Warm Handoff, or Cold Shoulder? An Analysis of Handoffs for Primary Care Behavioral Health Consultation on Patient Engagement and Systems Utilization

• Published in: Clinical practice in pediatric psychology 2020-09, Vol.8 (3), p.241-246
• Main Authors: Young, Nicholas D, Mathews, Brittany L, Pan, Amy Y, Herndon, Jason L, Bleck, Amanda A, Takala, Christopher R
• Format: Article
• Language: English
• Subjects: Client Participation; Female; Health Care Psychology; Health Care Utilization; Human; Integrated Services; Male; Pediatrics; Primary Health Care; Professional Consultation; Professional Referral; Test Construction
• ISSN: 2169-4826; 2169-4834
• DOI: 10.1037/cpp0000360

Objective: Referrals initiated via the "warm handoff" (HO) common to consultation-based models of integrated primary care are theorized to add value for patient outcomes relative to referral as usual (RAU) processes often used in colocated service models. The current evaluation tested this assumption in terms of impact on patient engagement, medical system utilization, and behavioral health system utilization. Method: Short-term longitudinal data were extracted for 175 integrated behavioral health referrals across urban pediatric primary care patients. A retrospective cohort design was used to assess differences between patients exposed to an HO immediately following referral versus RAU (control). Results: Analyses revealed significant differences for patients referred via HO at different time points, including fewer primary care provider appointment no-show/same-day cancellations, greater total behavioral health encounters, and fewer days from referral to any scheduled or completed follow-up behavioral health encounter. Conclusions: Consultation via HOs was associated with some short-term benefits on patient engagement and systems utilization for urban pediatric primary care patients compared to RAU. Preliminary findings may help stakeholders leverage the need for integrated (vs. colocated) models of pediatric integrated primary care to help inform economic- or value-based decisions on program development and promote care approaches that increase the likelihood of families staying engaged in care. Implications for Impact Statement "Warm handoffs" for immediate behavioral health consultation were associated with better pediatric patient engagement compared to referral as usual. Findings can help guide improvement with integrated primary care services, although future investigations are needed to further support or refute these preliminary results.