“Nice to meet you”: A quality improvement project to increase warm handoffs.

Abstract

Low rates of behavioral health (BH) engagement and poor follow-up can exacerbate youth mental health difficulties. Warm handoffs, when a primary care provider (PCP) introduces the patient to the BH care provider in an integrated setting, have been shown to improve the rate of BH follow-up appointments. This 1-year study describes a quality improvement (QI) project conducted at a large, urban pediatric primary care practice, with aims of (a) improving the percentage of warm handoffs performed for pediatric patients referred to behavioral health by 100% and (b) increasing the proportion of warm handoffs completed per primary care provider (PCP) for 60% of all PCPs. Methods: Using QI methods, a multidisciplinary team implemented tests of change via Plan-Do-Study-Act cycles (PDSAs) and completed a run chart of number of warm handoffs to assess performance. A balancing measure was used to determine impact of increased warm handoffs on behavioral health provider's sessions. Results: The percentage of warm handoffs doubled compared to the baseline period (37% vs. 18%), and there were significant differences in follow-up rates between referred patients who received a warm handoff (73.1%) and those who did not (49.5%), regardless of whether the same BH provider conducted the warm handoff and follow-up visit, or whether two different BH providers were involved. Additionally, the

Association of depression screening with diagnostic and treatment-related outcomes among youth

“…35 Instead of viewing parental attitudes as a barrier to care, active approaches that provide psychoeducation to parents and involve them in routine treatment decisions are likely to be more effective at ensuring treatment needs are met. 36 Preliminary studies of “warm hand-offs,” where an adolescent is introduced to a behavioral health provider at the time of referral, have been found to increase the likelihood of attendance at follow-up appointments; 37,38 however, these models may only be feasible in integrated settings where behavioral health providers are on-site. Other strategies have focused on integration of psychosocial screening tools into electronic health records and the use of computer-based decision support systems, which can improve workflow and streamline referral processes.…”

Utilization of Pediatric Psychology Services in Outpatient Pediatric Gastroenterology Within a Rural Health System

“…Before integration of psychology services, referrals from pediatric gastroenterology were ordered to the Department of Psychiatry and families were scheduled with pediatric psychologists throughout the health system. Following integration of services, an embedded psychologist provided direct patient contact through an introduction by the medical provider to the patient and family during a regularly scheduled medical visit at the main clinic, also termed a Warm Handoff (WHO) (9). WHOs were documented in the Electronic Health Record (EHR).…”

Researching warm hand-offs: Should we give a WHOot?

“…For those of you who are disinclined to engage in research but have embraced the cottage industry approach to PCBH (or other integrated care approaches) and prioritize the delivery of high-quality care, consider the option of quality improvement. Improved uptake and quality of WHOs in everyday practice is possible through the application of standard quality improvement approaches, such as plan-do-study-act (see Germán et al, 2020). Why quality improvement?…”