The Effects of Mental Health eConsults: A Clinic-level Randomized Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 900,000
- 试验地点
- 2
- 主要终点
- Use of eConsults
研究概览
简要总结
The purpose of this study is to assess whether electronic consultations between primary care providers and psychiatrists affects mental health services delivered in primary care settings.
详细描述
This study assesses the effects of electronic consultations (eConsults) between primary care providers and psychiatrists as a way to support the delivery of mental health services in primary care settings. The setting for the study are the primary care clinics of Allina Health.
The study uses a randomized rollout design. Across 45 primary care clinics, half of the clinics will be randomly assigned to receive access to eConsults at the start of the study. The other half of the clinics will provide care-as-usual for nine months, at which point they will also gain access to eConsults. Stratified randomization will be used, with stratification on whether primary care clinics have co-located specialty mental health services.
For primary care clinics that are given access to eConsults, the primary care providers in those clinics will have the option of ordering an eConsult on behalf of their patients, which will include specific questions about a particular patient's care. The request is routed to the service region's psychiatry pool, and the psychiatrists have the option of responding. If they choose to respond, the psychiatrist responds with their recommendations within one business day, and the PCP proceeds with care accordingly. The psychiatrist receives 0.75 work relative value units (wRVUs) for providing this service. All communications for the eConsult are routed through Allina's Epic system. Although patients will not be billed for eConsults over the course of the proposed research, some insurance plans do cover it and evidence of eConsult effectiveness may impel other insurers to cover the service.
The study will have two components. First, the investigators will collect web survey data from the primary care providers to assess how access to eConsults affects providers' perceptions of their support and skill for delivering mental health services to their patients. Second, the investigators will assess the effects of receiving eConsults at the patient level, by using data from the Electronic Medical Record system.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •For the provider surveys, we will recruit all of the primary care providers who work in Allina's primary care clinics to participate in the surveys
- •For the patient-level analysis, we will examine data from all patients seen in Allina's primary care clinics during the study period. We will include children and adults.
排除标准
- •We will exclude patients from the patient-level analysis who have opted that their secondary data not be used by Allina for research purposes.
研究组 & 干预措施
Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
干预措施: Mental Health eConsults (Other)
Usual care
Primary care clinics that will deliver care as usual for nine months, and will receive the eConsults intervention nine months subsequent to the eConsults "intervention" clinics.
干预措施: Care as usual (Other)
结局指标
主要结局
Use of eConsults
时间窗: Within one day of a primary care clinic visit
Whether an eConsult was actually ordered in a primary care visit for a mental health issue. Data will be extracted from the electronic medical record system.
次要结局
- How easy to consult with specialist(Baseline and 6 months)
- Patient contact with a specialist, 1 month(1-month)
- Total cost of care, 1 month(1-month)
- Total cost of care, 3 month(3-month)
- Any mental health service use, 3-month(3-month)
- Patient contact with a specialist, 3 months(3-month)
- Total cost of care, 6 month(6-month)
- Any mental health service use, 6 month(6-months)
- Change in depression symptoms(Baseline office visit to followup within 6 months)
- Providers get needed support for mental health care(Baseline and 6 months)
- Provider-perceived patient access(Baseline and six months)
- Frequency of specialist consultation(Baseline and 6 months)
- Patient contact with a specialist, 6 months(6-month)
- Any mental health service use, 2 week(2-week)
- Any mental health service use, 1 month(1-month)