An Evaluation of Virtual Psychiatric Transition of Care Offered in Behavioral Health (VPTC)

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

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).

Study Overview

• Status: Active, not recruiting
• Conditions: Mental Health Issue
• Intervention / Treatment: Behavioral: Virtual Psychiatric Transition of Care Program

Detailed 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.

• Study Type: Interventional
• Enrollment (Actual): 1082
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Jason Roberge, PhD; Phone Number: 704-355-0268; Email: jason.roberge@atriumhealth.org
• Study Contact Backup: Name: Whitney Rossman; Phone Number: 704-446-2104; Email: Whitney.rossman@atriumhealth.org

Study Locations

• United States
  • North Carolina
    • Charlotte, North Carolina, United States, 28036
      • Atrium Health Behavioral Health Davidson - Mountain Laurel
    • Charlotte, North Carolina, United States, 28036
      • Atrium Health Behavioral Health Davidson - River Birch
    • Charlotte, North Carolina, United States, 28203
      • Carolinas Medical Center Main - 6B
    • Charlotte, North Carolina, United States, 28211
      • Atrium Health Behavioral Health Charlotte - ED Obs
    • Charlotte, North Carolina, United States, 28211
      • Atrium Health Behavioral Health Charlotte - North and South
    • Davidson, North Carolina, United States, 28036
      • Atrium Health Behavioral Health Davidson - Frasier Fur
    • Kings Mountain, North Carolina, United States, 28086
      • Atrium Health Kings Mountain Psychiatry

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual program; Seen at a location where the virtual program is being offered	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
No Intervention: Standard care; Seen at a location where standard care is offered

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 Outcome Measures

Outcome Measure	Measure Description	Time Frame
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
30-day behavioral health acute care utilization	30-day behavioral health acute care utilization (ED visits, observation, and inpatient encounters)	day 30
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
Count of unavoidable Emergency Department (ED) visits	Examine the count of avoidable ED visits within 30 days of discharge	day 30

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
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
Change in Patient Health Questionnaire (PHQ-9) scores	Show the distribution of PHQ-9 score reduction among participants, intervention arm only	day 60
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

Collaborators and Investigators

• Sponsor: Wake Forest University Health Sciences
• Collaborators: The Duke Endowment
• Investigators: Principal Investigator: Jason Roberge, PhD, Wake Forest University Health Sciences

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2021
• Primary Completion (Actual): August 22, 2023
• Study Completion (Estimated): June 1, 2024

Study Registration Dates

• First Submitted: July 12, 2022
• First Submitted That Met QC Criteria: July 12, 2022
• First Posted (Actual): July 15, 2022

Study Record Updates

• Last Update Posted (Actual): February 28, 2024
• Last Update Submitted That Met QC Criteria: February 26, 2024
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Keywords: behavioral health symptoms
• Other Study ID Numbers: 11-21-02E

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No