Data Driven Decisions and Outcomes in Telepsychiatry

Telepsychiatry offers a variety of benefits in today's changing healthcare landscape, including an emphasis on integrated care and population management. It improves access to mental healthcare, addresses health disparities in rural counties and a national shortage of mental health providers, and has the potential to bring services to communities where unique language and cultural demographics are barriers to treatment. Telepsychiatry also serves as an excellent platform to train the next generation of healthcare workforce. However, perhaps an often-overlooked benefit of telepsychiatry, is that it as a fertile bed to collect data and conduct outcomes research.

Healthcare today is shifting from a volume-based to a value-based system. This new paradigm requires data-driven decision making that measures quality; reduces costs; and has changed—and is changing—the way providers are reimbursed.

Thus, as there are now many reasons to collect robust clinical data, it is important that telepsychiatry initiatives are designed with a focus not only on clinical service delivery, but also with an eye on how to be efficient in capturing outcomes that help make strategic decisions (e.g. financial, case management, etc.) for the institution or broader healthcare system. Data elements captured could include:

  1. patient and provider satisfaction,
  2. reliability,
  3. treatment outcomes,
  4. implementation outcomes, and
  5. cost effectiveness.

Outcomes in Telepsychiatry

While few studies use (preferred) non-inferiority designs, the overall literature suggests that the reliability of clinical assessments and overall treatment outcomes are comparable between in-person psychiatric care and telepsychiatry.

Furthermore, studies using basic measurement-based approaches and those employing more sophisticated methodologies for evaluating cost-effectiveness (including recidivism rates, length of stay, and overall healthcare utilization), indicate that telepsychiatry is not more expensive than in-person delivery of mental health services, with some studies suggesting that telepsychiatry is the more cost-effective option.

Additionally, patients and providers use telepsychiatry to treat a variety of conditions and are generally satisfied with it. Providers, however, tend to express concerns about the therapeutic rapport between patient and clinician for telepsychiatry sessions, although this attitude changes with time and experience on the part of the provider.

Finally, employers have demonstrated a great deal of interest in offering telepsychiatry to employees to reduce absenteeism and improve productivity of those who suffer from mental illness. Research by the American Psychiatric Foundation found that, with just three weeks of mental health treatment, the number of work-impaired employees with behavioral health conditions was reduced by half. By four months of treatment, two-thirds were no longer work impaired.

Using data-driven treatment models in telepsychiatry therefore have multiple applications in a variety of settings, and those who wish to adapt telepsychiatry into their practice should be mindful of the ultimate use of data to drive telepsychiatric care.

About the Author

Meera Narasimhan, M.D.
Professor and Chair, Department of Neuropsychiatry and Behavioral Sciences
University of South Carolina School of Medicine,
Special Advisory to USC President for Health Innovations and Economic Development

Dr. Narasimhan completed her residency in psychiatry at Yale University Department of Psychiatry and went on to complete a fellowship in neuroscience/ psychopharmacology at Yale.

Dr. Narasimhan has been involved with a statewide telepsychiatry project in the state of South Carolina, a large collaborative between the South Carolina Department of Mental Health, the University of South Carolina, and the South Carolina Hospital Association, which has been ongoing since 2009 with over 38,000 patients having been seen in 24 emergency departments via telepsychiatry. This project has demonstrated improved access to care, reduced healthcare utilization as it pertains to length of stay, improved outpatient follow-up rates, and reduced overall costs.

References

  1. Review of Telepsychiatry Outcomes. Hubley Set al 2016 World Journal of Psychiatry Jun 22;6(2):269-82.
  2. Impact of a Telepsychiatry Program at Emergency Departments Statewide on the Quality, Utilization, and Costs of Mental Health Services. Narasimhan et. al., Psychiatric Services 2015 Nov;66(11):1167-72

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