Quality, Economic Outcomes and Sustainability of Telepsychiatry (QUEST)

描述（由申请人提供）：在美国，精神和物质使用障碍患者占急诊科（艾德）就诊人数的很大一部分，且比例不断增长。急诊室经常缺乏提供行为健康人员的能力，这表明通过远程医疗集中提供这些服务可以提高潜在的效率和增加获得护理的机会。然而，很少有人知道这种方法的结果和成本提供行为服务的艾德设置。从2009年开始，南卡罗来纳州精神卫生部制定并开始实施一项全州范围的计划，根据该计划，精神科医生通过高速互联网视频连接为医院急诊科提供全天候的咨询服务。关于这种护理模式的服务利用的初步数据表明，在减少艾德住院时间、住院时间和总费用以及增加门诊心理健康随访率方面，具有临床实质性和统计学显著性的益处。调查结果表明，需要对这种方法的质量、成本和长期可持续性进行严格评估。该项目的赠款和评估将于2012年结束。本申请建议对这种方法进行严格的经济分析，以重组ER环境中行为护理的提供。分析将利用南卡罗来纳州的综合健康数据仓库，这是一个独特的所有付款人数据集，可以全面跟踪行为健康，健康和社会服务系统中个人的治疗联系人。数据将与来自南卡罗来纳州其他急诊室的患者进行比较，并使用医疗补助索赔数据，来自四个相邻的南方州。该数据集将通过审查来自介入医生的电子记录和参与该计划的急诊室的组织调查来丰富。该研究将使用计量经济学方法提供关于这种方法的成本，质量和可持续性的数据，这些方法可以提供这些影响的合理因果估计，以确定这种组织模式是否应该在全国范围内推广。 公共卫生相关性：许多急诊科缺乏充分治疗精神和物质使用障碍患者的能力，导致质量差、成本升高和不良后果。这项研究将提供严格和及时的数据，一个创新的和潜在的变革性的方法，以重组护理在急诊科，可作为一个模式，为其他国家和艾德设施在全国各地。

DESCRIPTION (provided by applicant): Persons with mental and substance use disorders account for a substantial and growing portion of Emergency Department (ED) visits in the United States. EDs frequently lack the capacity to provide behavioral health staff in EDs, pointing to the potential efficiencies and increased access to care that could be provided via centralized delivery of these services via telemedicine. However, little is known about the outcomes and costs of this approach for delivering behavioral services in ED settings. Beginning in 2009, the South Carolina Department of Mental Health developed and began implementing a statewide program under which psychiatrists are providing around-the- clock coverage for consultation with hospital emergency departments via high speed internet video connections. Preliminary data on service utilization for this model of care delivery indicate clinically substantial and statistically significant benefits on reducing length of ED stay, hospitalization, and total costs, and increasing rates of outpatient mental health follow-up. The findings point to a need for a rigorous assessment of quality, costs, and long-term sustainability of this approach. Grant funding for the program and the evaluation will end in 2012. This application proposes to conduct a rigorous economic analysis of this approach to restructuring delivery of behavioral care in ER settings. Analyses will draw on South Carolina's comprehensive health data warehouse, a unique, all-payer dataset that makes it possible to comprehensively track treatment contacts for individuals across the behavioral health, health, and social service systems. Data will be compared with patients from other EDs in South Carolina and, using Medicaid claims data, from four adjacent Southern states. The dataset will be enriched through reviews of electronic records from the interventionists and from an organizational survey of emergency rooms participating in the program. The study will provide data on cost, quality, and sustainability of this approach using econometric methods that can provide plausibly causal estimates of these impacts, to determine whether this organizational model should be scaled nationally. PUBLIC HEALTH RELEVANCE: Many emergency departments lack capacity to adequately treat patients with mental and substance use disorders, resulting in poor quality, elevated costs, and adverse outcomes. This study will provide rigorous and timely data on an innovative and potentially transformative approach to reorganizing care in EDs that may serve as a model for other states and ED facilities around the country.