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

基于急诊科的儿童和青少年精神科服务：北卡罗来纳州护理的深入调查

• 批准号: 10680482
• 负责人: Danielle Marie Brathwaite
• 金额: $ 5.27万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-14 至 2024-07-13
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10680482
• 关键词: Accident and Emergency department; Acute; Address; Adolescent; Adolescent and Young Adult; Affect; Age; Behavioral; Caring; Case Study; Cause of Death; Child; Child Care; Childhood; Clinical; Code; Collaborations; Computerized Medical Record; Crowding; Data; Development; Diagnosis; Emergency Care; Emergency Medicine; Emergency department visit; Evaluation; Feeling suicidal; Fellowship; Foundations; Future; Genetic Transcription; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; Hospitals; Institution; Intervention; Intervention Trial; Interview; Investigation; Length of Stay; Literature; Mental Health; Mental Health Services; Mental disorders; Mentorship; Methods; National Research Service Awards; North Carolina; Outcome; Outpatients; Patient Discharge; Patients; Pattern; Perception; Physicians; Positioning Attribute; Prevalence; Process; Provider; Psychiatric Emergency Services; Psychiatric therapeutic procedure; Regression Analysis; Research; Resources; Risk; Sampling; Scientist; Site; Source; Specific qualifier value; Structure; Suicide; Surveys; Time; Training; Universities; Work; Youth; acute care; acute symptom; adverse outcome; age group; care outcomes; care providers; care systems; career; child services; contextual factors; design; evidence base; evidence based guidelines; experience; hospital care; implementation intervention; improved; improved outcome; informant; insight; outpatient facility; patient population; pediatric patients; psychiatric emergency; recruit; response; severe mental illness; skills; tool

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.

项目总结/摘要 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（艾德）的精神卫生保健。到艾德就诊的儿科患者（<18岁） 患有急性精神病的人与那些去门诊的人有明显的不同。与自杀 精神科急症服务是这个年龄组别的主要死因，因此需要加强， 是高危儿科患者的主要资源。不幸的是，急诊科医生没有能力照顾 患有严重精神疾病的儿童患者人数。过度拥挤导致护理延误，艾德就诊时间延长， 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。狭义的语境， 单中心研究，有限的患者人群，以及缺乏多干预试验， 以前研究潜在解决方案的影响有限。为了解决这一问题，一个务实的，多方面的， 需要多方面的方法来真正了解哪些护理过程是实用和有效的， 真实的世界ED的结果。在文献中缺乏的是一个广泛的调查，目前正在做的ED和 讨论这些护理系统成功的背景。拟议项目旨在奠定 通过对精神病患者进行深入调查， 艾德护理在一个国家。 这个Kirschstein-NRSA F30奖学金的目的是确定现实世界的解决方案，以不断增长的 儿童和青少年的ED为基础的精神病护理负担。目标1将说明目前的结构， 儿科精神艾德护理的过程，通过深入的半结构化访谈与不同的护理 当地医院急诊室的医生目标2将评估如何改变需求ED为基础的儿科精神病 在北卡罗来纳州大学的医院中， 使用回归分析的医疗保健系统。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（NC）ED进行广泛调查， 信息.目标1和2将作为目标3调查的信息来源。这项建议 采用混合方法，将联合收割机传统的定量分析与定性编码相结合， 对目标1和3的答复的说明。综合起来，这三个目标的结果将提供一个 基础，从干预为重点和实施驱动的研究可以进行，以帮助创建 持续改变如何为儿童和青少年提供基于ED的护理。通过拟议的 调查，概述的培训计划，以及本申请中描述的指导团队，受训者 将成长为一个未来的物理学家，科学家，加强她在定性和定量方法的技能， 定位自己通过她未来的学术生涯进一步改善ED为基础的护理。