Mapping Utilization Trends: Identifying and Understanding High-Frequency ED Users in Pediatric MBH Care

Abstract

Pediatric emergency departments are experiencing a surge in visits related to mental and behavioral health (MBH), straining already overburdened healthcare systems. Understanding which subgroups of pediatric patients are most likely to return for repeated MBH-related visits is critical for designing targeted interventions and improving continuity of care. EHR data from 203,925 pediatric patients was used to identify utilization patterns among pediatric patients with MBH visits. We applied a SMOTE-enhanced, two-stage clustering algorithm based on total and consecutive MBH/non-MBH visits. Descriptive statistics and temporal visualizations were used to characterize and describe the resulting patient subgroups. Five distinct ED utilization clusters were identified, ranging from low utilizers with isolated MBH visits to high-frequency users with complex clinical profiles and substantial non-MBH utilization. These findings highlight the need for future research to identify high-risk trajectories and examine whether non-MBH visits may signal emerging behavioral health crises in pediatric populations.