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

NCT ID: NCT04148521

Last Updated: 2023-03-21

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 1089 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-10-14
• Study Completion Date: 2022-01-31

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.

Conditions

Depression; Anxiety; Substance Use Disorders

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

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.

Group Type: EXPERIMENTAL

Behavioral Health - Virtual Patient Navigation

Intervention Type: BEHAVIORAL

Patients are identified by a clinician in the ED as needing psychiatric evaluation and a referral is made to a tele-psych provider for a virtual consult. Patients can be enrolled to the intervention arm based on a randomization scheme that randomly allocates days that navigators are available. The psychiatrist will make a recommendation to admit or discharge the patient. For patients that have a discharge recommendation on days that BH-VPN is available, patients will be offered the BH-VPN program. Enrolled patients are followed for up to 45 days. On days where the navigator is available, all patients who meet eligibility criteria will be considered exposed to the intervention.

Usual care Behavioral Health

All patients who meet eligibility criteria at sites where the virtual patient navigator behavioral health program is not offered will be considered exposed to usual care.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Behavioral Health - Virtual Patient Navigation

Patients are identified by a clinician in the ED as needing psychiatric evaluation and a referral is made to a tele-psych provider for a virtual consult. Patients can be enrolled to the intervention arm based on a randomization scheme that randomly allocates days that navigators are available. The psychiatrist will make a recommendation to admit or discharge the patient. For patients that have a discharge recommendation on days that BH-VPN is available, patients will be offered the BH-VPN program. Enrolled patients are followed for up to 45 days. On days where the navigator is available, all patients who meet eligibility criteria will be considered exposed to the intervention.

Intervention Type: BEHAVIORAL

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

-

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Duke Endowment

OTHER

Sponsor Role: collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Jason Roberge, PhD

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

Atrium Health - Stanly

Albemarle, North Carolina, United States

Atrium Health - Kings Mountain

Kings Mountain, North Carolina, United States

Scotland Memorial Hospital

Laurinburg, North Carolina, United States

Atrium Health - Lincoln

Lincolnton, 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

Atrium Health - Anson

Wadesboro, North Carolina, United States

Columbus Regional Hospital

Whiteville, North Carolina, United States

Countries

United States

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

13952

Identifier Type: OTHER

Identifier Source: secondary_id

Pro00038573

Identifier Type: OTHER

Identifier Source: secondary_id

IRB00081746

Identifier Type: -

Identifier Source: org_study_id