By Theodore Vlavianos, MA, Director, Behavioral Health Partial Hospitalization Program, Zucker Hillside Hospital, and Marguerite McCarthy, MD, Psychiatrist in Charge, Behavioral Health Partial Hospitalization Program, Zucker Hillside Hospital
Does telehealth for mental healthcare services work? During the height of COVID-19, our Partial Hospitalization Program (PHP) – a short-term (up to six weeks), clinically intensive outpatient mental healthcare service designed to help high-risk individuals suffering from a subacute episode of mental illness to stabilize symptoms and transition back to their roles in the community – was tasked with going virtual.
In March 2020, COVID-19 cases were rising rapidly in the region and our PHP program at Zucker Hillside Hospital, Glen Oaks, New York, had to make swift decisions to ensure the safety of both patients and staff. Utilizing tele-psychiatry and a virtual care model for the PHP was not something that had been previously considered given the nature of the service delivery and patient profile. It was believed that PHP services were too labor intensive and complex to deliver virtually, while the patient cohort was considered too psychiatrically unstable to benefit from virtual care.
Nonetheless, a model of care was developed in the interest of patient and staff safety. Hospital administration, program management and the clinical team worked to weigh the concerns related to providing virtual PHP services against the health risks of continuing in-person care along with anticipation of city-wide stay-at-home orders. On March 17, 2020, the decision to convert the PHP to 100% remote was made and planning quickly began. In-house services were officially stopped, and the PHP was fully remote just two days later on March 19, 2020.
Overcoming Challenges
In our article, “Positive Outcomes in a Virtual Partial Hospitalization Program,” in the September 2022 issue of The Joint Commission Journal on Quality and Patient Safety (JQPS), we discuss many of the challenges we faced converting to a telehealth model and evaluate changes in our outcome measures resulting from this change.
Admittedly, we had skepticism about the telehealth model being successful for our program. Our biggest concerns were about:
- patients’ ability to access and use technology
- providers’ ability to successfully care for patients in a virtual care environment
We did see a subset of patients that had technology challenges. We were able to provide support and step-by-step guidance to help them overcome many of the obstacles they faced in this area. We also scheduled practice sessions to help patients learn how to navigate the platforms. This proved highly beneficial for many patients.
Improving Outcomes
To our surprise, many of the outcome measures proved to be on par, or better than the same metrics from in-person care. Attendance rates improved from 84.5% to 89.5% and patients reported high satisfaction with the care they received in the virtual care environment.
A comparison of Clinical Global Impression (CGI) scales showed similar results in both modalities and indicated no adverse effect from providing virtual care. Perhaps the most interesting result we saw was a decrease in hospitalizations from 16.5% to 9.9% in the virtual care model. This was very encouraging as the PHP is intended to prevent or reduce hospitalizations.
To our surprise, the virtual care model of PHP proved to be highly successful. We learned that our patient engagement and clinical outcomes support the ongoing use of telehealth for providing PHP services after the risk of COVID-19 infection is diminished.
Theodore Vlavianos, MA, MBA, is Director of the Behavioral Health Partial Hospitalization Program at Northwell Health’s Zucker Hillside Hospital in Glen Oaks, New York. Marguerite McCarthy, MD, is Psychiatrist in Charge of the Behavioral Health Partial Hospitalization Program at Zucker Hillside Hospital.