Mental Health
Conditions
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.
Interventions
BEHAVIORALBH-VPN
A bundle of usual care components, applied consistently and completely, along with access to behavioral health specific patient navigators and navigation services.
Sponsors
Wake Forest University Health Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergency Department to Inpatient Conversion Rate | 5 days | admission from the Emergency Department with behavioral health consult completed, to an inpatient or observation setting. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality, Comfort, and Care (QCC) Defined Readmission Rate | 30 days | readmission within 30 days to the same facility |
| Patient-centric (Protocol Defined) Readmission Rate | 30 days | readmission within 30 days to any facility which Carolinas Healthcare System have access to the data |
| Utilization of Healthcare Services Post-discharge From Emergency Department | 45 days | Number of Emergency Department, inpatient, observation encounters |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| BH-VPN A bundle of usual care components applied consistently and completely, plus access to mental health trained patient navigators and navigation services.
BH-VPN: A bundle of usual care components, applied consistently and completely, along with access to behavioral health specific patient navigators and navigation services. | 323 |
| Usual Care The standard intervention (Control - Usual Care) is given in this population. May contain some of the BH-VPN components. | 314 |
| Total | 637 |
Baseline characteristics
| Characteristic | BH-VPN | Total | Usual Care |
|---|---|---|---|
| Age, Continuous | 39.5 years STANDARD_DEVIATION 16.8 | 39.7 years STANDARD_DEVIATION 16.5 | 39.8 years STANDARD_DEVIATION 16.3 |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants | 4 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 4 Participants | 7 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 105 Participants | 195 Participants | 90 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 3 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 39 Participants | 76 Participants | 37 Participants |
| Race (NIH/OMB) White | 170 Participants | 352 Participants | 182 Participants |
| Region of Enrollment United States | 323 participants | 637 participants | 314 participants |
| Sex: Female, Male Female | 140 Participants | 279 Participants | 139 Participants |
| Sex: Female, Male Male | 183 Participants | 358 Participants | 175 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 323 | 4 / 314 |
| other Total, other adverse events | 0 / 323 | 0 / 314 |
| serious Total, serious adverse events | 0 / 323 | 0 / 314 |
Outcome results
Primary
Emergency Department to Inpatient Conversion Rate
admission from the Emergency Department with behavioral health consult completed, to an inpatient or observation setting.
Time frame: 5 days
Population: The number of patients that were admitted
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| BH-VPN | Emergency Department to Inpatient Conversion Rate | 178 participants |
| Usual Care | Emergency Department to Inpatient Conversion Rate | 198 participants |
p-value: 0.0695% CI: [0.54, 1.02]Regression, Logistic
Secondary
Patient-centric (Protocol Defined) Readmission Rate
readmission within 30 days to any facility which Carolinas Healthcare System have access to the data
Time frame: 30 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| BH-VPN | Patient-centric (Protocol Defined) Readmission Rate | 28 Participants |
| Usual Care | Patient-centric (Protocol Defined) Readmission Rate | 23 Participants |
p-value: 0.6295% CI: [0.65, 2.08]Mixed Models Analysis
Secondary
Quality, Comfort, and Care (QCC) Defined Readmission Rate
readmission within 30 days to the same facility
Time frame: 30 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| BH-VPN | Quality, Comfort, and Care (QCC) Defined Readmission Rate | 7 Participants |
| Usual Care | Quality, Comfort, and Care (QCC) Defined Readmission Rate | 2 Participants |
p-value: 0.7695% CI: [0.7, 1.64]Mixed Models Analysis
Secondary
Utilization of Healthcare Services Post-discharge From Emergency Department
Number of Emergency Department, inpatient, observation encounters
Time frame: 45 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| BH-VPN | Utilization of Healthcare Services Post-discharge From Emergency Department | 112 Participants |
| Usual Care | Utilization of Healthcare Services Post-discharge From Emergency Department | 89 Participants |
p-value: 0.080.96% CI: [0.96, 1.9]Mixed Models Analysis