Todd, MD, MPH</creator><creatorcontrib>Williams, Candice L., MD ; Cooper, William O., MD, MPH ; Balmer, Leanne S., RN ; Dudley, Judith A., BS ; Gideon, Patricia S., RN ; DeRanieri, Michelle M., RN ; Stratton, Shannon M., BS ; Callahan, S. Todd, MD, MPH</creatorcontrib><description>Abstract Objective Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aim of this study was to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior. Methods We conducted a large cohort study of youth, aged 7 to 18, enrolled in Tennessee Medicaid from 1995 to 2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal on the basis of external cause-of-injury codes (E codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization, and discharge instructions. Results Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (adjusted odds ratio [AOR] 0.72; 95% confidence interval [CI] 0.55–0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39–2.65). Female subjects were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41–0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01–2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date. Conclusions In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.</description><identifier>ISSN: 1876-2859</identifier><identifier>EISSN: 1876-2867</identifier><identifier>DOI: 10.1016/j.acap.2014.04.005</identifier><identifier>PMID: 24942933</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Adolescent ; adolescents ; Aftercare - statistics & numerical data ; Child ; Cohort Studies ; Female ; Hospitalization - statistics & numerical data ; Hospitals, Psychiatric - statistics & numerical data ; Humans ; Logistic Models ; Male ; Medicaid ; Mental Health Services - statistics & numerical data ; Neonatal and Perinatal Medicine ; Odds Ratio ; Patient Discharge - statistics & numerical data ; Pediatrics ; Retrospective Studies ; Rural Population - statistics & numerical data ; Sex Factors ; suicide ; Suicide, Attempted - statistics & numerical data ; Tennessee ; United States]]></subject><ispartof>Academic pediatrics, 2015-01, Vol.15 (1), p.36-40</ispartof><rights>Academic Pediatric Association</rights><rights>2015 Academic Pediatric Association</rights><rights>Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.</rights><rights>2014 Academic pediatric Association. Published by Elsevier Inc. All rights reserved. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c580t-209fdc4911d7e87012989e110729df56c021c6b79f8cb9210947ea192e2c7a773</citedby><cites>FETCH-LOGICAL-c580t-209fdc4911d7e87012989e110729df56c021c6b79f8cb9210947ea192e2c7a773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.acap.2014.04.005$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24942933$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Williams, Candice L., MD</creatorcontrib><creatorcontrib>Cooper, William O., MD, MPH</creatorcontrib><creatorcontrib>Balmer, Leanne S., RN</creatorcontrib><creatorcontrib>Dudley, Judith A., BS</creatorcontrib><creatorcontrib>Gideon, Patricia S., RN</creatorcontrib><creatorcontrib>DeRanieri, Michelle M., RN</creatorcontrib><creatorcontrib>Stratton, Shannon M., BS</creatorcontrib><creatorcontrib>Callahan, S. Todd, MD, MPH</creatorcontrib><title>Evaluation and Disposition of Medicaid-Insured Children and Adolescents With Suicide Attempts</title><title>Academic pediatrics</title><addtitle>Acad Pediatr</addtitle><description>Abstract Objective Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aim of this study was to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior. Methods We conducted a large cohort study of youth, aged 7 to 18, enrolled in Tennessee Medicaid from 1995 to 2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal on the basis of external cause-of-injury codes (E codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization, and discharge instructions. Results Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (adjusted odds ratio [AOR] 0.72; 95% confidence interval [CI] 0.55–0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39–2.65). Female subjects were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41–0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01–2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date. Conclusions In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.</description><subject>Adolescent</subject><subject>adolescents</subject><subject>Aftercare - statistics &amp; numerical data</subject><subject>Child</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Hospitalization - statistics &amp; numerical data</subject><subject>Hospitals, Psychiatric - statistics &amp; numerical data</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicaid</subject><subject>Mental Health Services - statistics &amp; numerical data</subject><subject>Neonatal and Perinatal Medicine</subject><subject>Odds Ratio</subject><subject>Patient Discharge - statistics &amp; numerical data</subject><subject>Pediatrics</subject><subject>Retrospective Studies</subject><subject>Rural Population - statistics &amp; numerical data</subject><subject>Sex Factors</subject><subject>suicide</subject><subject>Suicide, Attempted - statistics &amp; numerical data</subject><subject>Tennessee</subject><subject>United States</subject><issn>1876-2859</issn><issn>1876-2867</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Ul1rFDEUDaLYWv0DPsg8-jJrkpnJB0hhWVstVPpQxScJ2eSOmzU7GZPMQv99M25d1IfChSTknHM_zkXoNcELggl7t11oo8cFxaRd4BK4e4JOieCspoLxp8d7J0_Qi5S2GLNGCPYcndBWtlQ2zSn6frHXftLZhaHSg60-uDSG5H6_Q199BuuMdra-GtIUwVarjfM2wgG8tMFDMjDkVH1zeVPdTs44C9UyZ9iNOb1Ez3rtE7x6OM_Q18uLL6tP9fXNx6vV8ro2ncC5plj21rSSEMtBcEyoFBIIwZxK23fMYEoMW3PZC7OWlGDZctBEUqCGa86bM3R-0B2n9Q7sXFHUXo3R7XS8U0E79e_P4DbqR9irljJRZlkE3j4IxPBrgpTVzpXGvNcDhCkpwhopuSh1FSg9QE0MKUXoj2kIVrMvaqtmX9Tsi8IlcFdIb_4u8Ej5Y0QBvD8AoIxp7yCqZBwMpsw_gsnKBve4_vl_dOPdUKzzP-EO0jZMcSgGKKISVVjdzpsxLwZpcemeNc09x7C0Zg</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Williams, Candice L., MD</creator><creator>Cooper, William O., MD, MPH</creator><creator>Balmer, Leanne S., RN</creator><creator>Dudley, Judith A., BS</creator><creator>Gideon, Patricia S., RN</creator><creator>DeRanieri, Michelle M., RN</creator><creator>Stratton, Shannon M., BS</creator><creator>Callahan, S. 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Todd, MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c580t-209fdc4911d7e87012989e110729df56c021c6b79f8cb9210947ea192e2c7a773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>adolescents</topic><topic>Aftercare - statistics &amp; numerical data</topic><topic>Child</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Hospitalization - statistics &amp; numerical data</topic><topic>Hospitals, Psychiatric - statistics &amp; numerical data</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicaid</topic><topic>Mental Health Services - statistics &amp; numerical data</topic><topic>Neonatal and Perinatal Medicine</topic><topic>Odds Ratio</topic><topic>Patient Discharge - statistics &amp; numerical data</topic><topic>Pediatrics</topic><topic>Retrospective Studies</topic><topic>Rural Population - statistics &amp; numerical data</topic><topic>Sex Factors</topic><topic>suicide</topic><topic>Suicide, Attempted - statistics &amp; numerical data</topic><topic>Tennessee</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Williams, Candice L., MD</creatorcontrib><creatorcontrib>Cooper, William O., MD, MPH</creatorcontrib><creatorcontrib>Balmer, Leanne S., RN</creatorcontrib><creatorcontrib>Dudley, Judith A., BS</creatorcontrib><creatorcontrib>Gideon, Patricia S., RN</creatorcontrib><creatorcontrib>DeRanieri, Michelle M., RN</creatorcontrib><creatorcontrib>Stratton, Shannon M., BS</creatorcontrib><creatorcontrib>Callahan, S. Todd, MD, MPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Academic pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Williams, Candice L., MD</au><au>Cooper, William O., MD, MPH</au><au>Balmer, Leanne S., RN</au><au>Dudley, Judith A., BS</au><au>Gideon, Patricia S., RN</au><au>DeRanieri, Michelle M., RN</au><au>Stratton, Shannon M., BS</au><au>Callahan, S. Todd, MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation and Disposition of Medicaid-Insured Children and Adolescents With Suicide Attempts</atitle><jtitle>Academic pediatrics</jtitle><addtitle>Acad Pediatr</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>15</volume><issue>1</issue><spage>36</spage><epage>40</epage><pages>36-40</pages><issn>1876-2859</issn><eissn>1876-2867</eissn><abstract>Abstract Objective Guidelines and quality of care measures for the evaluation of adolescent suicidal behavior recommend prompt mental health evaluation, hospitalization of high-risk youth, and specific follow-up plans—all of which may be influenced by sociodemographic factors. The aim of this study was to identify sociodemographic characteristics associated with variations in the evaluation of youth with suicidal behavior. Methods We conducted a large cohort study of youth, aged 7 to 18, enrolled in Tennessee Medicaid from 1995 to 2006, who filled prescriptions for antidepressants and who presented for evaluation of injuries that were determined to be suicidal on the basis of external cause-of-injury codes (E codes) and ICD-9-CM codes and review of individual medical records. Chi-square tests and logistic regression were performed to assess the relationship between sociodemographic characteristics and documentation of mental health evaluation, hospitalization, and discharge instructions. Results Of 929 episodes of suicidal behavior evaluated in an acute setting, rural-residing youth were less likely to be admitted to a psychiatric hospital (adjusted odds ratio [AOR] 0.72; 95% confidence interval [CI] 0.55–0.95) and more likely to be medically hospitalized only (AOR 1.92; 95% CI 1.39–2.65). Female subjects were less likely to be admitted to a psychiatric hospital (AOR 0.55; 95% CI 0.41–0.74) and more likely to be discharged home (AOR 1.44; 95% CI 1.01–2.04). Only 40% of those discharged to home had documentation of discharge instructions with both follow-up provider and date. Conclusions In this statewide cohort of youth with suicidal behavior, there were significant differences in disposition associated with sociodemographic characteristics.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24942933</pmid><doi>10.1016/j.acap.2014.04.005</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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source MEDLINE; ScienceDirect Journals (5 years ago - present)
subjects Adolescent
adolescents
Aftercare - statistics & numerical data
Child
Cohort Studies
Female
Hospitalization - statistics & numerical data
Hospitals, Psychiatric - statistics & numerical data
Humans
Logistic Models
Male
Medicaid
Mental Health Services - statistics & numerical data
Neonatal and Perinatal Medicine
Odds Ratio
Patient Discharge - statistics & numerical data
Pediatrics
Retrospective Studies
Rural Population - statistics & numerical data
Sex Factors
suicide
Suicide, Attempted - statistics & numerical data
Tennessee
United States
title Evaluation and Disposition of Medicaid-Insured Children and Adolescents With Suicide Attempts
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