Project Summary
The cost of serious mental illness (SMI) in the United States is $317 billion annually. This translates to more than $1,000 for every man, women, and child in the United States. Hospitalization and Emergency Room (ER) visits have the highest costs. Outpatient services are overburdened. There is a push to get people out of hospitals quickly, while they are still quite ill. These factors cause patients to be lost in the transition from inpatient to outpatient care. Many individuals are repeatedly rehospitalized or continue to clog emergency rooms in an attempt to receive care. The importance of transitional care between inpatient/ER facilities and outpatient services to prevent this revolving door phenomenon has been continually stressed. There is little research on the best way to accomplish smooth transition to outpatient care. We developed a 90-day transitional care clinic (TCC) to address this need.
We propose a randomized treatment outcome study comparing two transitional service packages within our TCC: a Standard Care package versus an Engagement-Focused package that features a novel intake procedure and a Shared Decision-Making intervention. Access Group is an intake procedure designed to address many of the problems of traditional approaches to post-acute treatment engagement, including failure of patients to reach intake appointments. Shared Decision-Making (SDM) is a structured approach to provider-patient communication that has been shown to increase patient involvement in care and improve outcomes. Despite SMI patients’ desire to be more involved in their treatment decisions and promising early evidence of SDM’s effectiveness in SMI, SDM has not been systematically evaluated in transitional psychiatric care. In the proposed study, patients referred to TCC will be randomized to either Engagement-Focused Care or Standard Care.
The relative benefit of these two approaches will be evaluated in 300 individuals who will be randomized to these two treatments in a 2:1 ratio. We will examine attendance at intake and subsequent appointments at the TCC as well as their initial appointment once referred for long-term services in the community. We will examine reported satisfaction and shared decision making as well as quality of life in the two treatments. Results will be important in addressing the public health problem of rehospitalization in mental health. The new treatment package is designed to get individuals into treatment quickly and to teach them how to be good consumers of mental health treatments going forward.
Velligan DI, Roberts DL, Sierra C, Fredrick MM, Roach MJ. What Patients With Severe Mental Illness Transitioning From Hospital to Community Have to Say About Care and Shared Decision-Making. Issues Ment Health Nurs. 2016 Apr 7:1-6. [Epub ahead of print] PubMed PMID: 27054268.
Velligan DI, Roberts DL, Martinez M et al., Following AACP Guidelines for Transitions in Care: The Transitional Care Clinic. Psychiatric Services (November 2015).
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