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Engaging patients with mental disorders from emergency departments into outpatient care: a comparative effectiveness workforce study
Investigator (PI): Druss, Benjamin G
Performing Organization (PO): (Current): Emory University, Rollins School of Public Health, Department of Health Policy and Management / (404) 727-3956
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2021
Record Source/Award ID: PCORI/IHS-1510-32431
Funding: Total Award Amount: $2,506,623
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Comparing Two Ways to Help Patients with Mental Illness Transition from the Emergency Department to Outpatient Care--the EPIC Study. This research project is in progress. PCORI will post the research findings on this page (the PCORI website) within 90 days after the results are final. What is the research about? Many patients with mental illness seek treatment in the emergency department (ED). Professional care managers help patients with mental illness use outpatient services and achieve their long-term recovery plans. They can also help patients solve problems that keep them from getting outpatient care. Peer care managers, who have a history of mental illness but are in recovery, may be able to help patients use these services as well. In this study, the research team is comparing how often patients use mental health care outside the ED when working with peer versus professional care managers. Who can this research help? Findings from this study may help hospital administrators decide whether peer care managers can offer the same help for patients with mental illness as professional care managers do. What is the research team doing? The research team is recruiting 1,000 adults who have received care for a mental health disorder in one of eight EDs in South Carolina. Each of the EDs has one professional care manager who is a social worker or a nurse and one peer care manager. The team is assigning patients by chance to work with either the professional or the peer care manager. The research team is providing extra training for both peer and professional care managers to help patients identify barriers to getting outpatient care, learn their treatment options, and use outpatient services. Care managers meet with each patient during the patient's ED visit. They then meet regularly with each patient after discharge from the ED to help patients use outpatient services. The research team is comparing how often patients with each type of care manager get outpatient care after they leave the ED. The team is interviewing patients at the beginning of the study and 6 and 12 months after leaving the ED to follow up on patients' physical and mental health, alcohol and drug use, experiences with the recovery process, and barriers to getting care. Patients, health care providers, and South Carolina's mental health and Medicaid agencies help plan and conduct the study. Research methods at a glance. Design: The study design is a randomized controlled trial. Population: The study population is English-speaking adults ages 18 and older admitted to 1 of 8 emergency departments in South Carolina for a primary diagnosis of a mental disorder. Interventions/comparators are (a) care management by a professional care manager and (b) care management by a peer care manager. Outcomes: Outcomes are (a) primary: patients' outpatient treatment after ED discharge; and (b) secondary: proportion of scheduled outpatient visits attended, Patient-Reported Outcomes Measurement Information System (PROMIS[R]) measures of physical and mental health, alcohol and drug use, and social functioning, recovery assessment, and barriers to care. Timeframe: The timeframe is 30-day follow-up for primary outcome.
Abstract Archived: Patients with mental disorders are high users of emergency department (ED) services; however, after discharge, fewer than half of these patients successfully transition to outpatient care, and they suffer from high rates of ED readmission. Programs that allow patients with mental disorders to successfully engage with outpatient care hold the potential to improve quality and care outcomes, while increasing ED capacity to provide care for other urgent needs. Care management programs could address transitions of care in people with mental illness after ED discharge; however, it has been difficult to disseminate these models more broadly. One reason for this challenge has been a shortage of mental health professionals who can serve in these roles. There is now an opportunity to improve care and fill these gaps with a new provider group: certified peer specialists. These individuals have a history of mental illness and offer services to other individuals with mental disorders. This study will be the first to examine the potential benefits and trade-offs between certified peer specialists and professionals in managing care transitions for patients with mental disorders after ED discharge. The proposed study is a randomized study to compare the outcomes of care management delivered by peer specialists versus professionals. We will use a care management intervention, developed by the team, that has been demonstrated to improve quality and outcomes of care in patients with mental disorders. The study will examine differences across the two provider groups in how well patients engage with care, as well as mental health outcomes between the two treatment conditions. The study will be conducted at eight EDs in South Carolina; each site will have one professional care manager (i.e., social worker or nurse) and one peer care manager. At each site, 125 eligible subjects will be randomized to a one-year treatment engagement intervention with either a peer or professional care manager, resulting in a total of 1,000 participants. All care managers will deliver a manualized, evidence-based care management program that has been demonstrated to improve quality and outcomes of care in patients with mental illnesses. The findings will help patients, providers, and policy makers understand the benefits and trade-offs of using these two types of providers to facilitate care transitions in patients with mental illnesses; will inform the use of lay navigators for other health conditions; and will identify opportunities for cross-training and multidisciplinary teams that combine peer specialists and professionals.

MeSH Terms:
  • Case Management
  • Comparative Effectiveness Research
  • Continuity of Patient Care
  • Emergency Service, Hospital
  • Evidence-Based Medicine
  • Health Policy
  • Humans
  • Mental Disorders /*therapy
  • Mental Health Services /*organization & administration
  • Multicenter Studies as Topic
  • Outcome Assessment, Health Care
  • Outpatients
  • Peer Group
  • Quality of Health Care
  • Randomized Controlled Trials as Topic
  • South Carolina
Country: United States
State: Georgia
Zip Code: 30322
UI: 20164081
CTgovId: NCT02989805
Project Status: Ongoing
Record History: ('2020: Project shortened from 2023 to 2021, and 2020: Abstract archived to Abstract Archived 1 field and added new abstract. \n2018: Project extended to 2023. 2017: Project extended to 2022.',)