Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic.
Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2023.21798
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发表时间：
2023-07-03
影响因子：
13.8
通讯作者：
Duncan, Alison
中科院分区：
文献类型：
--
作者：
Herrera, Carolina-Nicole;Oblath, Rachel;Duncan, Alison
2019冠状病毒病大流行是否与最初由移动的危机小组评估的公共保险青年中精神病寄宿的变化有关？在这项对7625名精神病紧急服务人员进行的横断面研究中，由移动的危机小组评估的公共保险青年经历精神病寄宿的可能性高出2倍，寄宿青年在大流行期间出院接受精神病住院治疗的可能性低64%。这些发现表明，精神病服务项目没有准备好支持流行病期间出现的年轻人的敏锐度和需求水平。精神病寄宿是指需要强化精神病服务但已在临床监护下的病人在进入精神病设施时遇到延误。最初的报告显示，美国在COVID-19大流行期间发生了精神病寄宿危机;然而，人们对这场危机对公共保险青年的后果知之甚少。评估通过移动的危机小组（MCT）评估获得精神病紧急服务（PES）并由医疗补助或健康安全网计划覆盖的4至20岁人群的精神病住院率和出院模式的流行病相关变化。这项回顾性横断面研究使用了来自马萨诸塞州多通道PES项目的MCT遭遇的数据。对2018年1月1日至2021年8月31日期间居住在马萨诸塞州的公共保险青年的7625名MCT发起的PES进行了评估。将大流行前时期（2018年1月1日至2020年3月9日）的遭遇水平结果（精神病寄宿状态，重复访问和出院处置）与大流行期间（2020年3月10日至2021年8月31日）的结果进行比较。采用描述性统计和多元回归分析。在7625例MCT发起的PES治疗中，公共保险青少年的平均（SD）年龄为13.6（3.7）岁;大多数青少年被确定为男性（3656 [47.9%]），为黑人（2725 [35.7%]）或西班牙裔（2708 [35.5%]），讲英语（6941 [91.0%]）。在疫情期间，平均每月登船率比疫情前高出25. 3个百分点。在对协变量进行调整后，在大流行期间，遭遇导致寄宿的几率增加了一倍（调整后的比值比[AOR]，2.03; 95%CI，1.82-2.26; P < .001），寄宿青年出院接受精神病住院治疗的可能性降低了64%（AOR，0.36; 95%CI，0.31-0.43; P < .001）。在大流行期间入住的公共保险青年的30天再入院率显著较高（发病率比，2.17; 95%CI，1.88-2.50; P <0.001）。在大流行期间，住院患者出院到精神科病房（AOR，0.36; 95%CI，0.31-0.43; P <0.001）或社区急性治疗机构（AOR，0.70; 95%CI，0.55-0.90; P = 0.005）的可能性显著降低。在这项横断面研究中，公共保险的年轻人在COVID-19大流行期间更有可能经历精神病寄宿，如果寄宿，则不太可能转移到24小时护理水平。这些发现表明，针对青少年的精神病服务项目没有准备好支持流行病带来的敏锐度和需求水平。这项横断面研究评估了通过移动的危机小组评估获得精神病紧急服务的公共保险青年中与COVID-19大流行相关的精神病住院率和出院模式的变化。
Was the COVID-19 pandemic associated with changes in psychiatric boarding among publicly insured youths who were initially evaluated by a mobile crisis team? In this cross-sectional study of 7625 psychiatric emergency services encounters, publicly insured youths evaluated by mobile crisis teams were 2 times more likely to experience psychiatric boarding, and boarding youths were 64% less likely to be discharged to inpatient psychiatric care during the pandemic. These findings suggest that psychiatric service programs were not prepared to support the levels of acuity and demand from youths that emerged during the pandemic. Psychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths. To estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs. This retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed. Encounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used. Among 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P < .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P < .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P < .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P < .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005). In this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic. This cross-sectional study assesses COVID-19 pandemic–associated changes in psychiatric boarding rates and discharge modalities among publicly insured youths who accessed psychiatric emergency services through a mobile crisis team evaluation.
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影响因子：
3.8
作者：
Fendrich, Michael;Ives, Melissa;Plant, Robert
通讯作者：
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影响因子：
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