508 - Association of Pediatric Patients’ Rurality with ED Utilization for Psychiatric Emergencies

Publication Number: 508.3768

Jessica A. Murphy, Massachusetts General Hospital Dept. of Emergency Medicine, BOSTON, MA, United States; Melissa A. Meeker, Massachusetts General, Boston, MA, United States; Ashley Foster, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Rama Salhi, MassGeneral Hospital for Children, Boston, MA, United States; Matthew Tobey, Harvard Medical School, Boston, MA, United States; Margaret Samuels-Kalow, MassGeneral Hospital for Children, Boston, MA, United States

Background: Emergency departments (EDs) are essential resources in the timely assessment and intervention of mental health emergencies, especially for pediatric patients requiring further psychiatric care inpatient. However, rural youths face unique barriers to mental health care, potentially resulting in increased ED utilization. Understanding how patient rurality impacts ED utilization is critical to health equity.

Objective: This descriptive analysis examined the association between (1) patient rurality and ED encounters for all symptoms and for mental health symptoms and (2) Mental Health Provider Shortage Areas (mHPSAs) and ED encounters for mental health symptoms.

Design/Methods: This retrospective cohort study examined ED encounters of patients 5-17 years with a primary diagnosis of a mental health disorder from the Healthcare Cost and Utilization Project’s 2020 State Emergency Department and State Inpatient Databases for 5 US states. The primary exposure was patient rurality, determined by the patient’s home zip code and the National Center for Health Statistics rural-urban classification. Secondary exposures included patient location in a mHPSA, defined by the Health Resources and Services Administration by a ratio of population to mental health provider of 30,000 to 1 (20,000 to 1 where high needs are identified). The primary outcome was ED visits for mental health conditions stratified by mHPSA, patient rurality, and hospital rurality.

Results: During the study period, there were 2,097,865 ED encounters for any reason, and 265,360 (12.6%) for mental health. Of mental health encounters, 8.2%, were from rural populations.

Of mental health encounters, 61.8% were patients in mHPSAs. For rural patients with ED visits for mental health, 79.8% were from mental health HPSAs, compared to metropolitan patients of which 60.5% were from mHPSAs.

Of mental health encounters, 2.2% occurred at rural hospitals. Rural hospitals saw the largest proportion of patients in mHPSAs: for mental health encounters, 86.8% of rural hospitals’ visits were from mHPSAs, compared to only 60.5% of metropolitan hospitals’ visits. For suicide and self injury 87.2% of rural hospitals’ visits were from mHPSAs, compared to 55.0% of metropolitan hospitals.

Conclusion(s): Rural children seeking care for mental health emergencies are more likely to be from mHPSAs than metropolitan children, and rural hospitals serve higher rates of patients in mHPSAs. Efforts to address accessible outpatient psychiatry is needed to reduce preventable ED utilization for rural children with mental health conditions.

Table 1. Patient rurality and access to mental health providers.
*mHPSA = Mental Health Provider Shortage Area.
For rural patients with ED visits for mental health, 79.8% were from mental health HPSAs, compared to metropolitan patients of which 60.5% were from mHPSAs.

Table 2. Hospital rurality and patient access to mental health providers.
*mHPSA = Mental Health Provider Shortage Area.
Rural hospitals saw the largest proportion of patients in mHPSAs: for mental health encounters, 86.8% of rural hospitals’ visits were from mHPSAs, compared to only 60.5% of metropolitan hospitals’ visits.