Clinical and Policy Implications of a Statewide Emergency Telepsychiatry Program

描述（由申请人提供）：在美国，精神障碍患者占急诊科（艾德）就诊人数的很大一部分，而且比例还在不断增长。由于ED的广泛地理分布，远程医疗特别有希望增加获得和改善精神卫生保健的结果。然而，几乎没有现有的研究已经审查了远程精神病学服务的潜力，作为一种手段，治疗精神健康消费者看到在急诊科。目前尚不清楚各州是否或如何考虑将这些方案作为帮助这一高度弱势群体的战略。 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”，旨在改善全州急诊科就诊人员的护理。该计划将实施一个远程精神病学咨询系统，精神病医生将为医院急诊部门提供24小时咨询服务。该计划将在两年内推广到该州的所有急诊室。该申请建议建立在南卡罗来纳州精神卫生部和埃默里大学之间的伙伴关系，严格研究这一新举措的有效性，普遍性和财务可持续性。将通过比较精神疾病患者在急诊科就诊后与一组匹配对照组的护理机会和质量来研究有效性。 将通过检查个人，艾德，和PBHES计划的影响社区一级主持人的泛化能力进行评估。将从多个国家的角度，利用预算影响分析来审查财政可持续性。 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，使其能够全面跟踪个人在心理健康，健康和社会服务系统的治疗联系人。其他分析将比较南卡罗来纳州ED与格鲁吉亚匹配ED的结局，以说明PBHES计划在未参与ED中的潜在污染、该州内其他未测量的变化和删失效应。

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.