Novel Use of Mobile Integrated Emergency Medical Services to Improve Outcomes of Mental Health Emergencies

 描述（由申请人提供）：急诊科（艾德）因严重精神疾病（SMI）患者经历急性精神健康危机而不堪重负。自2007年以来，艾德就诊人数从每年9500万增加到每年1.4亿多，与原发性精神健康障碍相关的艾德就诊比例增加了18%，超过了所有其他艾德诊断的增长速度。1此外，对处于危机中的SMI患者的基于ED的护理效率低、成本高、质量差。北卡罗来纳州SMI患者的平均艾德住院时间为62小时（比典型的艾德患者长15倍以上），其特征是过度使用约束、不成比例的镇静抗精神病药物注射、高住院率和失控的成本。2，3迫切需要确定和测试更好地满足SMI患者需求的替代危机干预策略 与护理资源，并减少对ED的负担。 院前急救医疗服务（EMS）是一种很有前途的机制，通过快速、安全地将处于危机中的适当SMI患者转移到替代治疗机构，减少艾德的使用，改善患者护理。4最近，北卡罗来纳州威克县的EMS（人口130万）实施了一项大型试点干预措施，将经历行为健康危机的9-1-1患者转移到专门的危机中心 和评估服务单位位于附近的社区精神卫生中心自2013年以来，这一新颖的试点EMS项目已经评估了1,000多名处于危机中的患者，其中50%的患者被从ED转移。尽管EMS-转移的使用已经远远超过了我们对其安全性、可接受性和有效性的科学理解。维克县的这个大型创新试点项目提供了一个独特的机会，可以科学地评估干预措施，并为未来的大规模EMS干预急性精神健康危机服务研究做好准备。 这项R34申请要求两年的资金，以评估急性精神健康危机患者的试点EMS干预计划，包括干预的安全性，可接受性和初步疗效。这些发现将大大推进EMS干预急性精神疾病的科学，并使我们和其他研究人员能够对这种新的护理方法进行未来更大规模的研究。通过增加EMS和社区危机护理整合的证据基础，本研究将促进循证实践的采用和传播，以加强对重度精神障碍患者的急性危机治疗。此类计划的成功更广泛实施可以显着改善对患有急性心理健康危机的患者的护理并减少艾德的数量，进一步增强我们研究议程的广泛公共卫生意义。1

 DESCRIPTION (provided by applicant): Emergency departments (ED) are overburdened with patients with serious mental illness (SMI) experiencing acute mental health crises. Since 2007, the number of ED visits has increased from 95 million to over 140 million annually and the percentage of ED visits related to a primary mental health disorder has increased by 18%, outpacing the growth among all other ED diagnoses.1 Furthermore, the ED-based care of patients with SMI in crisis is inefficient, costly, and of poor quality. The average ED length of stay for a patient in North Carolina with SMI is 62 hours (over 15 times longer than the typical ED patient) and characterized by excessive use of restraints, disproportionate sedating anti-psychotic injections, high hospitalization rates, and runaway costs.2,3 There is an urgent need to identify and test alternative crisis intervention strategies that better match SMI patient needs with care resources and that reduce the burden on EDs. Prehospital emergency medical services (EMS) is a promising mechanism to reduce ED use and improve patient care by rapidly and safely diverting appropriate SMI patients in crisis to alternative treatment settings.4 Recently, EMS in Wake County, NC (population 1.3 million) implemented a large, pilot intervention to divert 9-1-1 patients experiencing a behavioral health crisis to a dedicated crisis and assessment services unit located within a nearby community mental health center (WakeBrook) instead of the ED.5,6 Since 2013, this novel, pilot EMS program has evaluated over 1,000 patients in crisis, 50% of whom were diverted away from the ED. Other communities have begun experimenting with similar programs, although the use of EMS- diversion has far outpaced our scientific understanding of its safety, acceptability, and effectiveness. This large, innovative pilot program in Wake County provides a unique opportunity to scientifically evaluate the intervention and prepare for a future, large-scale services study of EMS intervention in acute mental health crises. This R34 application requests two years of funding to evaluate this pilot EMS intervention program for patients with acute mental health crises, including the intervention's safety, acceptability, and preliminary efficacy. These findings will significantly advance the science of EMS interventions for acute mental illness and enable us, and other investigators, to undertake future, larger-scale studies of this novel care approach. By growing the evidence-base for the integration of EMS and community-based crisis care, this research will promote the adoption and dissemination of evidence-based practices to enhance acute crisis treatment for persons with SMI. Successful broader implementation of such programs could significantly improve the care of patients with acute mental health crises and reduce ED volumes, further enhancing the broad public health significance of our research agenda. 1