3rd Presentation of Fellowship Projects › wp-content › uploads › 2015 › 11 › 6-22...• CommonGround (CG) is a web-based application that was developed for use in an outpatient

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


• 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


• 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


• 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.


• 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


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


• 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.


• 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


• 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/

https://www.patdeegan.com/commonground

http://www.ccbh.com/providers/recoveryinstitute/resources/commonground/

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%


I felt comfortable with the

technology used in today's

session.

Percentage of respondents




Somewhat Agree 11.7%



I felt that my provider was

responsive to my needs.





Somewhat Agree 0%



My mental health needs were

addressed today.








I would recommend

telepsychiatry to a friend.







• Recruitment and retention

• Locums model vs. Community psychiatry

• Attracting remote community psychiatrists

The Future

Thank you!

Questions?

Documents

3rd Presentation of Fellowship Projects › wp-content › uploads › 2015 › 11 › 6-22...• CommonGround (CG) is a web-based application that was developed for use in an outpatient