title: Impact of a Telepsychiatry Program at Emergency Departments Statewide on the Quality, Utilization, and Costs of Mental Health Services.
abstract: OBJECTIVE
  This study estimated the impact of a statewide, centralized telepsychiatry service provided in nonpsychiatric emergency departments (EDs) on use of mental health services.
  
  
  METHODS
  Individuals treated via telepsychiatry were compared with a matched control group of individuals with mental health diagnoses who were treated in nonparticipating hospitals. Bivariate and two-part and generalized linear regression models were used to assess differences between the two groups in outpatient follow-up, hospital admission following the ED visit, length of hospital stay if admitted, and inpatient and total costs.
  
  
  RESULTS
  Between March 2009 and June 2013, there were 9,066 patients with at least one telepsychiatry visit. Of these, 7,261 had index telepsychiatry visits that the authors were able to successfully match. Compared with the matched control group, telepsychiatry recipients were more likely to receive 30-day outpatient follow-up (46% versus 16%, p<.001) and 90-day outpatient follow-up (54% versus 20%, p<.001). Telepsychiatry recipients were less likely than the control group to be admitted to the hospital during the index ED visit (11% versus 22%, p<.001). The combined effect of having a telepsychiatry consult during the index ED visit was a reduction of .86 days in inpatient length of stay. Thirty-day inpatient costs were $2,336 (p=.04) lower for the telepsychiatry versus the control group, but 30-day total health care costs were not statistically different.
  
  
  CONCLUSIONS
  Telepsychiatry delivered in the ED through a centralized coordinated program has great promise for improving linkage with outpatient mental health services while reducing inpatient utilization and hospital costs.
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Meera
authors.initials: M
authors.lastname: Narasimhan
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Druss
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Hockenberry
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Julie
authors.initials: J
authors.lastname: Royer
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Paul
authors.initials: P
authors.lastname: Weiss
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Gretl
authors.initials: G
authors.lastname: Glick
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
authors.affiliation: Dr. Narasimhan is with the Department of Neuropsychiatry, University of South Carolina, Columbia (e-mail: meera.narasimhan@uscmed.sc.edu ). Dr. Druss, Dr. Hockenberry and Ms. Glick are with the Department of Health Policy and Management, Rollins School of Public Health, and Mr. Weiss is with the Department of Biostatistics, all at Emory University, Atlanta, Georgia. Ms. Royer is with the South Carolina Office of Research and Statistics, Columbia. Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Mr. Magill is with the South Carolina Department of Mental Health, Columbia.
authors.forename: John
authors.initials: J
authors.lastname: Magill
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D008875:Middle Aged; D010045:Outpatients; D011613:Psychotherapy / Q000379:methods*; D013022:South Carolina; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult