An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health

Mental Health Issue Clinical Trial

— VPTC  

Official title:

An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health Settings

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05460078
• Other study ID #: 11-21-02E
• Status: Active, not recruiting
• Phase: N/A
• Start date: November 1, 2021
• Est. completion date: June 2024

Study information

• Verified date: May 2024
• Source: Wake Forest University Health Sciences
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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).

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.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 1082
• Est. completion date: June 2024
• Est. primary completion date: August 22, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Mental Health Issue

Intervention

Behavioral:
• Virtual Psychiatric Transition of Care Program
Behavioral Health facility or units that have discharged patients meeting inclusion criteria will be randomly assigned as either an intervention or standard care site. Intervention sites will be those using the VPTC program. This evaluation design will integrate into current workflows for the measurement of outcomes. Prior to discharge, patients may be referred to the VPTC program if they report residency or shelter in North Carolina, are 18 years of age or older on the day of discharge and can access virtual care (phone/video). The VPTC program is defined by: Psychiatric consultation Medication management services with pharmacological consultation following of Health Coaching participation and provide treatment recommendations Tracking of behavioral health symptoms and provide treatment recommendations Health coaching; Psychoeducational support Treatment and safety planning Assistance connecting with an outpatient care provider

Locations

Country	Name	City	State
United States	Atrium Health Behavioral Health Charlotte - ED Obs	Charlotte	North Carolina
United States	Atrium Health Behavioral Health Charlotte - North and South	Charlotte	North Carolina
United States	Atrium Health Behavioral Health Davidson - Mountain Laurel	Charlotte	North Carolina
United States	Atrium Health Behavioral Health Davidson - River Birch	Charlotte	North Carolina
United States	Carolinas Medical Center Main - 6B	Charlotte	North Carolina
United States	Atrium Health Behavioral Health Davidson - Frasier Fur	Davidson	North Carolina
United States	Atrium Health Kings Mountain Psychiatry	Kings Mountain	North Carolina

Sponsors (2)

Lead Sponsor	Collaborator
Wake Forest University Health Sciences	The Duke Endowment

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Percent of patients - Depression reduction	Percent of patients with a 5 point reduction of their Patient Health Questionnaire (PHQ-9) score who had an initial PHQ-9 score = 10, intervention arm only	day 60
Other	Change in Patient Health Questionnaire (PHQ-9) scores	Show the distribution of PHQ-9 score reduction among participants, intervention arm only	day 60
Other	Percent of patients - report no suicide ideation	Percent of patients with a PHQ-9, Question 9=0 upon graduation among patients with an initial Q9>0, intervention arm only	day 60
Primary	30-day all cause non-elective acute care post discharge utilization	30-day all cause non-elective acute care post discharge utilization (Emergency Department (ED), inpatient, and observation encounters)	day 30
Secondary	60-day all cause non-elective acute care utilization	60-day all cause non-elective acute care utilization (ED visits, observation, and inpatient encounters)	day 60
Secondary	30-day behavioral health acute care utilization	30-day behavioral health acute care utilization (ED visits, observation, and inpatient encounters)	day 30
Secondary	Number of Subjects with Behavioral Health office visit	Examine the percent of patients that had a behavioral health office visit within 7 days of discharge	day 7
Secondary	Count of unavoidable Emergency Department (ED) visits	Examine the count of avoidable ED visits within 30 days of discharge	day 30