Engaging Patients With Mental Disorders From the ED in Outpatient Care

NCT02989805 | Completed Results DMC

• 1 other identifier: IRB00091841
• Study Type: interventional
• Target: 326
• Locations: 1 country
• Sites: 1

Brief Summary

This study will compare the effectiveness of professional and peer care managers in improving linkage to and engagement in outpatient care after an emergency department (ED) discharge, as well as the mechanisms by which engagement occurs. The study will use a multi-site randomized trial study design across 8 EDs in South Carolina with telepsychiatry programs; each site will have one professional care manager (social worker or nurse) and one peer specialist care manager. Eligible subjects at each site will be randomized to a one-year treatment engagement intervention, the Coordination, Access, Referral and Evaluation (CARE) Program with either a peer or professional care manager, resulting in a total of 290 participants across sites. The CARE program will focus on shared decision-making between care managers and patients, and combines the traditional medical model of care management with a recovery-based approach.

Conditions

Mental Disorder

Keywords

Emergency Medicine; Psychiatry; Health Promotion; Public Health

Outcome Measures

Primary Outcomes (1)

• Number of Participants Attending at Least One Outpatient Visit

  This outcome was operationally measured as at least one outpatient visit for a mental health problem in the 30 days after discharge from the emergency department. Data were obtained from the South Carolina Office of Revenue and Fiscal Affairs (RFA). The RFA data warehouse pulls client-specific data from an array of health and human services facilities, agencies and organizations and makes possible the integration of data from disparate sources at the client level by means of an internally assigned unique tracking number.

  30 days after discharge

Secondary Outcomes (3)

• Percentage of Outpatient Visits Attended

  6 months after discharge

• Number of Participants Being Readmitted to the Emergency Room

  6 months after discharge

• Number of Participants Being Admitted for Inpatient Hospitalization

  6 months after discharge

Study Arms (2)

Professional Care Manager

ACTIVE COMPARATOR

Each participating site will have a nurse or social worker to provide care management. Training activities will include modules for each of the key domains covered in the intervention: shared decision making, action planning; motivational interviewing; and mental health as a cornerstone of recovery, working effectively within the mental health system; and self-care and stress management.

Behavioral: Care Management

Peer Specialist Care Manager

EXPERIMENTAL

Each participating site will have a peer specialist to provide care management. Peer specialists will have a minimum of a high school education, a history of a mental illness, be self-described as 'in recovery,' and have reliable transportation to the study site. All certified peer specialists will receive training in a curriculum that supports identifying and pursuing goals for recovery; developing and documenting recovery-focused treatment plans; and supporting linkages with community-based services. Peers learn to help other individuals with mental health conditions to facilitate mental health dialogues; explore mental health choices and options; identify and work with a clinician; and obtain access to community health supports.

Behavioral: Care Management

Interventions

Care Management BEHAVIORAL

Professionals and peers will each deliver the same intervention. The intervention combines a traditional medical model of care management with a recovery-based approach.

Peer Specialist Care Manager; Professional Care Manager

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Admission to the emergency department for a primary diagnosis of a mental disorder
• Plan for discharge to a participating community mental health center (CMHC)
• Lives within the CMHC catchment area

You may not qualify if:

• Cognitive impairment
• Not able to speak English
• Admission to the hospital from the emergency department

Sponsors & Collaborators

• Emory University: lead
• Patient-Centered Outcomes Research Institute: collaborator

Study Sites (1)

University of South Carolina

Columbia, South Carolina, 29203, United States

Location

MeSH Terms

Conditions

Mental Disorders

Results Point of Contact

• Title: Benjamin Druss, MD, MPH
• Organization: Emory University

bdruss@emory.edu

404-712-9602

Study Officials

• Benjamin Druss, MD

  Emory University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: December 8, 2016
• First Posted: December 12, 2016
• Study Start: April 3, 2017
• Primary Completion: December 31, 2019
• Study Completion: December 31, 2019
• Last Updated: March 16, 2020
• Results First Posted: March 16, 2020

Record last verified: 2020-02

Locations

US (1)