An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health

Study Overview
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Brief Summary
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The primary objective is to evaluate the effectiveness of a post inpatient discharge virtual psychiatric care team compared to standard care, to reduce 30-day all cause non-elective acute care utilization (Emergency Department (ED), observation, and inpatient encounters).

Detailed Description
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The foundational idea for the Virtual Psychiatric Transition of Care (VPTC) program came from the Atrium Health Hospital at Home care model which has garnered wide acclaim and financial support in the acute care world. A behavioral health care team comprised of licensed clinicians (Behavioral Health Professionals), health coaches, a consulting psychiatric pharmacist and psychiatric providers follow patients for 45 days or more depending on patient need after their acute care encounter. Patient enrolled in the VPTC program will receive the following core components: Introduction to the patient follow-up process, psychosocial assessment, tracking and treatment recommendations for (residential movement, nutrition, sleep hygiene, stress management, pain management, perinatal/postpartum mood disorders, substance abuse), tracking and treatment recommendations for behavioral health symptoms (depression, anxiety, suicidal ideation, etc.), placement into an appropriate case management program if needed, navigation to additional psychiatric or substance use services if needed, and motivational interviewing and brief therapeutic recommendations if needed. For patients that have attempted suicide, they will begin the VPTC program following the zero suicide pathway. The Atrium Health Behavioral Health Service Line created the 'Zero Suicide pathway', in 2019 for those patients identified as high risk for suicide when leaving inpatient units. Zero Suicide is a national movement sponsored by the 2012 National Strategy for Suicide Prevention, National Alliance for Suicide Prevention, Suicide Prevention Resource Center and the Substance Abuse and Mental Health Services Administration (SAMHSA). It is a programmatic approach to keep patients from falling through the cracks in a fragmented and disconnected healthcare system and is based on the belief that suicide is preventable, and suicide deaths are not fated. Since access to mental health services is constrained in our community, patients often fall through the cracks when transitioning between points of care.

Official Title
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An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health Settings

Conditions
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Mental Health Issue

Intervention / Treatment
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* Behavioral: Virtual Psychiatric Transition of Care Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Residency or shelter in North Carolina 18 years of age or older on the day of discharge Access virtual care (phone/video) Discharged from a behavioral health hospital or a behavioral health unit Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: stepped-wedge
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual program<br>Seen at a location where the virtual program is being offered | Behavioral: Virtual Psychiatric Transition of Care Program<br>* Behavioral Health facility or units that have discharged patients meeting inclusion criteria will be randomly assigned as either an intervention or standard care site. Intervention sites will be those using the VPTC program. This evaluation design will integrate into current workflows for the measurement of outcomes. Prior to discharge, patients may be referred to the VPTC program if they report residency or shelter in North Carolina, are 18 years of age or older on the day of discharge and can access virtual care (phone/video). The VPTC program is defined by: Psychiatric consultation Medication management services with pharmacological consultation following of Health Coaching participation and provide treatment recommendations Tracking of behavioral health symptoms and provide treatment recommendations Health coaching; Psychoeducational support Treatment and safety planning Assistance connecting with an outpatient care provider<br>|
| No Intervention: Standard care<br>Seen at a location where standard care is offered | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30-day all cause non-elective acute care post discharge utilization | 30-day all cause non-elective acute care post discharge utilization (Emergency Department (ED), inpatient, and observation encounters) | day 30 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 60-day all cause non-elective acute care utilization | 60-day all cause non-elective acute care utilization (ED visits, observation, and inpatient encounters) | day 60 | 
| 30-day behavioral health acute care utilization | 30-day behavioral health acute care utilization (ED visits, observation, and inpatient encounters) | day 30 | 
| Number of Subjects with Behavioral Health office visit | Examine the percent of patients that had a behavioral health office visit within 7 days of discharge | day 7 | 
| Count of unavoidable Emergency Department (ED) visits | Examine the count of avoidable ED visits within 30 days of discharge | day 30 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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behavioral health symptoms