RACIST MEDICINE U$A
Nearly half of children on Medicaid lack outpatient follow-up within a month after emergency care for mental health
Timely follow-up in Black children particularly low
Peer-Reviewed PublicationOnly 56 percent of Medicaid-enrolled children received any outpatient follow-up within 30 days after discharge from the Emergency Department (ED) for a mental health concern, according to a large study published in the journal Pediatrics. Rates of timely follow-up among Black children were particularly low, with 10 percent fewer receiving an outpatient mental health appointment within 30 days compared to white children.
“Our results show the dire need to improve access to outpatient mental health services for children,” said lead author Jennifer Hoffmann, MD, MS, Emergency Medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “We especially need to remove barriers to mental health care for Black children. Strategies may include reducing stigma in seeking mental health care, improving diversity in the pediatric mental health workforce, and increasing availability of community and school-based mental health services.”
Follow-up within seven and 30 days of a mental health ED visit for children ages 6 to 17 years was added to the National Child Core Set of quality measures in 2022, and state Medicaid agencies will be mandated to report annual adherence rates starting in 2024.
“This work offers some critical insights into the challenges and inequities in mental healthcare for children and youth. These findings should spur efforts to strengthen systems to support mental health for children and youth and new initiatives to non-Hispanic Black children and youth to effective care,” said Dr. Sarah Hudson Scholle, Vice President for Research & Analysis at the National Committee for Quality Assurance (NCQA). NCQA evaluates evidence to select specific quality measures to be used to assess healthcare quality. Based on NCQA recommendations, the quality measure "follow-up within seven and 30 days after an emergency department visit for mental illness in children" was added to the National Child Core Set of quality measures in 2022.
To examine rates of mental health follow-up, Dr. Hoffmann and colleagues conducted a retrospective study of 28,551 children aged 6-17 years with mental health ED discharges from January 2018 to June 2019 using the IBM Watson MarketScan Medicaid database.
They found that after the initial ED discharge, less than one-third of children had mental health follow-up within seven days and just over half had follow-up within 30 days. Children without prior mental health outpatient care were at highest risk for poor access to follow-up care.
“Clearly we need to do better for children who come to the ED in a mental health crisis. Interventions to link to outpatient mental health care should prioritize follow-up within five days of a mental health ED discharge,” said Dr. Hoffmann, who also is the Children's Research Fund Junior Board Research Scholar. “To improve follow-up after mental health ED visits, we need to focus on children with new diagnoses who have not previously engaged in outpatient mental health care. Future research should assess specific strategies to promote outpatient follow-up, such as care coordination and use of telemedicine.”
Research at Ann & Robert H. Lurie Children’s Hospital of Chicago is conducted through Stanley Manne Children’s Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Emergency medicine-focused research at Lurie Children’s is conducted through the Grainger Research Program in Pediatric Emergency Medicine.
JOURNAL
PEDIATRICS
For children with cancer, different
neighborhoods may produce different
outcomes for different races
An analysis from Rutgers may help solve a mystery: Why do Black and Hispanic children suffer more life-threatening complications from cancer and cancer care than white children who get the same treatments at the same facilities?
Researchers combined health and location data and found that the neighborhoods where children live had a bigger impact on outcomes than race and ethnicity alone. Their findings were published in Cancer Nursing.
Correlation between neighborhoods and complications doesn’t prove neighborhoods cause complications, but the hypothesis was bolstered by a second observation. The tie between neighborhood and outcome increases with age.
Infants and toddlers who develop cancer fare about the same no matter where they live, the study data showed. Outcomes begin to diverge in grade school and keep on diverging into adolescence as children spend more time outside the house.
“There are many location-related factors that could be a causal factor for complications,” said Beth Savage, an assistant professor at the Rutgers School of Nursing and lead author of the study.
“To use one example, added Savage, who is also a member of the Cancer Health Equity Center of Excellence at Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, "stress can damage health, and stressors like crime, air and noise pollution or poor-quality housing are more common in economically challenged neighborhoods than rich ones.”
“Neighborhood disadvantage is more common among Black and Hispanic persons. The neighborhood one lives in may also influence wellbeing and cancer outcomes through its impact on healthy behaviors and access to healthy foods and green space,” said Anita Kinney, director of the Cancer Health Equity Center of Excellence, associate director for Population Science and Community Outreach at Rutgers Cancer Institute and professor of biostatistics and epidemiology at Rutgers School of Public Health.
The researchers used 2018 medical data from the State Inpatient Databases (SID) of nine states — California, Florida, Maryland, Michigan, New Jersey, North Carolina, Rhode Island, Washington and Wisconsin — all of which included each patient’s home zip code. This allowed them to match racial demographics and health outcomes from 24,786 juvenile cancer patients with the Child Opportunity Index 2.0 (COI) rank of each child’s home neighborhood.
COI ranks are a composite of 29 measures of neighborhood quality in areas such as education, environment and socioeconomic resources. The average home zip code COI rank for children in the study was 60 for white children, 36 for Hispanic children and 33 for Black children.
Overall, the researchers found evidence of one or more potentially life-threatening complications on the hospital discharge records of 32 percent of white children, 36 percent of Hispanic children and 37 percent of Black children.
However, when researchers looked at how children of different races but similar neighborhoods fared, they found no significant differences between white and Hispanic children and the smallest possible significant difference between white and Black children.
Adjusting for age – and thus for exposure to the neighborhoods outside each child’s home – also reduced racial disparities in outcomes. Indeed, there were no significant racial differences in serious complications from cancer and cancer care among children under age 4.
The researchers hope to further this work by comparing health outcomes to individual census tracts, which are much smaller than zip code areas, and by finding other location data that might allow them to figure out what aspects of different neighborhoods might drive higher complication rates.
“The potential culprits are numerous,” Savage said. “Until we live in a more just America where all races live in high-opportunity neighborhoods, it is important to know what’s driving outcomes in lower-opportunity neighborhoods so we can at least ameliorate those dangers.”
JOURNAL
Cancer Nursing
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Race, Neighborhood Opportunity, and Life-Threatening Complications in Children With Cancer
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