Infused Telemental Health Home Monitoring: Right Care, Right Time, Right Place

For oral/poster presentation:

Abstract Title:
Infused Telemental Health Monitoring: the Right Care, at the Right time, at the Right Place

Definition: Infused Telemental Health Home Monitoring: home monitoring of patients with a mental health primary diagnosis and co-morbid medical diagnosis.

History of Telemental Health Program:

.CCHT and Telemental Health (TMH) are nationwide VHA programs

.2003-Care Coordination (CCHT) started

.2008-New York Harbor added Telemental Health as a subdivision

.New York Harbor has 100 CCHT enrollees

.200 Telemental Health enrollees

.Two designated Telemental Health Care Coordinators

Abstract Content: 
Purpose:
To provide current information to health clinicians regarding expanded provisions of patient care beyond mental health institutional settings to Veterans with mental health and co-morbid medical diagnosis using of health informatics, integrated mental health and medical disease management protocols and Telehealth technologies. This presentation/ poster will also review New York Harbor’s Veteran Affairs Infused (integrated) Telemental Health Home Monitoring Program.

Significance:
In 2008 the Veterans Health Administration(VHA) added a subdivision, Telemental Health to their Care Coordination/ Home Telehealth (CCHT) department. This subdivision was created to ensure that eligible veterans with a mental health diagnosis have access to a comprehensive and integrated high quality healthcare continuum that addresses both medical and mental health needs of veterans in urban and rural communities utilizing home monitoring devices and case management. The Telemental staff utilizes FDA approved in-home messaging devices and telephone automated programs for disease management of mental health and co-morbid medical diagnosis. Registered nurses who specialize in Mental Health nursing and who have medical skills provide case management services to augment care provided by VHA and non-VHA medical and mental health providers.

Design (Background/Rationale):
A chart review of patients enrolled in the program more than 12 months was conducted. The review consisted of the most used mental health diagnosis, the percentage of patients that have a medical diagnosis and mental health diagnosis, the percentage of psychiatric and medical in-patient admissions, and the type of Telehealth devices used.

Description of Methods:
Veterans are referred to the program by self-referral or medical/mental health providers. Accepted veterans are expected to complete daily self-report protocols via telehealth monitors/ cell phone systems. If a high risk behavior or symptom is alerted, a Telemental health coordinator will contact the patient for further interventions. These interventions include: patient education, provider notification, crisis intervention, referrals to VHA/non-VHA community services.

Findings/ Outcomes :

1. The majority of patients in the telemental health CCHT program had  at least one medical co-morbidity.
2. There was a significant decrease in hospital admissions and length of stay. 3.
3. There has also been marked improvement in compliance with clinic appointments and medication regimes.

   Conclusions/Interpretations
   Implications:
    Infused Telemental health services facilitate access to care and improve the health of mental health patients with specific intent of providing the right care, in the right place, at the right time. This expanded care improves chronic disease management, patient satisfaction, increase access to services and reduce resource utilization, thus decreasing healthcare costs. VHA health professionals emphasize that home telehealth does not replace traditional homecare but can help veterans understand and manage their medical and mental health conditions at home. Proper management of these chronic conditions can delay the need for institutional care and maintain independence for an extended time.

4. The VHA has proven that an enterprise wide Infused (integrated)Telemental Health program is an appropriate and cost effective way of managing mental health patients with co-morbid medical disorders in both urban and rural settings. Infused home monitoring provides veterans with the Right Care, In the Right Place, at the Right Time.