Virtual Mental Health Crisis Ward: Evaluating Patient Outcomes and Cost Effectiveness

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Shterenberg, Ravit
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A virtual psychiatric reassessment and observation Unit (vROU) was launched in March 2020 at the Winnipeg Crisis Response Center (CRC) in response to the COVID-19 pandemic. It is based on a hospital-at-home model where patients receive monitoring and interventions from home with the goal of reducing hospitalizations. This study's aim was to assess the vROU user characteristics, patient-level predictors of hospitalization, acute care use in the 30 days post discharge, and cost-effectiveness of the model in comparison to usual hospital care using a break-even analysis. A retrospective chart review of all admissions from the first two years of the program (March 23rd, 2020 to May 31st, 2022) was completed. Pre and post-program health care utilization from electronic patient records were retrieved including emergency department visits and hospitalizations. A logistic regression was completed to identify predictors of hospitalization from the vROU. Thirty-day cumulative survival for acute care use post-discharge was calculated. A break-even cost analysis was done using data from the Canadian Institute for Health Information to create cost models for the program compared to usual hospital-based care. During the study period, the vROU had 197 admissions; 59.7% of which exhibited suicidal behaviour and 26.9% that presented with psychosis and/or mania. Suicidal planning (OR = 14.50, 95% CI 1.19-176.34, P=.036) and psychosis and/or mania (OR = 45.30, 95% CI 5.26-389.93, P=<.001) were significantly associated with hospitalization. Twelve patients (Cumulative survival=.93) were hospitalized in the 30 days post-discharge. The vROU was cost-saving compared to usual care.
Virtual Mental Health, Health Crisis