Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study

• Published in: BMC health services research 2024-02, Vol.24 (1), p.247-247, Article 247
• Main Authors: Adu, Medard K, da Luz Dias, Raquel, Obuobi-Donkor, Gloria, Ezeanozie, Ngozi, Sridharan, Sanjana, Morrison, Jason, Simon, Patryk, Taylor, Bryanne, MacKinnon, Monica, Gossen, Shiloh, Awara, Mahmoud, White, Mattew, Shalaby, Reham, Agyapong, Belinda, Eboreime, Ejemai, Wang, JianLi, Feng, Cindy, Wozney, Lori, Koto, Prosper, Warford, Jordan, Murphy, Gail Tomblin, Agyapong, Vincent Israel Opoku
• Format: Article
• Language: English
• Subjects: Access; Attitude surveys; Community; Costs; Early intervention; Emergency admission; Emergency medical care; Emergency services; Evaluation; Health care access; Health care expenditures; Health care industry; Health care policy; Health service utilization; Health services utilization; Homeless people; Hospitalization; Hospitals; Information sources; Information technology; Leadership; Management; Medical appointments and schedules; Medical care; Medical records; Mental disorders; Mental health; Mental health care; Mental health services; Pandemics; Patient admissions; Patients; Policy making; Primary care; Program evaluation; Psychiatric services; Psychiatrists; Quality of life; Rapid access; Satisfaction; Stabilization; Study Protocol; Treatment methods; Utilization; Well being
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-10697-7

Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that