title: Team-Based Telecare for Bipolar Disorder.
abstract: Numerous randomized controlled trials indicate that collaborative chronic care models improve outcome in a wide variety of mental health conditions, including bipolar disorder. However, their spread into clinical practice is limited by the need for a critical mass of patients and specialty providers in the same locale. Clinical videoconferencing has the potential to overcome these geographic limitations.
  
  
  
  A videoconference-based collaborative care program for bipolar disorder was implemented in the Department of Veterans Affairs. Program evaluation assessed experience with the first 400 participants, guided by five domains specified by the American Telemedicine Association: treatment engagement, including identification of subpopulations at risk for not being reached; participation in treatment; clinical impact; patient safety; and quality of care.
  
  
  
  Participation rates resembled those for facility-based collaborative care. No participant characteristics predicted nonengagement. Program completers demonstrated significant improvements in several clinical indices, without evidence of compromise in patient safety. Guideline-based quality of care assessment after 1 year indicated increased lithium use, decreased antidepressant use, and increased prazosin use in individuals with comorbid post-traumatic stress disorder, but no impact on already high rates of lithium serum level monitoring.
  
  
  
  Clinical videoconferencing can extend the reach of collaborative care models for bipolar disorder. The next step involves assessment of the videoconference-based collaborative care for other serious mental health conditions, investigation of barriers and facilitators of broad implementation of the model, and evaluation of the business case for deployment and sustainability in clinical practice.
authors.affiliation: 1 VA Center for Healthcare Organization and Implementation Research , Boston, Massachusetts.|2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
authors.affiliation: 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts.
authors.forename: Lois
authors.initials: L
authors.lastname: Krawczyk
authors.affiliation: 1 VA Center for Healthcare Organization and Implementation Research , Boston, Massachusetts.|2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
authors.affiliation: 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.
authors.forename: Erica
authors.initials: E
authors.lastname: Abel
authors.affiliation: 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts.
authors.forename: David N
authors.initials: DN
authors.lastname: Osser
authors.affiliation: 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.
authors.forename: Aleda
authors.initials: A
authors.lastname: Franz
authors.affiliation: 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.affiliation: 4 Hunter Holmes McGuire VA Medical Center , Richmond, Virginia.
authors.forename: Meghan
authors.initials: M
authors.lastname: Rooney
authors.affiliation: 2 Department of Psychiatry, Harvard Medical School and VA Boston Healthcare System , Boston, Massachusetts.
authors.forename: Jerry
authors.initials: J
authors.lastname: Fleming
authors.affiliation: 3 Yale School of Medicine and VA Connecticut Healthcare System , West Haven, Connecticut.|5 VA Central Office , Office of Telehealth Services, West Haven, Connecticut.
authors.forename: Linda
authors.initials: L
authors.lastname: Godleski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000628:therapy*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D049269:Videoconferencing / Q000458:organization & administration*
keywords: bipolar disorder; implementation; quality; telehealth