A Virtual Navigation Intervention to Reduce Behavioral Health Admissions From Rural Emergency Departments

Not Applicable

Completed

• Conditions: Depression; Anxiety; Substance Use Disorders
• Interventions: Behavioral: Behavioral Health - Virtual Patient Navigation

• Registration Number: NCT04148521
• Lead Sponsor: Wake Forest University Health Sciences

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.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2019-10-14
• Study First Submitted: 2019-10-30
• Study First Submitted QC: 2019-10-31
• Study First Posted: 2019-11-01
• Primary Completion: 2021-10-31
• Study Completion: 2022-01-31
• Status Verified: 2022-02
• Results First Submitted: 2022-02-21
• Results First Submitted QC: 2022-02-21
• Results First Posted: 2022-04-12
• Last Update Submitted: 2023-03-17
• Last Update Posted: 2023-03-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1089

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

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Exclusion Criteria

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

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Behavioral Health - Virtual Patient Navigation	Behavioral Health - Virtual Patient Navigation	All patients who meet eligibility criteria at sites where the virtual patient navigation behavioral health program is offered will be considered exposed to the intervention.

Primary Outcome Measures

Name	Time	Method
Assessing Hospital Admissions	Up to 2 weeks from initial ED admission	Compare the effectiveness of having the Behavioral Health - Virtual Patient Navigation (BH-VPN) program available compared to usual care, on admission rates among patients in the ED with a telepsychiatric consult

Secondary Outcome Measures

Name	Time	Method
45-day Post Discharge Utilization Rate With a Self-harm Diagnosis	45 days	Compare the frequency of patients with any encounter with a self-harm diagnosis within 45 days of the ED visit between the 2 arms of the study
45-day Post Discharge ED Utilization Rate With a Behavioral Health Crisis	45 days	Compare the frequency of patients who return to the ED and have a telepsychiatric consult within 45 days of their initial ED visit between the 2 arms of the study
45-day Post Discharge Utilization Rate	45 days	Comparing the 45-day utilization (ED, IP, OBS encounter) rate after the ED encounter between the 2 arms of the study

Trial Locations

Locations (9)

Atrium Health - Lincoln; 🇺🇸 Lincolnton, North Carolina, United States

Atrium Health - Kings Mountain; 🇺🇸 Kings Mountain, North Carolina, United States

Atrium Health - Stanly; 🇺🇸 Albemarle, North Carolina, United States

Scotland Memorial Hospital; 🇺🇸 Laurinburg, North Carolina, United States

Carolinas HealthCare System - Blue Ridge - Morganton; 🇺🇸 Morganton, North Carolina, United States

Atrium Health - Cleveland; 🇺🇸 Shelby, North Carolina, United States

Carolinas HealthCare System - Valdese; 🇺🇸 Valdese, North Carolina, United States

Columbus Regional Hospital; 🇺🇸 Whiteville, North Carolina, United States

Atrium Health - Anson; 🇺🇸 Wadesboro, North Carolina, United States