McClure Jessica M, Mara Constance A, Stark Lori J, Anderson Jeffrey, Young Melissa, Aggarwal Avneesh, Harris Emily, Modi Avani C
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC15018, Cincinnati, OH, 45229, USA.
Office of Population Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Behav Health Serv Res. 2025 Apr;52(2):357-366. doi: 10.1007/s11414-024-09928-w. Epub 2025 Jan 9.
Rates of depression among youth and emergency department (ED) visits for un- or under-treated symptoms are on the rise. Early identification and treatment of depression is imperative at the patient, program, system, and population levels. This paper examines the individual and cumulative impact of Project ECHO and the inclusion of IBH services in pediatric primary care practices on mental health-related ED rates among youth diagnosed with depression for those practices. Twenty-eight practices participated and provided data on 5,388 patients diagnosed with depression who were seen between 2019 and 2022. A binominal mixed effect model was used to examine the impact of Project ECHO and IBH on mental health-related ED rates among youth diagnosed with depression per month within each practice. Compared to practices without an IBH program, those who implemented IBH had a significantly lower rate of mental health-related ED visits among this patient population (Incident Rate Ratio (IRR) = 0.80, p = .005, 95% Confidence Intervale (CI) = 0.68, 0.93). No significant differences were found between practices regardless of participation in Project ECHO, nor was there a significant interaction effect between practices that employed Project ECHO and IBH in combination. This study shows promising results with IBH having a positive impact on practice outcomes compared to treatment as usual, while Project ECHO in isolation or combined with IBH did not significantly affect rates of mental health-related ED visits.
青少年抑郁症的发病率以及因症状未得到治疗或治疗不足而前往急诊科就诊的情况正在上升。在患者、项目、系统和人群层面，抑郁症的早期识别和治疗势在必行。本文探讨了ECHO项目以及在儿科初级保健实践中纳入综合行为健康（IBH）服务对这些实践中被诊断为抑郁症的青少年心理健康相关急诊就诊率的个体影响和累积影响。28家医疗机构参与其中，并提供了2019年至2022年间就诊的5388名被诊断为抑郁症患者的数据。采用二项混合效应模型来检验ECHO项目和IBH对每家医疗机构内每月被诊断为抑郁症的青少年心理健康相关急诊就诊率的影响。与没有IBH项目的医疗机构相比，实施了IBH的医疗机构在该患者群体中心理健康相关急诊就诊率显著更低（发病率比（IRR）=0.80，p = 0.005，95%置信区间（CI）=0.68，0.93）。无论是否参与ECHO项目，各医疗机构之间均未发现显著差异，同时采用ECHO项目和IBH的医疗机构之间也没有显著的交互作用。这项研究显示了有前景的结果，与常规治疗相比，IBH对实践结果有积极影响，而单独的ECHO项目或与IBH联合使用均未显著影响心理健康相关急诊就诊率。
