Faculty Bibliography

This study aims to evaluate the quality and potential clinical benefits of a novel program, called the Enhanced Treatment and Recovery (EnTRy) Program, which provides Coordinated Specialty Care (CSC) without limits on diagnosis, age, or treatment time to individuals with serious mental illnesses (SMI). To assess recovery of participants, we compared the baseline Substance Abuse and Mental Health Services Administration (SAMSHA) National Outcome Measures (NOMs) in patients enrolled in EnTRy to that at 6 months and 12 months. To explore whether EnTRy provided benefits over standard treatment, we compared the time engaged in treatment for the EnTRy cohort with that of a historic sample from the same clinical site. Participants were significantly less likely to have a psychiatric hospitalization in the past 30 days during follow-up assessment at 6 months (19% at baseline, 1% at 6 months, (χ² (1, N = 1006) = 91, p<0.0001) and 12 months (16% at baseline, 1% at 12 months, χ² (1, N = 486) = 37.633, p<0.0001). Participants were similarly less likely to have psychiatric emergency service encounters in the past 30 days at 6 months (18% at baseline, 1% at 6 months, χ² (1, N = 1004) = 86.808, p < 0.0001) and at 12 months (16% at baseline, 2% at 12 months, χ²(1, N = 486) = 32.387, p= 0.0001). Patients enrolled in the EnTRy program remained engaged with care for significantly longer than a historical sample (p< 0.0001 by Mantel-Cox logrank) with a logrank hazard ratio of 2.0 (CI 1.65- 2.43). Age and diagnosis-unlimited CSC may be particularly effective for individuals with SMI who recently received hospital level care and may help maintain gains in individuals who have aged out of programs dedicated to first episode psychiatric illness.

This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.