Evaluation of Behavioral Health-Virtual Patient Navigation Team (BH-VPN)

Study Overview
=================
Brief Summary
-----------------
Patients who present to one of the participating EDs with a telepsychiatric consult performed will be treated and followed per the behavioral health virtual patient navigation pathway (BH-VPN) or usual care. The BH-VPN is inclusive of several components which will all be consistently applied to patients randomized to the intervention, as well as having access to behavioral health trained patient navigators. These key components are often deployed inconsistently as a part of usual care, but per the intervention, will be completed in totality for subjects who are assigned to and participate in the BH-VPN plan. This study includes a qualitative sub-study to measure perceptions of the impact of the BH-VPN on readmission rates and patient outcomes, experiences with the services provided by the BH-VPN, and provider and clinician ideas for how to improve the services provided by the BH-VPN.

Official Title
-----------------
An Evaluation of ED to Admission Conversion Among Patients With a Telepsychiatric Consult Who Are Followed by a Behavioral Health - Virtual Patient Navigation Team

Conditions
-----------------
Mental Health

Intervention / Treatment
-----------------
* Behavioral: BH-VPN


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Present at a participating ED Completed telepsychiatric consult as captured in the EMR Completed telepsychiatric consult Monday - Friday during Navigator's potential hours of operation. Exclusion Criteria: None per the protocol

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: BH-VPN<br>A bundle of usual care components applied consistently and completely, plus access to mental health trained patient navigators and navigation services. | Behavioral: BH-VPN<br>* A bundle of usual care components, applied consistently and completely, along with access to behavioral health specific patient navigators and navigation services.<br>|
| No Intervention: Usual Care<br>The standard intervention (Control - Usual Care) is given in this population. May contain some of the BH-VPN components. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Emergency Department to Inpatient Conversion Rate | admission from the Emergency Department with behavioral health consult completed, to an inpatient or observation setting. | 5 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality, Comfort, and Care (QCC) Defined Readmission Rate | readmission within 30 days to the same facility | 30 days | 
| Patient-centric (Protocol Defined) Readmission Rate | readmission within 30 days to any facility which Carolinas Healthcare System have access to the data | 30 days | 
| Utilization of Healthcare Services Post-discharge From Emergency Department | Number of Emergency Department, inpatient, observation encounters | 45 days |