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3rd Annual: Challenges & Innovations in Rural Psychiatry Conference
Presentation of Fellowship Projects
June 22, 2016
© 2016 Community Care Behavioral Health Organization
Presenters & Disclosures
DeanAnn Farris DO, MS Rural Psychiatry Fellow,
Psychiatrist, Deerfield Behavioral Health, Warren, PA
No conflicts of interest to disclose
Joseph Holmes, DO, MS Med. Ed. Rural Psychiatry Fellow,
Psychiatrist, Stairways Behavioral Health, Erie, PA
No conflicts of interest to disclose
© 2016 Community Care Behavioral Health Organization
Use of Collaborative Care Technology in
Inpatient Psychiatric Services
DeanAnn Farris, DO, MS
Inpatient unit approach for psychiatric treatment.
Collaborative care technology used in an outpatient setting.
Implementation of collaborative care technology on an inpatient unit.
Methods of assessing the impact of collaborative care on the inpatient
unit.
Findings and observations.
Content
• There are inherent advantages and opportunities in the inpatient setting
– Ability to monitor a patient 24 hours a day
– Adjust medication more rapidly
– Promote intensive therapy
• Inpatient psychiatric units continue to use
the approach of hierarchical decision making
for treatment.
• Strategies that involve psychiatric self-care, are often not well integrated into the
inpatient setting.
Inpatient Treatment Approach
• There is an ongoing shift in the field, moving from physician driven care and
focusing more on collaborative care.
• Incorporating this shift with traditional treatment strategies could maximize the
potential of the inpatient setting.
• Individuals who are engaged and active in their own care have better health and
functioning, have a higher quality of life, and are more satisfied with their
treatment.1
• Providing patients with a tool that empowers them to play a role in their own care
could have a synergistic effect on their overall progress and recovery.
Inpatient Treatment Approach
• CommonGround (CG) is a web-based application that was
developed for use in an outpatient setting to help patient’s take a
more active role in their treatment.2
• The application is used in a clinic’s Decision Support Center
(DSC) – Area inside the clinic with computers
– Has staff specifically trained to work with patients on CG
– Helps prepare them to engage with their physician prior to their
appointment4
Collaborative Care Technology
CG assists in strengthening the individual’s own capacity to move toward recovery by promoting self care, collaborating with the physician, and through education.
• The patient completes a Health Report in the DSC prior to their appointment – Goals (short and long term)
– Summarizes progress since their last visit
– Describes current symptoms
– Concerns or questions3
• Library – Provides information through a variety of resources
• Diagnosis
• Medication
• Coping skills
• Promotes personal medicine – Things that an individual does to manage stress and obtain wellness.
CommonGround
• Using CommonGround on an inpatient unit could help jumpstart recovery and improve the overall outcome of hospitalization
– Engaging patients in their treatment
– Unifying the patient and staff
– Empowerment
• Providing the patient with the ability to achieve noticeable gains in wellness and functioning
Inpatient CommonGround
• In 2014, the community hospital in
Warren, PA became the first acute
inpatient unit to implement this
program.
• An office on the unit was converted
into the DSC
– Touchscreen computers
– Headphones
Inpatient CommonGround
• DSC
– Specialized staff that provide
• An orientation and introduction to CG
• Assist in completing Health Reports for treatment team meetings
• Treatment team meetings
– Held at least once a week for each patient
– Patient, physician, physician’s assistant, behavioral health technician, nurse and
social worker
Inpatient CommonGround
• The Health Report is utilized as the format for the meeting
– Power statement/personal treatment goals
– Progress since admission
– Treatment
– Discharge planning
• The Shared Decision
– Summarizes goals
– Changes to the treatment plan
– Is approved by both the team and the patient
Inpatient CommonGround
• The DSC is available to patients at any time.
• The patients that follow up with the outpatient clinic will continue using CG at
home and prior to office visits.
• The patients that go elsewhere are still able to
access CG for one month, and have the
option for library access thereafter.
Inpatient CommonGround
• At discharge, surveys
were utilized to collect
information about their
experience with CG.
– age ranges
– number of days on the unit
– how often and why the
program was used
Patient Survey
Common Ground Survey
Age:
18-25 26-54 55+
Number of Days on the Inpatient Unit:
1-3 4-7 7-10 10-15 15+
How I used the system:
1. How many times did you use the Common Ground system during your stay?:
Daily 1 time per week 2 or more times per week Never
2. I used the Common Ground System to (check all that apply):
Find information on my diagnosis
Find information on medications
Watch recovery videos
Learn tips on how to manage my symptoms
Complete a Health Report before Treatment Team
Create a Power Statement
Other_______________________
• A scale was used for patients
to evaluate their experience
with CG.
• Comment section that
that encouraged feedback
about the program.
Patient Survey
Strongly
Disagree
Disagree Somewhat
Agree
Agree Strongly Agree
| | | | |
Please use the following scale to answer each question:
1. Common Ground has helped me better understand my diagnosis.
1 2 3 4 5
2. Common Ground has helped me better understand my medications.
1 2 3 4 5
3. Common Ground has helped me better understand treatment options.
1 2 3 4 5
4. Common Ground has helped me become more active in my treatment.
1 2 3 4 5
5. Common Ground has made it easier to talk to my doctor.
1 2 3 4 5
6. Common Ground has made it easier to talk with the Treatment Team.
1 2 3 4 5
Strongly
Disagree
Disagree Somewhat
Agree
Agree Strongly Agree
| | | | |
1 2 3 4 5
Findings and Observations
1 2 3 4 5
Common Ground has helped me better undestand my diagnosis.
Common ground has helped me beter understand my medications
Common Ground has helped me better understand treatment options.
Common Ground has helped me become more active in my treatment.
Common Ground has made it easier to talk to my doctor.
Common Ground has made it easier to talk with the Treatment Team
Common Ground is easy to use.
Common Ground is a good tool to support recovery.
Patient Perspective
Findings and Observations
0
5
10
15
20
25
Diagnosis Medications Videos Symptoms Health Report Power Statement Other
Patient's Purpose of Use
• Patient perspective
– The highest rated statements were that CG was easy to use and that it helped individuals
better understand their medicine (mean=4.21 and 3.85 respectively).
– The majority agreed that CG was a good tool to support recovery.
• Patient’s purpose of use
• Learn about their symptoms, diagnosis and medication
Findings and Observations
• During treatment team, patient’s that used CG seemed more open to
discussing symptoms, participating in therapy and other recovery
tools.
• Some patients reported feeling more confident and prepared for
discharge compared to other times when they were hospitalized.
• Some that utilized the educational resources in the CG library kept
printed materials to use after discharge.
Findings and Observations
• Prior to discharge, patients that used CG presented as motivated and goal
oriented towards their future recovery.
• They seemed to benefit from having another treatment option they could actively
participate in, rather than taking a more passive role.
• Spreadsheets are currently tracked through the outpatient clinic. They record patient information, whether they are a clinic patient or referred, whether they have completed past reports, and if they requested and received home access.
– New users added to CommonGround: 416
– Total Health Reports completed: 378
– Total home log in accounts added: 373
Findings and Observations
• General observations on integrating traditional and collaborative treatment
strategies for inpatient care have been promising and could have an impact on
their progress after discharge.
• CG was originally designed for outpatient services; where a health care report
and interaction with providers can be months apart.
• Using CG could have an impact on their overall progress that is unique to the
inpatient experience
– It always available for use
• Progress can be updated more often
• Education and interactions with the staff occur multiple times a day.
– Opportunities to streamline material on CG for inpatient use.
Collaborative Care on Inpatient Units
Collaborative Care Technology in Inpatient Psychiatric Services
• Implementing additional treatment options for
inpatient settings is a worthwhile endeavor.
• Particularly for those in the field that seek to
expand the role of psychiatric inpatient care as
an important part of the recovery process.
• Using innovative technology or other tools to
promote collaborative care could help acute
psychiatric units transform into centers of
psychiatric excellence.
Resources
References
1. Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Self-management and
health care utilization: Do increases in patient activation result in improved self-
management behaviors? Health Services Research, 42, 1443–1463.
2. Deegan, Pat (n.d.) CommonGround PDA. Retrieved from
https://www.patdeegan.com/commonground
3. CCBH. Recovery Resources. (n.d.) Retrieved from
http://www.ccbh.com/providers/recoveryinstitute/resources/commonground/
4. Scattergood Foundation. Advancing Strategies for Behavioral Health (n.d.)
Retrieved from http://scattergoodfoundation.org/innovideas/pat-deegan-phd-
associates-llc#.VYcvTPlVhBc
5. Author unknown. Picture. (n.d.) Retrieved from http://www.wgh.org/
Joseph Holmes D.O. MS Med. Ed.
Telepsychiatry: Problems, Potential, and the Future
No conflicts of interest to disclose.
Disclosures
26
Dr. Penny Chapman
Rick Seager
Dr. Manish Saphra
Dr. Shabana Khan
The Administrative team at SBH
My support staff
Recognition and Thanks
27
• Define the rationale for telepsychiatry
• Explore the potentials and problems inherent to telepsychiatry
• Discuss Planning and implementation of a telepsychiatry service arm in the
community psychiatry setting.
• Understand the evolving nature of telepsychiatry and explore potential future
directions.
Learning Objectives:
• Not Enough Psychiatrists
• Lifestyle flexibility?
• Cost efficacy?
Why Telepsychiatry?
• State Bulletin
• Medicaid payor guidelines
• ATA Guidelines
• Best practices
Creating Organizational policy and procedures
Videoconferencing Platform Choice: In house vs cloud based solutions
• Zoom
• Cloud Visit
• Polycom
Technology selection
EMR Decisions: Not all EMRs are created equal
• Credible
• Evolv
• PracticeFusion
EMR Selection
• Requirements
• Characteristics of good surrogates
• Workflow
• Community resources
• Crisis management
Staff selection and training
Five Question Survey with a five point likert scale:
1. I am satisfied with my visit.
2. I felt comfortable with the technology used in today's session.
3. I felt that my provider was responsive to my needs.
4. My mental health needs were addressed today.
5. I would recommend telepsychiatry to a friend.
Performance evaluation and improvement measures.
Satisfaction survey results
I am satisfied with my visit. Percentage of respondents
Completely Disagree 0%
Somewhat Disagree 0%
Neither Disagree or Agree 5.9%
Somewhat Agree 5.9%
Completely Agree 88.2%
Satisfaction survey results
I felt comfortable with the
technology used in today's
session.
Percentage of respondents
Completely Disagree 0%
Somewhat Disagree 0%
Neither Disagree or Agree 11.7%
Somewhat Agree 11.7%
Completely Agree 76.6%
Satisfaction survey results
I felt that my provider was
responsive to my needs.
Percentage of respondents
Completely Disagree 0%
Somewhat Disagree 0%
Neither Disagree or Agree 5.8%
Somewhat Agree 0%
Completely Agree 94.1%
Satisfaction survey results
My mental health needs were
addressed today.
Percentage of respondents
Completely Disagree 0%
Somewhat Disagree 0%
Neither Disagree or Agree 5.8%
Somewhat Agree 11.7%
Completely Agree 82.3%
Satisfaction survey results
I would recommend
telepsychiatry to a friend.
Percentage of respondents
Completely Disagree 0%
Somewhat Disagree 0%
Neither Disagree or Agree 11.7%
Somewhat Agree 23.5%
Completely Agree 64.7%
• Recruitment and retention
• Locums model vs. Community psychiatry
• Attracting remote community psychiatrists
The Future
Thank you!
Questions?
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