Oral Papers: Collaborative Care & Community C-L I
Introduction: Psychiatric consults have been available at our institution via telemedicine since 2014 and are used for hospitals in rural parts of the state with limited access to psychiatrists. Descriptive results of telepsychiatry consultation populations served have been previously reported in studies by both our institution and others that conduct telepsychiatry consults at medical hospitals; however, patient outcomes and comparison of telepsychiatry consults to in-person consults have not been examined.
Aims: This project aimed to track patient health outcomes associated with the telepsychiatry program at UPMC Horizon hospital, one telepsychiatry site for the psychiatry Consultation-Liaison (CL) service at UPMC. The secondary aim was to evaluate an established telemedicine consultation service as compared to an in-person service to ensure delivery of quality care.
Methods: Healthcare utilization metrics prior to a patient's telepsychiatry consult were compared to healthcare utilization after consult. Patient characteristics and outcomes including emergency department (ED) visits and inpatient and observation admissions were extracted from the electronic health record and were examined at 7, 30, 60 and 90 days before versus after the consult. We also compared these outcomes to a matched group of in-person psychiatric consults from two similarly-sized medical-surgical hospitals. Adjustments were made based on insurance, median income due to differences in baseline socieoeconomic status, intensive care unit (ICU) stay, index length of stay (LOS), skilled nursing facility (SNF) transfer, co-occurring psychiatric/medical disorders. Multivariable logistic regression models were used to adjust for group differences in outcomes.
Results: A total of 233 telepsychiatry consults (189 inpatients and 44 ED patients) were performed at Horizon between June 2016 & October 2017. Mood and anxiety disorders were the most common diagnoses. Inpatient utilization was significantly reduced in the 7 days post-discharge, when compared to the 7 days pre-admission (2.1% vs. 6.9%p=.020). ED visits were significantly decreased after the telepsychiatry consult compared to before within 7-days (4.2% vs. 11.1%; p=0.012) as well as at 30, 60, and 90 days (p< 0.001 at each interval). Comparisons of healthcare utilization between telepsychiatry and in-person consults indicated that patients with a telepsychiatry consult had reduced odds of future ED visits compared to inpatient consults at 7 days (p=0.037) and at all extended time-frames (p< 0.001 at each interval).
Conclusions: Patients seen by the psychiatry CL service via telepsychiatry were found to have lower rates of ED and inpatient utilization in the time periods post-consultation compared to pre-consultation. As this effect was not seen in our in-person sites, we hypothesize that the impact of telepsychiatry consultation in under-resourced, rural areas may be greater due to the limited access to care. The lower SES of the telepsychiatry consults compared to the in-person consults likely indicates some inherent differences between these groups.