125 - Mental Healthcare Utilization for Children Before and After Firearm Injury

Poster Number: 125
Publication Number: 125.329

Christian Pulcini, University of Vermont, Shelburne, VT, United States; Monika Goyal, Children's National Medical Center, Washington, DC, United States; Heidi G. De Souza, Children's Hospital Association, Lenexa, KS, United States; Matthew Hall, Children's Hospital Association, Lenexa, Kansas, KS, United States; Sofia Chaudhary, Emory University School of Medicine/ Children's Healthcare of Atlanta, Atlanta, GA, United States; Joel M. Fein, Center for Violence Prevention at Children's Hospital of Philadelphia, Philadelphia, PA, United States; Eric W. Fleegler, Boston Children's Hospital, Boston, MA, United States

Background: Firearm injuries are a leading cause of morbidity and mortality in children and have the potential to cause significant psychological distress.

Objective: We compared mental healthcare encounters and expenditures one year before and up to two years following a non-fatal firearm injury.

Design/Methods: We analyzed data from the Medicaid MarketScan claims database. We included outpatient mental health claims for children 0–18 years of age with an ICD9/10 claim associated with firearm injuries from 2010-2016. We evaluated the cohort in two subgroups: low-prior outpatient mental healthcare utilization and high-prior outpatient mental health utilization. We used descriptive statistics to characterize patient demographics and healthcare service utilization and Wilcoxon Sign Rank Tests to compare healthcare expenditures.

Results: A total of 852 children (764 [90%] low-prior utilizers, 88 [10%] high-prior utilizers) with firearm injuries were included. Low utilizers had 896 mental health visits (1.2/child) in the year prior and 2491 visits (3.3/child) in year 1 and 2610 visits (3.4/child) in year 2 post injury, a 178% and 191% increase respectively (p=0.007). High utilizers had 4918 (55.9/child) in the year prior and 2440 (27.7/child) in year 1 and 1906 (21.7/child) in year 2 post injury, a 50% and 61% decrease respectively (p < 0.001). Mental health expenditures for the low utilizers increased from $99,349 prior to $410,762 (313% increase) in year 1 and $590,627 (494% increase from baseline) in year 2 (p < 0.001). The high utilizer mental health population decreased from $798,216 prior to $370,304 (54% decrease) in year 1 and $268,460 (66% decrease from baseline) in year 2 (p < 0.001).Conclusion(s): In this study of outpatient mental healthcare utilization after firearm injury, children with low prior outpatient mental healthcare utilization had significant, sustained increases in overall utilization and expenditures. In contrast, those with previously high outpatient mental healthcare utilization had significant, sustained decreases up to two years after the injury. This suggests that although previously healthy children are receiving needed services, further longitudinal study is needed to determine why those firearm injury patients with high baseline mental health needs had a decrease in utilization sustained over two years.
Mental Healthcare Utilization for Children Before and After Firearm InjuryUVM CV Pulcini 10.13.21 Full.pdf