Videoconferenced Telebehavioral Health Referral Process Adherence

Abstract

Background: In 2015, the Army mandated 100% digital storage of telehealth consent forms (DA4700) in the Health Artifact and Image Management Solution (HAIMS) system, and a telebehavioral health (TBH) hub clinic set an aim to accomplish this by improving adherence to referral procedures essential to expanding patient access to videoconferenced (VC) behavioral health care.

Methods: The Knowledge-to-Action (KTA) planned action framework underpinned development of a two-phase, PDSA (Plan-Do-Study-Act) quality improvement project to increase the rates of TBH new intake consent form completeness and upload adherence. First, a provider education initiative addressed form uploads. Second, TBH consultants prepared (signed and sent) intake forms to referring sites for their patients to finalize during the initial VC encounter. A chart review of consecutive new intake encounters compared data extracted from CY2015 Q1 baseline records (n = 65) with data from CY2016 Q1 improvement period records (n = 40). A total of 352 forms were reviewed.

Results: Referrals (N = 118) that resulted in kept new VC TBH intake visits (n = 105), originated from three military behavioral health clinic referral sites. In CY2016 Q1, all DA4700 consent forms were uploaded to HAIMS. Telehealth treatment and medication consent form upload adherence increased from 94% and 68%, respectively, to 100% (p > 0.05). Form completeness increased from 36% to 95% (p < 0.001), and multiple linear regression analysis predicted an average 59% increase across the three referral sites (sr2 = 0.54).

Conclusion: Consultant preparation of telehealth new intake consent forms effectively improved form completeness and increased adherence to new intake referral processes essential to this hub clinic expanding patient access to TBH care.

Figure 1.

Telebehavioral Health New Intake Referral Process Adherence Periods. Process Adherence: Upload of Telehealth Informed Consent [DA4700] and Psychoactive Medication Consent [local form] forms, within 72 hr after a documented new intake visit with all intake forms completed. Informed Consent: of the required DA4700 telehealth consent forms, the percentage uploaded within 72 hr after a new intake visit. Med Consent: of the required Psychoactive Medication Consent forms required, the percentage uploaded within 72 hr after a new intake visit. Forms Complete: correct date, patient and provider signatures on each of four required forms, (A) [DA4700], (B) Privacy Act [DA8001], (C) Limits of Confidentiality [DD2005], and (D) Psychoactive Medication Consent when medications were prescribed during the visit. Pre-improvement Baseline: January through March, 2015. Improvement Period 1: January, 2016. Improvement Period 2: February, 2016. *p < 0.001.