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

技巧型与同步型与异步型心电疗法比较 护理设施(CATeleST) 摘要 在熟练护理设施(SNF)中，获得精神咨询是一个关键问题，尤其是 在农村环境中。该SNF研究人群是AHRQ优先人群，包括患有 慢性护理需求和临终关怀，也满足了2020年健康人的关键主题 老年人的痴呆症和情绪障碍。医疗保险和医疗补助服务中心 (CMS)认识到这一问题，并在农村报销同步心灵感应(STP) 环境，但不是在大都市地区。许多设施都很难找到精神科医生和 有几个已经与我们的卫生系统签订了合同，提供STP服务。尽管有可用的 STP，由于行政障碍，它没有得到充分利用。 异步遥信(ATP)利用记录的视频通过加密的方式传输和存储 数据门户，并允许更及时、更灵活地提供高质量的精神疾病 磋商。ATP更以患者为中心，因为护理机构的工作人员和家庭成员 积极参与采访和录像过程。通过解决精神病患者 在需要紧急或住院治疗之前不会治疗的症状， 可以在2015年改善医疗质量(AHRQ优先事项1)和SNF居民的生活质量，我们 获得了内部拨款并设计了研究方案(由加州大学戴维斯分校IRB批准)， 使我们完成了一项试点研究，以测试在SNF中使用ATP的方法和可行性 这场审判。我们已经在两个SNF成功完成了20个ATP和20个STP基线评估 网站。我们发现三磷酸腺苷和三磷酸腺苷都会导致不适当的抗精神病药物的减少。 使用，因此改善了患者的安全性(AHRQ优先事项2)。 因为我们已经成功地试行了在SNF中比较ATP和STP所需的程序 ，我们现在计划对ATP和STP(n=250)进行一项大规模的比较研究 为了验证我们的假设，即ATP在临床上与STP一样有效，但更容易获得， 管理简单，成本效益高。我们计划与6个SNF合作，并遵循每个 在这项为期5年的研究中，参与者总共为期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