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Psychiatr Serv. 2015 Nov;66(11):1167-72. doi: 10.1176/appi.ps.201400122. Epub 2015 Jul 1.

Impact of a Telepsychiatry Program at Emergency Departments Statewide on the Quality, Utilization, and Costs of Mental Health Services.

Author information

1
Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.

Abstract

OBJECTIVE:

This study estimated the impact of a statewide, centralized telepsychiatry service provided in nonpsychiatric emergency departments (EDs) on use of mental health services.

METHODS:

Individuals treated via telepsychiatry were compared with a matched control group of individuals with mental health diagnoses who were treated in nonparticipating hospitals. Bivariate and two-part and generalized linear regression models were used to assess differences between the two groups in outpatient follow-up, hospital admission following the ED visit, length of hospital stay if admitted, and inpatient and total costs.

RESULTS:

Between March 2009 and June 2013, there were 9,066 patients with at least one telepsychiatry visit. Of these, 7,261 had index telepsychiatry visits that the authors were able to successfully match. Compared with the matched control group, telepsychiatry recipients were more likely to receive 30-day outpatient follow-up (46% versus 16%, p<.001) and 90-day outpatient follow-up (54% versus 20%, p<.001). Telepsychiatry recipients were less likely than the control group to be admitted to the hospital during the index ED visit (11% versus 22%, p<.001). The combined effect of having a telepsychiatry consult during the index ED visit was a reduction of .86 days in inpatient length of stay. Thirty-day inpatient costs were $2,336 (p=.04) lower for the telepsychiatry versus the control group, but 30-day total health care costs were not statistically different.

CONCLUSIONS:

Telepsychiatry delivered in the ED through a centralized coordinated program has great promise for improving linkage with outpatient mental health services while reducing inpatient utilization and hospital costs.

PMID:
26129992
PMCID:
PMC4699583
DOI:
10.1176/appi.ps.201400122
[Indexed for MEDLINE]
Free PMC Article

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