Clinical Services

Facilitated Roundtable Discussion

CS1-14 - Behavioral Health - Virtual Patient Navigation, Results from a Pragmatic Research Trial

Tuesday, May 1
11:35 AM - 12:00 PM
Location: Education Zone, Booth 2416, Zone 1

The number of patients presenting to emergency departments (ED) in the need of psychiatric care, continues to increase. With outpatient behavioral health resources and funding on the decline, oftentimes the attending ED physician must decide to admit a patient in lieu of discharge due to the lack of outpatient resources or the perceived inability of a patient to navigate a complex system. As a part of usual care, Carolinas HealthCare System currently offers 21 of its EDs 24-7 virtual access to licensed clinicians and psychiatrists who provide psychiatric evaluations and recommend dispositions (telepsychiatry). From a partnership with the Center for Medicaid and Medicare we developed and are evaluating a Behavioral Health - Virtual Patient Navigation program (BH-VPN), which provides short-term follow up navigation to patients receiving usual care. A patient navigator connects with the patient virtually prior to leaving the ED and then communicates during regularly scheduled calls and assists as needed in obtaining services or overcoming any barriers to treatment, for up to 45 days post ED discharge.

We designed a pragmatic, randomized research evaluation among patients in behavioral health crisis who present to an ED and receive a telepsychiatric consult. We describe team composition, design of the BH-VPN service, and enrollment status. The results herein focus on the effect this initiative has on the conversion from ED discharge to hospital admission.

Available evidence suggests that adoption and utilization of virtual care in tandem with wrap-around services may reduce utilization and improve health outcomes. However, variations in study designs limit our ability to draw definitive conclusions. By integrating virtual patient navigation into the existing telepsychiatry program, we expect to decrease the number of patients admitted for inpatient psychiatric treatment from the ED. The methods and results described here provide a template for conducting research to improve outcomes among behavioral health patients that present to an emergency department.

Learning Objectives:

Jason Roberge

Data Scientist
Carolinas HealthCare System

Dr. Roberge received his PhD from the University of Arizona in Epidemiology. During his time at the UofA, Dr. Roberge focused heavily on statistics and the quantitative aspects of Epidemiology. He has spent most of his academic career evaluating water quality. He designed and managed a binational case control study examining arsenic in drinking water. He has worked at Carolinas HealthCare System for 5 years and now works within the Center for Outcomes Research and Evaluation. He recently completed work on the study: Aiming to Improve Readmissions Through InteGrated Hospital Transitions (AIRTIGHT). This was a pragmatic trial assessing the relationship between 30-day readmissions and focused care for high risk patients. His current role focuses on 2 HIIN initiatives, both aimed at reducing utilization and readmissions. Acting as co-principal investigator, one initiative focuses on the care provided to COPD patients while the other initiative focuses on care provided to behavior health patients seen in the ED.


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Wayne Sparks

Physician - MD
Carolinas HealthCare System

Dr. Wayne Sparks completed his undergraduate education at Duke University with B.S. degrees in Zoology and Psychology, and his M.D. at Wake Forest University School of Medicine. He also completed his Psychiatric Residency at Wake Forest Baptist Medical Center. He joined Carolinas HealthCare System in 1997 at the start of one of the nation’s few 24-hour Psychiatric Emergency Departments staffed with Board Certified Psychiatrists. He also served as the Medical Director of the Psychiatric ED from 2001 – 2017.

Dr. Sparks has been doing Telepsychiatry since 1997, which started as a coverage system for one CHS facility’s solo psychiatrist. He has been Medical Director of Telepsychiatry since 2001 and has been integral in the implementation, growth, and management of the delivery of virtual psychiatric care for patients in 21 Medical ED’s and Inpatient Medical Units across the Carolinas HealthCare System. Dr. Sparks is the Regional Medical Director for the Behavioral Health Service Line of Carolinas HealthCare System and is currently the Chief of the Department of Psychiatry of Carolinas Medical Center.


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Christine Zazzaro

Assistant Vice President, Behavioral Health Access
Carolinas HealthCare System

Ms. Zazzaro received her undergraduate and graduate degrees from The University of South Carolina. She has worked in the fields of Mental Health and Substance abuse for over 24 years. As the AVP of Behavioral Health Access she is responsible for the strategic planning and expansion of Carolinas HealthCare System’s Telepsychiatry program, behavioral health centralized patient placement program and behavioral health contract management. Under her direction, the program has grown to provide virtual consultations for patients in 22 Acute Care Emergency Rooms and multiple inpatient units as well as broadening the scope of virtual psychiatric care to include centralized patient placement, virtual patient navigation, and private, secure transportation for behavioral health patients who need hospitalization.


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CS1-14 - Behavioral Health - Virtual Patient Navigation, Results from a Pragmatic Research Trial

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