Quality, Economic Outcomes and Sustainability of Telepsychiatry (QUEST)

描述(由申请人提供)：精神和药物使用障碍患者在美国急诊科就诊中占很大比例，而且比例不断上升。急诊室往往缺乏在急诊室提供行为保健工作人员的能力，这表明通过远程医疗集中提供这些服务可能会提高效率并增加获得护理的机会。然而，人们对这种方法在ED环境中提供行为服务的结果和成本知之甚少。从2009年开始，南卡罗来纳州精神卫生局制定并开始实施一项全州范围的计划，根据该计划，精神病学家通过高速互联网视频连接为医院急诊科提供全天候咨询。关于这种护理提供模式的服务利用的初步数据表明，在减少急诊住院时间、住院时间和总成本以及提高门诊精神健康随访率方面，临床上具有实质性和统计学意义上的显著好处。研究结果表明，有必要对这一方法的质量、成本和长期可持续性进行严格评估。为该计划提供资金，评估将于2012年结束。这项申请建议对这种方法进行严格的经济分析，以重组急诊室环境中行为护理的交付。分析将利用南卡罗来纳州全面的健康数据仓库，这是一个独特的、所有付款人的数据集，使其能够全面跟踪行为健康、健康和社会服务系统中个人的治疗接触者。数据将与南卡罗来纳州其他急诊室的患者进行比较，并使用医疗补助索赔数据，与来自南方四个相邻州的患者进行比较。将通过审查干预者的电子记录和对参与该计划的急诊室进行组织调查来丰富数据集。这项研究将使用计量经济学方法提供关于这种方法的成本、质量和可持续性的数据，这些方法可以提供这些影响的可信的因果估计，以确定是否应该在全国范围内推广这种组织模式。

DESCRIPTION (provided by applicant): Persons with mental and substance use disorders account for a substantial and growing portion of Emergency Department (ED) visits in the United States. EDs frequently lack the capacity to provide behavioral health staff in EDs, pointing to the potential efficiencies and increased access to care that could be provided via centralized delivery of these services via telemedicine. However, little is known about the outcomes and costs of this approach for delivering behavioral services in ED settings. Beginning in 2009, the South Carolina Department of Mental Health developed and began implementing a statewide program under which psychiatrists are providing around-the- clock coverage for consultation with hospital emergency departments via high speed internet video connections. Preliminary data on service utilization for this model of care delivery indicate clinically substantial and statistically significant benefits on reducing length of ED stay, hospitalization, and total costs, and increasing rates of outpatient mental health follow-up. The findings point to a need for a rigorous assessment of quality, costs, and long-term sustainability of this approach. Grant funding for the program and the evaluation will end in 2012. This application proposes to conduct a rigorous economic analysis of this approach to restructuring delivery of behavioral care in ER settings. Analyses will draw on South Carolina's comprehensive health data warehouse, a unique, all-payer dataset that makes it possible to comprehensively track treatment contacts for individuals across the behavioral health, health, and social service systems. Data will be compared with patients from other EDs in South Carolina and, using Medicaid claims data, from four adjacent Southern states. The dataset will be enriched through reviews of electronic records from the interventionists and from an organizational survey of emergency rooms participating in the program. The study will provide data on cost, quality, and sustainability of this approach using econometric methods that can provide plausibly causal estimates of these impacts, to determine whether this organizational model should be scaled nationally.