title: Aftercare, emergency department visits, and readmission in adolescents.
abstract: OBJECTIVE
  U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization.
  
  
  METHODS
  We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately.
  
  
  RESULTS
  We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score-based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05-1.42), and readmission (HR = 1.38, 95% CI = 1.14-1.66), but not ED visits (HR = 1.14, 95% CI = 0.95-1.37).
  
  
  CONCLUSIONS
  Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use.
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada. corine.carlisle@sickkids.ca
authors.forename: Corine E
authors.initials: CE
authors.lastname: Carlisle
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.forename: Russell
authors.initials: R
authors.lastname: Schachar
authors.forename: Teresa
authors.initials: T
authors.lastname: To
mesh_terms: D000293:Adolescent; D000359:Aftercare / Q000379:methods / Q000523:psychology / Q000592:standards; D002170:Canada; D016001:Confidence Intervals; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004637:Emergency Services, Psychiatric / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007256:Information Systems / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000592:standards; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D055815:Young Adult