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- Title
Disparities in Psychiatric Emergency Department Boarding of Children and Adolescents.
- Authors
Overhage, Lindsay N.; Lê Cook, Benjamin; Rosenthal, Meredith B.; McDowell, Alex; Benson, Nicole M.
- Abstract
This cross-sectional study investigates if there are racial, ethnic, or gender disparities in the length of boarding in emergency departments for youth awaiting inpatient psychiatric care. Key Points: Question: Are there racial, ethnic, or gender disparities in length of boarding or likelihood of inpatient admission for youth who board in emergency departments while awaiting inpatient psychiatric care? Findings: In this cross-sectional study including 4942 episodes of youth boarding for at least 3 midnights, transgender and nonbinary youth were 9.1% less likely to be admitted and boarded 2.2 days longer than cisgender females; these differences were statistically significant. Black youth were 4.3% less likely to be admitted than their White peers, also statistically significant. Meaning: There is a high need for targeted resources to reduce boarding and promote equitable access to care. Importance: Since the COVID-19 pandemic, emergency department boarding of youth with mental health concerns has increased. Objective: To summarize characteristics (including gender, age, race, ethnicity, insurance, diagnosis, and barriers to placement) of youth who boarded in emergency departments while awaiting inpatient psychiatric care and to test for racial, ethnic, and gender disparities in boarding lengths and inpatient admission rates after boarding. Secondarily, to assess whether statewide demand for inpatient psychiatric care correlated with individual outcomes. Design, Setting, and Participants: This cross-sectional analysis included administrative data collected from May 2020 to June 2022 and represented a statewide study of Massachusetts. All youth aged 5 to 17 years who boarded in Massachusetts emergency departments for 3 or more midnights while awaiting inpatient psychiatric care were included. Exposure: Boarding for 3 or more midnights while awaiting inpatient psychiatric care. Main Outcomes and Measures: Emergency department boarding length (number of midnights) and whether inpatient care was received after boarding. Statistical analyses performed included logistic and gamma regressions; assessed gender, racial, and ethnic disparities; and correlations between statewide demand for psychiatric care and boarding outcomes. Results: A total of 4942 boarding episodes were identified: 2648 (54%) for cisgender females, 1958 (40%) for cisgender males, and 336 (7%) for transgender or nonbinary youth. A total of 1337 youth (27%) were younger than 13 years. Depression was the most common diagnosis (2138 [43%]). A total of 2748 episodes (56%) resulted in inpatient admission, and 171 transgender and nonbinary youth (51%) received inpatient care compared with 1558 cisgender females (59%; adjusted difference: −9.1 percentage points; 95% CI, −14.7 to −3.6 percentage points). Transgender or nonbinary youth boarded for a mean (SD) of 10.4 (8.3) midnights compared with 8.6 (6.9) midnights for cisgender females (adjusted difference: 2.2 midnights; 95% CI, 1.2-3.2 midnights). Fewer Black youth were admitted than White youth (382 [51%] and 1231 [56%], respectively; adjusted difference: −4.3 percentage points; 95% CI, −8.4 to −0.2 percentage points). For every additional 100 youth boarding statewide on the day of assessment, the percentage of youth admitted was 19.4 percentage points lower (95% CI, −23.6% to −15.2%) and boarding times were 3.0 midnights longer (95% CI, 2.4-3.7 midnights). Conclusions and Relevance: In this cross-sectional study, almost one-half of 3 or more midnight boarding episodes did not result in admission, highlighting a need to understand the effects of boarding without admission. Gender and racial disparities were identified, suggesting the need for targeted resources to reduce boarding and promote equitable access to care.
- Subjects
MASSACHUSETTS; HEALTH services accessibility; SEXISM; STATISTICAL correlation; CROSS-sectional method; PATIENTS; PSYCHIATRIC treatment; CHILD psychopathology; EMERGENCY services in psychiatric hospitals; HOSPITAL care; HOSPITAL admission &; discharge; LOGISTIC regression analysis; TREATMENT effectiveness; DESCRIPTIVE statistics; RACISM; RESEARCH; HEALTH equity; TIME; MENTAL depression; CHILDREN
- Publication
JAMA Pediatrics, 2024, Vol 178, Issue 9, p923
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2024.1991