Clinical trial NCT04148521: A Virtual Navigation Intervention to Reduce Behavioral Health Admissions From Rural Emergency Departments
Official title: A Virtual Navigation Intervention to Reduce Behavioral Health Admissions From Rural Emergency Departments (VIBRANT)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Depression
Anxiety
Substance Use Disorders
Lead sponsor: Wake Forest University Health Sciences
Sponsor class: OTHER
Collaborators: name: The Duke Endowment
First posted: 2019-11-01
Enrollment: 1089
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This research project is a pragmatic, randomized evaluation of a quality improvement initiative which seeks to evaluate the effects of standardizing the use of a BH-VPN program among patients with a telepsychiatric consult. The outcomes evaluation of this intervention has been designed to integrate with routine care and minimize frontline staff burden by deploying an evaluation in a real-world setting.

Detailed description: Hospital admissions are common amongst those with mental illness. Significant morbidity exists for patients who are being admitted to a psychiatric hospital from the Emergency Department (ED).Additionally, commitment to a hospital setting may have adverse effects on patients psychologically, degrade relationships with therapists, and disrupt continuity of care. ED providers often decide to admit to a psychiatric hospital because of limited availability of behavioral health resources. To better enhance transitions of care for those with mental illness, Atrium Health has designed a behavioral health virtual patient navigation (BH-VPN)program that helps coordinate services and follow-up care, while facilitating the safe discharge of patients. Patients presenting to an ED that have a tele psychiatric consult who are recommended for discharge are eligible for services. The Behavioral health Service line is expanding the program to additional rural emergency departments. Using an outcomes evaluation, the investigators will inform Atrium Health on the effect of the BH-VPN program to reduce hospital admissions among patients with a tele psychiatric consult in the ED. The proposed hypothesis is that by having the BH-VPN program available in an ED, more patients will be discharged from the ED than admitted.

Eligibility criteria: Inclusion Criteria:

Eligible patients must meet each of the following criteria:

* Present to an ED at participating sites
* Complete a telepsychiatric consult as captured in the electronic medical record
* Complete a telepsychiatric consult during the navigator's hours of operation
* ≥ 18 years of age at time of ED admission

Exclusion Criteria:• Patients currently enrolled in the BH-VPN program upon their index ED encounter

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Primary outcomes:
measure: Assessing Hospital Admissions
timeFrame: Up to 2 weeks from initial ED admission
Secondary outcomes:
measure: 45-day Post Discharge Utilization Rate
timeFrame: 45 days
measure: 45-day Post Discharge Utilization Rate With a Self-harm Diagnosis
timeFrame: 45 days
measure: 45-day Post Discharge ED Utilization Rate With a Behavioral Health Crisis
timeFrame: 45 days
Other outcomes:
Locations:
city: Albemarle
country: United States
facility: Atrium Health - Stanly
state: North Carolina
city: Kings Mountain
country: United States
facility: Atrium Health - Kings Mountain
state: North Carolina
city: Laurinburg
country: United States
facility: Scotland Memorial Hospital
state: North Carolina
city: Lincolnton
country: United States
facility: Atrium Health - Lincoln
state: North Carolina
city: Morganton
country: United States
facility: Carolinas HealthCare System - Blue Ridge - Morganton
state: North Carolina
city: Shelby
country: United States
facility: Atrium Health - Cleveland
state: North Carolina
city: Valdese
country: United States
facility: Carolinas HealthCare System - Valdese
state: North Carolina
city: Wadesboro
country: United States
facility: Atrium Health - Anson
state: North Carolina
city: Whiteville
country: United States
facility: Columbus Regional Hospital
state: North Carolina
Study officials:
affiliation: Wake Forest University Health Sciences
name: Jason Roberge, PhD
role: PRINCIPAL_INVESTIGATOR
References: