Sy Atezaz Saeed, MD, MS, FAC Psych, Professor and Chair Department of Psychiatry and Behavioral Medicine Brody School of Medicine - East Carolina University Director North Carolina Statewide Telepsychiatry Program (NC-STeP)
• 65 hospitals in network, 53 hospitals live, as of 03/31/18 with 30 hospitals reporting Telepsychiatry patients in their ED – not all live hospitals had telepsychiatry patients • 774 patient assessments were billed for Model 1 hospitals during the reporting period • Average consult elapsed time 3 hours and 8 minutes (Model 1) • The Median Length of ED Stay was 29.4 hours • The Average Length of ED Stay was 56.8 hours – 54.8 hours for those discharged to home – 59 hours for those transferred to another facility
• 753 patients who received telepsychiatry services had an IVC in place during their ED stay. – 343 (45.5%) of those patients did not have an IVC in place when discharged. • Of the ED patients who received telepsychiatry services, 39.4% were discharged to home. 37.5% were discharged to another facility. *Note: Data for Bladen hospital was not submitted as of April 25, 2018. Data for Novant Brunswick for February and March was not submitted as of April 25, 2018. Data for Cone hospitals for January through March 2018 did not include a discharge disposition, so Cone is not included in the average LOS calculation by discharge (i.e. Home, Transfer). They are included in the overall average LOS and median LOS.
Since project During During During During During inception in Quarter Quarter Quarter Quarter Quarter November 2013 Jan-Mar 2017 Apr-Jun 2017 Jul-Sep 2017 Oct-Dec 2017 Jan-Mar 2018 Total 20,297 916 1,096 967 991 1,217 Patient Encounters Model 1 Hospital 14,741 463 587 486 507 623 Patient Encounters Model 2 Hospital 5,556 453 509 481 484 594 Patient Encounters 30,234 993 1,189 1,049 1,116 1,368 Total Number of Assessments (Billed Assessments for Model 1 Hospitals + Number of Patient Encounters for Model 2 Hospitals)
NC-STeP Benchmarks Goals Values Reached Value Reached as Value reached as Year-to-Date Cumulative Target to of most recent of this reporting Total with % of be reached by previous quarter quarter the Yearly Target 6/30/2018 (12/31/2017) (03/31/2018) 1,966 Number of IVCs 2,584 630 753 76.08% 835 Number of IVCs Overturned 1,034 240 343 80.75% Total Number of Assessments 3,533 1,116 1,368 (Billed assessments for Model 1 5,473 64.55% hospitals + Number of patient encounters for Model 2 hospitals.)
BASELINE TARGET TO BE VALUES/MEASURES EVALUATION CRITERIA VALUES/MEASURES REACHED BY REACHED AS OF AS REPORTED ON 06/30/2018 03/31/2018 03/31/2017 1. The number of full- time equivalent (FTE) 2.1 FTEs 2.3 FTEs 1.9 FTEs positions supported by these contracts 343 in this quarter 2. The number of YTD Total 835 overturned Cumulative total involuntary 396 1,034 since program commitments inception 3,651 (inpatient admission prevented) 3. The number of participating 30 47 47 consultant providers
BASELINE TARGET TO VALUES/MEASURES EVALUATION VALUES/MEASURES BE REACHED REACHED AS OF CRITERIA AS REPORTED ON BY 06/30/2018 03/31/2018 03/31/2017 4. The number of 1,368 in this quarter telepsychiatry YTD Total 3,533 2,024 5,743 assessments Cumulative total since conducted. program inception 30,234 5. The number of 43 59 65 telepsychiatry 53 Live referring sites 6. The reports of 753 in this quarter involuntary YTD Total 1,966 999 2,584 commitments to Cumulative total since enrolled hospitals program inception 12,097
BASELINE TARGET TO VALUES/MEASURES EVALUATION VALUES/MEASURES BE REACHED REACHED AS OF CRITERIA AS REPORTED ON BY 06/30/2018 03/31/2018 03/31/2017 7. The average (mean) Length of 53.2 hours 53 hours QTD = 56.8 Stay for all patients with a primary Median = 29.4 mental health diagnosis across all dispositions. 8. The rate of "satisfied" or 55.4% 85% 73% "strongly satisfied" among emergency department staff participating in NC- STeP.
BASELINE TARGET TO VALUES/MEASURES EVALUATION VALUES/MEASURES BE REACHED REACHED AS OF CRITERIA AS REPORTED ON BY 06/30/2018 03/31/2018 03/31/2017 9. The rate of "satisfied" or 100% 0% 85% "strongly satisfied" (no responses among hospital received) CEOs/COOs participating in NC-STeP. 10. The rate of "satisfied" or 83% 72% 85% "strongly satisfied" among consulting (hub) providers participating in NC-STeP.
BASELINE TARGET TO VALUES/MEASURES EVALUATION VALUES/MEASURES BE REACHED REACHED AS OF CRITERIA AS REPORTED ON BY 06/30/2018 03/31/2018 03/31/2017 11. The rate of "satisfied" or 60% 80% 85% "strongly satisfied" among emergency department physicians participating in the statewide telepsychiatry program. 12. The ratio of overall revenues 0.39:1.00 0.16:1.00 >1.00:1.00 (billing, subscription fees), exclusive of grant YTD Average funding, to 0.21:1.00 program costs Cumulative average (exclusive of start- since program up costs). inception 0.50:1.00
BASELINE TARGET TO VALUES/MEASURES EVALUATION VALUES/MEASURES BE REACHED REACHED AS OF CRITERIA AS REPORTED ON BY 06/30/2018 03/31/2018 03/31/2017 13. Cumulative return $1,852,200 in this on investment to state quarter $2,138,400 $5,583,600 psychiatric facilities YTD $4,509,000 through overturned Cumulative total since involuntary program inception commitments. $19,715,400 (inpatient admission prevented)
100 120 140 20 40 60 80 0 *indicates Model 2 hospital Albemarle 50 Beaufort 10 Chowan 7 Duplin 45 Edgecombe Outer Banks 51 Wilson 42 Number of NC-STeP Patients by Hospital Lenoir 21 *Bladen *McDowell 126 *Highland Cashiers 6 *Novant Kernersville *Novant Thomasville *Novant Rowan *Blue Ridge 44 *Transylvania 71 January - March 2018 St. Lukes 12 *Angel 97 *Hugh Chatham 91 *UNC Johnston 2 Morehead 25 Maria Parham 37 Murphy 89 Chatham 6 Ashe 6 Dosher 10 Harris Northern of Surry 74 *Annie Penn 32 *Forsyth Med Center *Med Center High Point *Moses Cone 103 *Novant Clemmons *Wesley Long Cone 1 *Alamance 1 Lake Norman 3 Haywood 116 Pender 19 Person *Novant Brunswick 20
Percent of Use by Hospital Jan-Mar 2018 (based on number of patient encounters) McDowell Angel Moses Cone Albemarle All Others Combined Murphy McDowell 10% 10% Northern of Surry Angel Haywood 8% Wilson 10% Transylvania Moses Cone Annie Penn Hugh Chatham 8% Outer Banks 7% Blue Ridge Albemarle Morehead Maria Parham 4% 2% Duplin Duplin 4% Murphy Morehead 7% Hugh Chatham Northern of Maria Parham Haywood Outer Surry 4% Banks 6% All Others Combined Transylvania 4% 6% Blue Ridge 4% Annie Penn Wilson 3% 3%
January-March 2018 400 350 300 371 250 200 252 150 100 50 Number of Patients 0 CBC OV by Provider (Model 1) October - December 2017 400 350 300 250 289 200 209 150 100 50 0 CBC OV
50.2% percent of patients had a LOS of 30 hours or less Number of patients with a LOS in this category 25 patients had a LOS longer than 300 hours Median Length of Stay for Jan-Mar 2018 = 29.4 Hours
51% percent of patients Had a LOS of 30 hours or less Number of patients with a LOS in this category There were 65 patients with a length of stay longer than 300 hours. Median Length of Stay for Jan-Dec 2017 = 29.2 Hours
Number of Patients by Model Jan-Mar 2018 650 623 594 600 550 500 450 400 350 300 Model 1 Model 2 October - December 2017 650 600 550 498 484 500 450 400 350 300 Model 1 Model 2
Consult Elapsed Time: January – March 2018 Comparison of CBC & OV Average Consult Elapsed Time Average Consult Elapsed Time In Queue to Exam Complete In Queue to Exam Complete (hh:mm:ss) (hh:mm:ss) 03:50:24 3:13:36 03:21:36 02:52:48 3:04:21 02:24:00 Exam Elapsed Time, 1:40:28 01:55:12 1:49:15 In Queue Wait Time, 1:28:31 01:26:24 1:07:46 00:57:36 00:28:48 00:00:00 In Queue Wait Time Total Elapsed Time CBC Elapsed Time OV Elapsed Time
100 120 140 160 180 20 40 60 80 0 * indicates Model 2 hospital 76.1 Albemarle 62.7 Beaufort 52.4 Chowan 62.4 Duplin Edgecombe 34.5 Outer Banks 43.8 Wilson 114 Lenoir Average Length of Stay for NC-STeP Patients by Hospital *Bladen 44.342.2 *McDowell *Highland Cashiers *Novant Kernersville *Novant Thomasville *Novant Rowan 29.5 *Blue Ridge 34.2 *Transylvania January - March 2018 85.9 St. Lukes 33.9 *Angel 44.7 *Hugh Chatham (in hours) 12.3 *UNC Johnston 82.9 Morehead 153.6 Maria Parham 67.8 Murphy 122.3 Chatham 49.8 Ashe 32.7 Dosher Harris 70.7 Northern of Surry 50.9 *Annie Penn *Forsyth Med Center *Med Center High Point 44.2 *Moses Cone *Novant Clemmons *Wesley Long Cone 92 20.8 *Alamance 66.963.5 *Novant Brunswick Haywood 39.4 Pender Person 56.8 Average across all hospitals
Average Length of Stay by Provider Jan-Mar 2018 (in hours) 80 72.7 70.1 70 60 48.7 50 45.9 37.4 40 30 20 10 0 0 Novant Cone Health Cape Fear Mission Old Vineyard CBC (111 patients) (137 patients) (no data) (344 patients) (252 patients) (371 patients)
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