title: Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care.
abstract: Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO®(Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.
authors.affiliation: 1 Institute for Urban Health , The New York Academy of Medicine, New York, New York.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fisher
authors.affiliation: 2 Department of Psychiatry, University of Rochester Medical Center , Rochester, New York.|3 School of Nursing, University of Rochester Medical Center , Rochester, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Hasselberg
authors.affiliation: 2 Department of Psychiatry, University of Rochester Medical Center , Rochester, New York.
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
authors.affiliation: 1 Institute for Urban Health , The New York Academy of Medicine, New York, New York.
authors.forename: Linda
authors.initials: L
authors.lastname: Weiss
authors.affiliation: 4 Thomas Jefferson University , Philadelphia, Pennsylvania.|5 Lakenau Institute for Medical Research , Wynnewood, Pennsylvania.
authors.forename: Norma A
authors.initials: NA
authors.lastname: Padrón
authors.affiliation: 2 Department of Psychiatry, University of Rochester Medical Center , Rochester, New York.
authors.forename: Erin
authors.initials: E
authors.lastname: Tiernan
authors.affiliation: 6 Finger Lakes Geriatric Education Center, University of Rochester Medical Center , Rochester, New York.|7 Psychology Department, State University of New York College at Buffalo , Buffalo, New York.
authors.forename: Jurgis
authors.initials: J
authors.lastname: Karuza
authors.affiliation: 8 Excellus BlueCross BlueShield , Rochester, New York.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Donath
authors.affiliation: 1 Institute for Urban Health , The New York Academy of Medicine, New York, New York.|9 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania.|10 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020375:Education, Distance; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D000071252:Mentoring / Q000379:methods*; D009518:New York; D058007:Physicians, Primary Care / Q000193:education*; D013685:Telecommunications
keywords: care management; distance learning; geriatric mental health; primary care; rural health care