Comparison of Asynchronous Telepsychiatry Alongside Synchronous Telepsychiatry in Skilled Nursing Facilities (CATALYST)

熟练工人异步远程精神治疗与同步远程精神治疗的比较 护理设施（CATeleST） 摘要 获得精神科咨询是专业护理机构（SNF）的一个关键问题， 在农村地区。该SNF研究人群是AHRQ优先人群，包括以下患者 慢性病护理需求和临终医疗保健，并满足健康人2020年的关键主题， 老年痴呆症和情绪障碍。医疗保险和医疗补助服务中心 (CMS)认识到这一问题，并为农村地区的同步远程精神治疗（STP）提供补偿。 但不是在大都市地区。许多机构难以获得精神科医生， 有几家公司已与我们的卫生系统签订合同，提供STP服务。尽管有 STP，由于行政障碍而未得到充分利用。 异步远程精神病学（ATP）利用通过加密传输和存储的记录视频， 数据门户网站，并允许更及时和灵活地提供高质量的精神病学 诊症计算ATP更以患者为中心，因为护理机构的工作人员和家庭成员 积极参与访谈和录像过程。通过解决精神病问题 在需要急诊或住院治疗之前， 可以提高医疗质量（AHRQ优先级#1）和SNF居民的生活质量2015年，我们 获得了内部资助并设计了研究方案（经加州大学戴维斯分校IRB批准）， 使我们能够完成一项试点研究，以测试在SNF中使用ATP的方法和可行性， 这次审判我们已在两个SNF成功完成20项ATP和20项STP基线评估 网站.我们发现ATP和STP都能减少不适当的抗精神病药物的使用 使用，从而提高患者安全性（AHRQ优先级#2）。 由于我们已经成功试行了在SNF中比较ATP与STP所需的程序 人群中，我们现在计划进行一项ATP与STP（n=250）的大规模比较研究， 为了检验我们的假设，即ATP在临床上与STP一样有效，但更容易获得， 行政上简单，成本效益高。我们计划与6个SNF合作， 在这项为期5年的研究中，参与者总共参加了12个月。 1

Comparison of Asynchronous Telepsychiatry vs. Synchronous Telepsychiatry in Skilled Nursing Facilities (CATeleST) ABSTRACT Access to psychiatric consultation is a critical problem in Skilled Nursing Facilities (SNFs), especially in rural settings. This SNF study population is an AHRQ priority population including people with chronic care needs and end-of-life healthcare, and also meets the Healthy People 2020 key topics of dementia and mood disorders in older adults. The Center for Medicare and Medicaid Services (CMS) recognizes this problem and reimburses for Synchronous Telepsychiatry (STP) in rural settings, but not in metropolitan regions. Many facilities struggle with access to psychiatrists and several have contracted with our health system to provide STP services. Despite the availability of STP, it is underutilized due to administrative barriers. Asynchronous Telepsychiatry (ATP) utilizes recorded video transmitted and stored through encrypted data portals and allows for a more timely and flexible delivery of high-quality psychiatric consultations. ATP is more patient-centered because nursing facility staff and family members participate actively in the interviewing and video-recording processes. By addressing psychiatric symptoms that would otherwise be untreated until emergency or inpatient treatment is needed, ATP may improve health care quality (AHRQ Priority #1) and SNF residents' quality-of-life In 2015, we obtained an internal grant and designed study protocols (approved by the UC Davis IRB) that have allowed us to complete a pilot study to test the methodology and feasibility of using ATP in SNFs for this trial. We have successfully completed 20 ATP and 20 STP baseline evaluations at two SNF sites. We found both ATP and STP lead to reductions of inappropriate antipsychotic medication usage and therefore improved patient safety (AHRQ Priority #2). As we have successfully piloted the procedures necessary to compare ATP vs. STP in SNF populations, we now plan to conduct a large scale comparative study of ATP vs. STP (n=250) in order to test our hypothesis that ATP is as clinically effective as STP but is more accessible, administratively simple and cost-effective. We plan to collaborate with 6 SNFs and follow each participant for a total of 12 months in this 5 year study. 1