Participants included about 13,000 adult patients with 17,000 visits at two Los Angeles EDs from April, 2020 through September, 2021. Researchers examined the relation between in-person and telehealth visits following a patient’s ED discharge with the number of subsequent ED or hospital admissions occurring within 30 days of the patient’s initial discharge.
But preventing repeat emergency department (ED) visits is not among them, a new study finds. 11, 23, 24 As markers of previous MH service use, we included the number of MH outpatient visits, MH ED visits, and MH hospitalizations in the year preceding the index ED visit.Since coming into widespread use at the start of the COVID-19 pandemic, telehealth has proven useful for many purposes.
7, 11, 20, 21 To define non-MH comorbid conditions, we used non-MH body systems from the Pediatric Medical Complexity Algorithm to group patients into 3 categories using ICD-10-CM codes: no chronic conditions, noncomplex chronic conditions, or complex chronic conditions. 22 As markers of the complexity of the index ED discharge, we included the number of distinct CAMHD-CS MH diagnosis groups identified from ICD-10-CM codes during the index ED discharge, and the number of calendar days in the ED during the index ED discharge encounter. We assessed race and ethnicity using a health equity framework, considering both as social constructs rather than biologic determinants. The sociodemographic variables included were age group (6 to 11 or 12 to 17 years), sex, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other, missing), and insurance type (fee-for-service or managed care).
We then removed ED discharges with assigned MH diagnosis groups and repeated the process until <20% of all ED discharges remained, which were then categorized as “other.” This process resulted in assignment of each ED discharge to 1 of 5 MH diagnosis groups: intentional self-harm depressive disorders disruptive, impulse control, and conduct disorders trauma and stressor-related disorders and other. 20, 21 If the ICD-10-CM codes for an ED discharge corresponded to multiple CAMHD-CS groups, we assigned the ED discharge to the most prevalent matching MH diagnosis group in the overall sample. For the remaining ED discharges, we used the Child and Adolescent Mental Health Disorders Classification System (CAMHD-CS) to assign a MH diagnosis group.
BEST CARE FOR FOLLOW ED VISITS CODE
We first considered ED discharges with any claims matching the HEDIS “intentional self-harm” code set as their own MH diagnosis group. We used a systematic method to assign each ED discharge, which may have multiple claims and ICD-10-CM diagnosis codes, to a single MH diagnosis group.
We defined outpatient MH visits based on POS codes for outpatient settings (eg, school, home, office, health clinic) or outpatient visit procedure codes (eg, CPT 99211 “Office or other outpatient visit for E/M of an established patient”), which included care provided by MH specialists and nonspecialists. We identified MH ED visits using POS code 23 and CPT evaluation and management codes 98281 through 98285, and MH hospitalizations based on POS codes for inpatient hospitals and inpatient psychiatric facilities (codes 21 and 51, respectively). 6 Primary MH diagnoses were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) HEDIS diagnosis code sets for “mental health illness” or “intentional self-harm.” The MH encounter location (outpatient visit, ED visit, or hospitalization) was determined by procedure and place of service (POS) codes. We defined MH encounters following specifications in the Healthcare Effectiveness Data and Information Set (HEDIS) quality measure definition for MH follow-up after ED visits.
0 kommentar(er)
