Emergency Department-Based Psychiatric Services for Children and Adolescents: An In-depth Investigation of Care in North Carolina

项目摘要/摘要 在美国，儿童和青少年中精神疾病的患病率正在增加，就像使用 急诊科(ED)的精神健康护理。到急诊室就诊的儿科患者(&lt；18岁) 患有急性精神疾病的患者与到门诊机构就诊的患者明显不同。有自杀倾向 作为这一年龄段的主要死亡原因，精神科紧急服务需要加强，因为 这是儿科高危患者的主要资源。不幸的是，急诊室没有足够的装备来照顾不断增长的 患有严重精神疾病的儿科患者数量。过度拥挤导致护理延误，急诊室就诊时间延长， 并减少了患者获得服务的机会。尽管有这些不利的结果，基于证据的研究 改善护理的解决方案没有为发生有意义的变化奠定适当的基础。狭隘的背景， 单一地点调查、有限的患者群体和缺乏多干预试验是造成这一问题的因素 以前的研究着眼于潜在解决方案的有限影响。为了弥补这一点，一个务实、多元的 需要多方面的方法来真正了解哪些护理过程在改进方面是实用和有效的 在现实世界的EDS中的结果。文献中没有对急诊室目前正在做的事情进行广泛的调查 对这些护理系统取得成功的背景的讨论。拟议的项目旨在铺设 通过对精神病学的深入调查来理解这些背景因素的基础 单一状态下的急诊护理。 此Kirschstein-NRSA F30联谊会的目标是为不断增长的 儿童和青少年基于ED的精神护理的负担。目标1将描述当前的结构和 不同护理方式下半结构化访谈对儿科精神科急诊护理过程的影响 当地医院急诊室的提供者。目标2将评估以ED为基础的儿科精神病患者不断变化的需求 在北卡罗来纳大学的医院中，护理影响了患者和医院层面的结果 医疗保健系统采用回归分析。目标3将进一步描述当前的结构、流程和 通过对所有北卡罗来纳州(北卡罗来纳州)急救人员进行广泛调查，以收集更广泛的 信息。目标1和目标2将作为信息来源，为目标3中的调查提供信息。 采用混合方法，将传统的定量分析与定性编码相结合，并 目标1和目标3的答复说明。综合起来，这三个目标的结果将提供 可以进行以干预为重点和实施驱动的研究的基础，以帮助创建 向儿童和青少年提供以急诊为基础的护理的方式发生了持久的变化。通过建议的 调查、概述的培训计划以及本申请表中描述的指导团队、学员 将成长为一名未来的内科科学家，加强她在定性和定量方法方面的技能，以及 让自己在未来的学术生涯中进一步提高基于急诊的护理水平。

PROJECT SUMMARY/ABSTRACT The prevalence of mental illness among children and adolescents in the U.S. is increasing, just as is use of the emergency department (ED) for mental health care. Pediatric patients (<18 years) who present to the ED with an acute psychiatric illness are distinctly different from those presenting to outpatient facilities. With suicide as a leading cause of death among this age group, psychiatric emergency services need to be strengthened as a primary resource for pediatric patients at risk. Unfortunately, EDs are ill-equipped to care for the growing number of pediatric patients with serious mental illness. Overcrowding has led to delays in care, longer ED visits, and decreased access to services for patients. Despite these adverse outcomes, research on evidence-based solutions to improve care have not laid a proper foundation to make meaningful change occur. Narrow contexts, single site investigations, restricted patient populations, and a lack of multi-intervention trials have factored into the limited impact of previous studies looking at potential solutions. In order to remedy this, a pragmatic, multi- faceted approach is needed to truly understand what processes of care are practical and effective at improving outcomes in real world EDs. Absent in the literature is a broad survey of what is currently being done in EDs and a discussion of the contexts in which these systems of care are successful. The proposed project seeks to lay the foundation for understanding these contextual factors by conducting an in-depth investigation of psychiatric ED care in a single state. The objective of this Kirschstein-NRSA F30 Fellowship is to identify real-world solutions to the growing burden of ED-based psychiatric care for children and adolescents. Aim 1 will describe the current structure and processes of pediatric psychiatric ED care through in-depth semi-structured interviews with different care providers at local hospital EDs. Aim 2 will evaluate how the changing demand for ED-based pediatric psychiatric care has impacted patient and hospital-level outcomes among hospitals within the University of North Carolina healthcare system using regression analysis. Aim 3 will further describe the current structure, processes, and outcomes of care through a broad survey of all North Carolina (NC) EDs in order to gather a wider breadth of information. Aims 1 and 2 will be used as one source of information to inform the survey in Aim 3. This proposal uses a mixed methods approach that will combine traditional quantitative analysis with qualitative coding and description of responses from Aims 1 and 3. Taken together, the results from these three aims will provide a foundation from which intervention-focused and implementation-driven research can be conducted to help create lasting change in how ED-based care is provided to children and adolescents. Through the proposed investigation, the outlined training plan, and the mentorship team described within this application, the trainee will grow as a future physician-scientist, strengthen her skills in both qualitative and quantitative methods, and position herself to further improve ED-based care through her future academic career.