Development of New Quality Measures for Hospital-Based Care of Suicidal Youth

Objectives

To develop, validate, and test the feasibility of implementation of four new quality measures assessing ED and inpatient care for suicidal youth.

Methods

Four quality measures were developed to assess hospital-based care for suicidal youth. These measures, focused on counseling caregivers about a) restricting access to lethal means of self-harm and b) benefits and risks of anti-depressant medications, were operationalized into 2 caregiver surveys, assessing ED and inpatient quality, respectively. Survey field tests included caregivers of youth who received inpatient and/or ED care for suicidality at one of two children's hospitals between 7/2013-6/2014. We examined the feasibility of obtaining measure scores and variation in scores. Multivariate models examined associations between quality measure scores and four validation metrics: modified Child Hospital Consumer Assessments of Health Care Providers and Systems© communication composites, hospital readmissions, and ED return visits.

Results

Response rates were 35% (ED) and 31% (inpatient). Most caregivers reported receiving counseling to restrict their child's access to lethal means of self-harm (90% in the ED and 96% in the inpatient setting). In the inpatient setting, caregivers reported higher rates of counseling on benefits (95%) of newly prescribed anti-depressants than risks (physical side effects 85%, increased suicidality 72%). Higher scores on the latter measure were associated with higher nurse (p<0.001) and doctor (p<0.01) communication composite scores. Measure scores were not associated with readmissions or ED return visits.

Conclusions

These new quality measures evaluate key aspects of care for suicidal youth, and may facilitate assessing quality of care for this vulnerable population.