Year: 2022
Type: article
Abstract: BACKGROUND: The number of youth presenting to hospitals with suicidality and/or self-harm has increased substantially in recent years. We implemented a multihospital quality improvement (QI) collaborative from February 1, 2018 to January 31, 2019, aiming for an absolute increase in hospitals' mean rate of caregiver lethal means counseling (LMC) of 10 percentage points (from a baseline mean performance of 68% to 78%) by the end of the collaborative, and to evaluate the effectiveness of the collaborative on LMC, adjusting for secular trends. METHODS: This 8 hospital collaborative used a structured process of alternating learning sessions and action periods to improve LMC across hospitals. Electronic medical record documentation of caregiver LMC was evaluated during 3 phases: precollaborative, active QI collaborative, and postcollaborative. We used statistical process control to evaluate changes in LMC monthly. Following collaborative completion, interrupted time series analyses were used to evaluate changes in the level and trend and slope of LMC, adjusting for covariates. RESULTS: In the study, 4208 children and adolescents were included-1314 (31.2%) precollaborative, 1335 (31.7%) during the active QI collaborative, and 1559 (37.0%) postcollaborative. Statistical process control analyses demonstrated that LMC increased from a hospital-level mean of 68% precollaborative to 75% (February 2018) and then 86% (October 2018) during the collaborative. In interrupted time series analyses, there were no significant differences in LMC during and following the collaborative beyond those expected based on pre-collaborative trends. CONCLUSIONS: LMC increased during the collaborative, but the increase did not exceed expected trends. Interventions developed by participating hospitals may be beneficial to others aiming to improve LMC for caregivers of hospitalized youth with suicidality.
Source: PEDIATRICS
Authors: JoAnna K. Leyenaar, Anagha Tolpadi, Layla Parast, Megan Esporas, Maria T. Britto, Courtney Gidengil, Karen M. Wilson, Naomi S. Bardach, William T. Basco, Mark S. Brittan, Derek J. Williams, Kelly E. Wood, Steven Yung, Erin Dawley, Audrey Elliott, Kirstin A. Manges, Gregory Plemmons, Timothy Rice, Brandy Wiener, Rita Mangione-Smith
Institutions: Dartmouth College, Dartmouth Institute for Health Policy and Clinical Practice, RAND Corporation, Children's Hospital Association, Cincinnati Children's Hospital Medical Center, University of Cincinnati, University of Rochester Medicine, University of Rochester, University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, Medical University of South Carolina, Children's Hospital Colorado, University of Colorado Anschutz, Monroe Carell Jr. Children's Hospital, Vanderbilt University, University of Iowa, Icahn School of Medicine at Mount Sinai, Kaiser Permanente Washington Health Research Institute
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W4307966151