Clinical trial NCT05460078: An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health
Official title: An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health Settings
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mental Health Issue
Keywords: behavioral health symptoms
Lead sponsor: Wake Forest University Health Sciences
Sponsor class: OTHER
Collaborators: name: The Duke Endowment
First posted: 2022-07-15
Enrollment: 7526
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: stepped-wedge
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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

Primary outcomes:
measure: Number of Participants With All Cause Non-elective Acute Care Post Discharge Utilization Within 30 Days
timeFrame: day 30
Secondary outcomes:
measure: 60-day All Cause Non-elective Acute Care Utilization
timeFrame: day 60
measure: 45-day Behavioral Health Acute Care Utilization
timeFrame: day 45
measure: 45-day All Cause Non-elective Acute Care Utilization
timeFrame: day 45
Other outcomes:
Locations:
city: Charlotte
country: United States
facility: Atrium Health Behavioral Health Davidson - Mountain Laurel
state: North Carolina
city: Charlotte
country: United States
facility: Atrium Health Behavioral Health Davidson - River Birch
state: North Carolina
city: Charlotte
country: United States
facility: Carolinas Medical Center Main - 6B
state: North Carolina
city: Charlotte
country: United States
facility: Atrium Health Behavioral Health Charlotte - ED Obs
state: North Carolina
city: Charlotte
country: United States
facility: Atrium Health Behavioral Health Charlotte - North and South
state: North Carolina
city: Davidson
country: United States
facility: Atrium Health Behavioral Health Davidson - Frasier Fur
state: North Carolina
city: Kings Mountain
country: United States
facility: Atrium Health Kings Mountain Psychiatry
state: North Carolina
Study officials:
affiliation: Wake Forest University Health Sciences
name: Jason Roberge, PhD
role: PRINCIPAL_INVESTIGATOR
References: