improving transitional care experiences in mental health

Conditions: Standard Treatment Versus Engagement Focused Treatment

Summary: the cost of serious mental illness (smi) in the u.s. is $317 billion annually. this translates to more than $1000 for every man, women, and child in the u.s. hospitalization and emergency room (er) visits have the highest costs. outpatient services are overburdened. there is a push to get people out of hospitals quickly, while they are still quite ill. these factors cause patients to be lost in the transition from inpatient to outpatient care. many individuals are repeatedly rehospitalized or continue to clog emergency rooms in an attempt to receive care. the importance of transitional care between inpatient/er facilities and outpatient services to prevent this revolving door phenomenon has been continually stressed. there is little research on the best way to accomplish smooth transition to outpatient care. we developed a 90-day transitional care clinic (tcc) to address this need. we propose a randomized treatment outcome study comparing two transitional service packages within our tcc: a standard care package versus an engagement-focused package that features a novel intake procedure and a shared decision-making intervention: access group is an intake procedure designed to address many of the problems of traditional approaches to post-acute treatment engagement, including failure of patients to reach intake appointments. shared decision-making (sdm) is a structured approach to provider-patient communication that has been shown to increase patient involvement in care and improve outcomes. despite smi patients' desire to be more involved in their treatment decisions and promising early evidence of sdm's effectiveness in smi, sdm has not been systematically evaluated in transitional psychiatric care. in the proposed study, patients referred to tcc will be randomized to either engagement-focused care or standard care. the relative benefit of these two approaches will be evaluated in 300 individuals who will be randomized to these two treatments in a 2:1 ratio. we hypothesize that attendance at appointments, reported satisfaction, shared decision making and quality of life will be higher for engagement focused care. the new treatment package is designed to get individuals into treatment quickly and to teach them how to be good consumers of mental health treatments going forward.

aim 1: to compare efc to sc with respect to linkage to tcc services. hypothesis a: patients referred to efc will exhibit a significantly greater rate of attendance at their tcc intake appointment than sc patients. aim 2: to compare efc to sc with respect to patient participation in outpatient treatment. hypothesis b: patients referred to efc will report significantly greater shared decision-making in their tcc prescriber appointments than sc patients. hypothesis c: patients referred to efc will exhibit significantly greater attendance at post-intake scheduled tcc appointments than sc patients. hypothesis d: patients referred to efc will exhibit a significantly greater rate of attendance at initial post-tcc scheduled mental health appointments than sc patients. aim 3: to compare engagement-focused care (efc) to standard care (sc) with respect to patients' long term quality of life. hypothesis e: patients who receive efc will exhibit significantly greater quality of life than sc patients six months after tcc termination.

Eligibility criteria:
inclusion criteria: * serious mental illness including (schizophrenia, schizoaffective disorder, mood disorders, anxiety disorders), referral from inpatient psychiatric unit or emergency service at the time of discharge to the transitional care clinic, ability to sign informed consent exclusion criteria: * unable to complete assessments

Keywords: serious mental illness transitions shared decision making