Clinical and Policy Implications of a Statewide Emergency Telepsychiatry Program

描述(由申请人提供)：精神障碍患者在美国急诊科就诊中占很大比例，而且比例还在不断增长。由于急救药物的广泛地理分布，远程医疗在增加获得精神卫生保健的机会和改善结果方面具有特别的前景。然而，几乎没有现有的研究考察了心灵感应服务作为治疗急诊科心理健康患者的一种手段的潜力。目前尚不清楚各州是否或如何考虑采用这些计划，作为接触这些高度脆弱人群的战略。2008年8月，南卡罗来纳州将开始实施一项雄心勃勃的计划，名为行为健康紧急服务伙伴(PBHES)，旨在改善全州急诊科患者的护理。该计划将实施精神分裂症会诊制度，精神科医生将为医院急诊科提供全天候咨询。该计划将在两年内在该州所有急诊室推出。这项申请建议建立在南卡罗来纳州精神卫生部门和埃默里大学之间的合作伙伴关系上，以严格研究这一新倡议的有效性、普适性和财务可持续性。将通过比较精神疾病患者在急诊科就诊后获得的机会和护理质量与一组匹配的对照组来研究有效性。普适性将通过检查个人、教育部门和社区层面的PBHES计划影响主持人进行评估。财政可持续性将使用从多个国家角度进行的预算影响分析进行审查。 分析将利用南卡罗来纳州的数据仓库，这是一个独特的、全面的、所有付款人的数据集，使其能够全面跟踪心理健康、健康和社会服务系统中个人的治疗接触者。其他分析将比较南卡罗来纳州的EDS和佐治亚州匹配的EDS的结果，以考虑未参与EDS的PBHES计划的潜在污染、州内其他未测量的变化以及审查影响。

DESCRIPTION (provided by applicant): Persons with mental disorders account for a large and growing portion of Emergency Department (ED) visits in the United States. Because of the wide geographic distribution of EDs, telemedicine holds particular promise for increasing access and improving outcomes of mental health care. However, almost no existing research has examined the potential of telepsychiatry services as a means of treating mental health consumers seen in emergency departments. It is not clear if, or how, states might consider adopting these programs as a strategy for reaching this highly vulnerable population. In August 2008, South Carolina will begin implementing an ambitious plan titled, Partners in Behavioral Health Emergency Services (PBHES), designed to improve care for persons seen in its Emergency Departments statewide. The plan will implement a telepsychiatry consultation system in which psychiatrists will provide around-the-clock coverage for consultation with hospital emergency departments. The program will be rolled out to all emergency rooms in the State over a two-year period. This application proposes to build on a partnership between the South Carolina Department of Mental Health and Emory University to rigorously study the effectiveness, generalizability, and financial sustainability of this new initiative. Effectiveness will be studied by comparing access and quality of care for persons with mental illness following an emergency department visit to a set of matched controls. Generalizability will be assessed by examining the individual, the ED, and community-level moderators of the PBHES program's impact. Financial sustainability will be examined using a budget impact analysis from multiple state perspectives. Analyses will draw upon South Carolina's Data Warehouse, a unique, comprehensive, all-payer dataset that makes it possible to comprehensively track treatment contacts for individuals across the mental health, health, and social service systems. Additional analyses will compare outcomes for EDs in South Carolina to matched EDs in Georgia in order to account for potential contamination of the PBHES program in nonparticipating EDs, other unmeasured changes within the state, and censoring effects.