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Mental Health eConsults

keskiviikko 30. lokakuuta 2019 päivittänyt: 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.

Tutkimuksen yleiskatsaus

Tila

Valmis

Ehdot

Interventio / Hoito

Yksityiskohtainen kuvaus

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.

Opintotyyppi

Interventio

Ilmoittautuminen (Odotettu)

900000

Vaihe

  • Ei sovellettavissa

Yhteystiedot ja paikat

Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.

Opiskelupaikat

  • Yhdysvallat
    • Minnesota
      • Minneapolis, Minnesota, Yhdysvallat, 55407
        • Allina Health

Osallistumiskriteerit

Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.

Kelpoisuusvaatimukset

Opintokelpoiset iät

  • Lapsi
  • Aikuinen
  • Vanhempi Aikuinen

Hyväksyy terveitä vapaaehtoisia

Joo

Sukupuolet, jotka voivat opiskella

Kaikki

Kuvaus

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.

Opintosuunnitelma

Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.

Miten tutkimus on suunniteltu?

Suunnittelun yksityiskohdat

  • Ensisijainen käyttötarkoitus: Terveyspalvelututkimus
  • Jako: Satunnaistettu
  • Inventiomalli: Rinnakkaistehtävä
  • Naamiointi: Ei mitään (avoin tarra)

Aseet ja interventiot

Osallistujaryhmä / Arm
Interventio / Hoito
Kokeellinen: Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
Muut: 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.
Active Comparator: 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.
Muut: Care as usual
Providers in primary care clinics will deliver care as usual to their patients.

Mitä tutkimuksessa mitataan?

Ensisijaiset tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Use of eConsults
Aikaikkuna: 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

Toissijaiset tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Frequency of specialist consultation
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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

Muut tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Emergency department use, 1 month
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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
Aikaikkuna: 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

Yhteistyökumppanit ja tutkijat

Täältä löydät tähän tutkimukseen osallistuvat ihmiset ja organisaatiot.

Sponsori

University of Minnesota

Yhteistyökumppanit

Allina Health System

Tutkijat

  • Päätutkija: Ezra Golberstein, Ph.D., University of Minnesota

Opintojen ennätyspäivät

Nämä päivämäärät seuraavat ClinicalTrials.gov-sivustolle lähetettyjen tutkimustietueiden ja yhteenvetojen edistymistä. National Library of Medicine (NLM) tarkistaa tutkimustiedot ja raportoidut tulokset varmistaakseen, että ne täyttävät tietyt laadunvalvontastandardit, ennen kuin ne julkaistaan ​​julkisella verkkosivustolla.

Opi tärkeimmät päivämäärät

Opiskelun aloitus

Lauantai 1. elokuuta 2015

Ensisijainen valmistuminen (Todellinen)

Sunnuntai 1. tammikuuta 2017

Opintojen valmistuminen (Todellinen)

Keskiviikko 1. maaliskuuta 2017

Opintoihin ilmoittautumispäivät

Ensimmäinen lähetetty

Perjantai 14. elokuuta 2015

Ensimmäinen toimitettu, joka täytti QC-kriteerit

Tiistai 18. elokuuta 2015

Ensimmäinen Lähetetty (Arvio)

Keskiviikko 19. elokuuta 2015

Tutkimustietojen päivitykset

Viimeisin päivitys julkaistu (Todellinen)

Perjantai 1. marraskuuta 2019

Viimeisin lähetetty päivitys, joka täytti QC-kriteerit

Keskiviikko 30. lokakuuta 2019

Viimeksi vahvistettu

Tiistai 1. lokakuuta 2019

Lisää tietoa

Tähän tutkimukseen liittyvät termit

Muita asiaankuuluvia MeSH-ehtoja

Muut tutkimustunnusnumerot

  • 1507S76668

Nämä tiedot haettiin suoraan verkkosivustolta clinicaltrials.gov ilman muutoksia. Jos sinulla on pyyntöjä muuttaa, poistaa tai päivittää tutkimustietojasi, ota yhteyttä register@clinicaltrials.gov. Heti kun muutos on otettu käyttöön osoitteessa clinicaltrials.gov, se päivitetään automaattisesti myös verkkosivustollemme .

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