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Mental Health eConsults

30. října 2019 aktualizováno: University of Minnesota

The Effects of Mental Health eConsults: A Clinic-level Randomized Trial

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.

Přehled studie

Postavení

Dokončeno

Podmínky

Intervence / Léčba

Detailní popis

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.

Typ studie

Intervenční

Zápis (Očekávaný)

900000

Fáze

  • Nelze použít

Kontakty a umístění

Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.

Studijní místa

  • Spojené státy
    • Minnesota
      • Minneapolis, Minnesota, Spojené státy, 55407
        • Allina Health

Kritéria účasti

Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.

Kritéria způsobilosti

Věk způsobilý ke studiu

  • Dítě
  • Dospělý
  • Starší dospělý

Přijímá zdravé dobrovolníky

Ano

Pohlaví způsobilá ke studiu

Všechno

Popis

Inclusion Criteria:

  • 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.

Exclusion Criteria:

  • We will exclude patients from the patient-level analysis who have opted that their secondary data not be used by Allina for research purposes.

Studijní plán

Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.

Jak je studie koncipována?

Detaily designu

  • Primární účel: Výzkum zdravotnických služeb
  • Přidělení: Randomizované
  • Intervenční model: Paralelní přiřazení
  • Maskování: Žádné (otevřený štítek)

Zbraně a zásahy

Skupina účastníků / Arm
Intervence / Léčba
Experimentální: Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
Jiný: Mental Health eConsults
Providers in primary care clinics who receive the intervention will be able to use electronic consultations (eConsults) with psychiatrists. If a primary care provider wishes to use eConsults, he/she will enter a specific question about a patient in the electronic medical record system and submit as an eConsult. A psychiatrist will review the question and the patient's record, and send a response back to the primary care provider within one business day.
Aktivní komparátor: 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.
Jiný: Care as usual
Providers in primary care clinics will deliver care as usual to their patients.

Co je měření studie?

Primární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Use of eConsults
Časové okno: 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.
Within one day of a primary care clinic visit

Sekundární výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Frequency of specialist consultation
Časové okno: Baseline and 6 months
Primary care providers report how often in the past 6 months they consult with a mental health specialist for help with a patient's mental health issues at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and 6 months
How easy to consult with specialist
Časové okno: Baseline and 6 months
Primary care providers report how easy it is in the past 6 months to consult with a mental health specialist for help with a patient's mental health issues at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and 6 months
Patient contact with a specialist, 1 month
Časové okno: 1-month
Whether patients see a mental health specialist within a month after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Patient contact with a specialist, 3 months
Časové okno: 3-month
Whether patients see a mental health specialist within 3 months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Patient contact with a specialist, 6 months
Časové okno: 6-month
Whether patients see a mental health specialist within 6 months after a primary care visit. Data will be extracted from the electronic medical record system.
6-month
Change in depression symptoms
Časové okno: Baseline office visit to followup within 6 months
Depressive symptoms, as measured by the PHQ-9 at the office visit and again at a routine PHQ9 measurement within six months.
Baseline office visit to followup within 6 months
Total cost of care, 1 month
Časové okno: 1-month
Total health care spending one month after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.
1-month
Total cost of care, 3 month
Časové okno: 3-month
Total health care spending three months after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.
3-month
Total cost of care, 6 month
Časové okno: 6-month
Total health care spending six months after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.
6-month
Providers get needed support for mental health care
Časové okno: Baseline and 6 months
Providers indicate agreement with whether they have adequate support for delivering five aspects of mental health care at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and 6 months
Any mental health service use, 2 week
Časové okno: 2-week
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
2-week
Any mental health service use, 1 month
Časové okno: 1-month
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Any mental health service use, 3-month
Časové okno: 3-month
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Any mental health service use, 6 month
Časové okno: 6-months
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
6-months
Provider-perceived patient access
Časové okno: Baseline and six months
Providers' perceptions of how quickly their patients are able to access needed specialty mental health services at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and six months

Další výstupní opatření

Měření výsledku
Popis opatření
Časové okno
Emergency department use, 1 month
Časové okno: 1-month
Whether there was any emergency department use in the months after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Emergency department use, 3 months
Časové okno: 3-month
Whether there was any emergency department use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Psychotropic medication use, 1 month
Časové okno: 1-month
Whether there was any psychotropic drug prescription and use in the month after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Psychotropic medication use, 3 month
Časové okno: 3-month
Whether there was any psychotropic drug prescription and use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Inpatient use, 1 month
Časové okno: 1-month
Whether there was any emergency department use in the month after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Inpatient use, 3 month
Časové okno: 3-month
Whether there was any emergency department use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Confidence in depression treatment
Časové okno: Baseline and six months
Providers are asked about their levels of confidence in five aspects of depression treatment at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and six months
Skill in depression treatment
Časové okno: Baseline and six months
Providers are asked to assess their skill in four aspects of depression treatment at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and six months

Spolupracovníci a vyšetřovatelé

Zde najdete lidi a organizace zapojené do této studie.

Sponzor

University of Minnesota

Spolupracovníci

Allina Health System

Vyšetřovatelé

  • Vrchní vyšetřovatel: Ezra Golberstein, Ph.D., University of Minnesota

Termíny studijních záznamů

Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.

Hlavní termíny studia

Začátek studia

1. srpna 2015

Primární dokončení (Aktuální)

1. ledna 2017

Dokončení studie (Aktuální)

1. března 2017

Termíny zápisu do studia

První předloženo

14. srpna 2015

První předloženo, které splnilo kritéria kontroly kvality

18. srpna 2015

První zveřejněno (Odhad)

19. srpna 2015

Aktualizace studijních záznamů

Poslední zveřejněná aktualizace (Aktuální)

1. listopadu 2019

Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality

30. října 2019

Naposledy ověřeno

1. října 2019

Více informací

Termíny související s touto studií

Další relevantní podmínky MeSH

Další identifikační čísla studie

  • 1507S76668

Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .

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