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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4076 — Timely Evaluation for Veterans New to Mental Health: Findings from the My VA Access Chart Reviews

Lead/Presenter: Elaine Lasky
All Authors: Lasky EC (SMITREC, Office of Mental Health Operations) Billera DM (Denver VAMC) Riley JA (Bedford VAMC) Mach JJ (SMITREC, Office of Mental Health Operations) Cornwell BL (SMITREC, Office of Mental Health Operations) Mulawa JJ (SMITREC, Office of Mental Health Operations) Kearney LK (VA Center for Integrated Healthcare) Smith CA (Office of Mental Health Operations) Katz IR (Office of Mental Health Operations) McCarthy JF (SMITREC, Office of Mental Health Operations)

Veterans Affairs (VA) policy requires that Veterans requesting or referred for mental health (MH) treatment must receive timely initial evaluations, including determination of urgency, provision of immediate services when urgent, identification of appropriate setting for treatment, arrangement for treatment, provision of contact information, and addressing concerns. When not urgent, Veterans should receive evaluations that day if presenting in person or by the next day if by telephone. In April 2016, the My VA Access Initiative began chart reviews to assess performance. We describe chart review sampling, protocols, and findings, overall and by setting where need was identified.

For six months between 4/1/2016-1/31/2017, we identified Veterans new to MH (with MH encounter, appointment, or consult request after two-year clean period). 4200 randomly selected charts were reviewed (5 per administrative parent site per month). For reviews from May through January, chi-square tests evaluated whether meeting all goals differed by setting where need was identified (Emergency Department, MH, Non-PC-MHI Primary Care, OEF/OIF Clinic, PC-MHI, Veterans Crisis Line [VCL], Women's Health, Other) and whether in-person or by telephone.

Meeting all goals ranged from 31% (May 2016) to 42% (January 2017). Veterans were most often informed of the next step for care by a licensed independent provider (LIP). Questions/concerns were responded to by an LIP or a registered nurse. Urgency was typically established by asking about suicidal thoughts and documented by an LIP (56%-65%). Given urgent need, emergency treatment was provided for 75-100% of Veterans. Providing instructions for accessing emergency services was documented for 50% or fewer. Documentation of meeting all goals was more likely when need was identified in the Emergency Department (p < 0.001) or VCL (p < 0.001) versus MH settings, and when in person (44.4%) vs. by telephone (25.6%; p < 0.001).

Although reviews indicate incomplete documentation, there were improvements in documenting responses to concerns and arrangement for treatment. Findings suggest the need to enhance suicide screening and providing emergency contact information for use outside of clinic hours.

Further work is needed to deliver and document initial evaluations for Veteran new to mental health.