Clinical and Policy Implications of a Statewide Emergency Telepsychiatry Program

描述（由申请人提供）：在美国，精神障碍患者在急诊科（ED）就诊中占很大比例，而且比例在不断增长。由于急诊科的地理分布广泛，远程医疗特别有望增加获得精神卫生保健的机会并改善其结果。然而，几乎没有现有的研究审查了远程精神病学服务作为治疗急诊科精神健康消费者的一种手段的潜力。目前尚不清楚各州是否或如何考虑将这些项目作为一种策略，以接触到这一高度脆弱的人群。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”，旨在改善对在全州急诊室就诊的人的护理。该方案将实行精神科医生向医院急诊科提供24小时咨询的远程精神科咨询制度。该计划将在两年的时间内推广到该州的所有急诊室。该应用程序建议建立在南卡罗来纳州心理健康部门和埃默里大学之间的伙伴关系的基础上，以严格研究这项新举措的有效性、普遍性和财务可持续性。将通过比较急诊科就诊后精神疾病患者获得护理的机会和质量与一组匹配的对照来研究有效性。将通过检查PBHES项目影响的个人、ED和社区级主持人来评估普遍性。财务可持续性将从多个国家的角度使用预算影响分析进行检查。

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.