Mental Health eConsults

This study assesses the effects of electronic consultations (eConsults) between primary care
providers and psychiatrists as a way to support the delivery of mental health services in
primary care settings. The setting for the study are the primary care clinics of Allina
Health.

The study uses a randomized rollout design. Across 45 primary care clinics, half of the
clinics will be randomly assigned to receive access to eConsults at the start of the study.
The other half of the clinics will provide care-as-usual for nine months, at which point
they will also gain access to eConsults. Stratified randomization will be used, with
stratification on whether primary care clinics have co-located specialty mental health
services.

For primary care clinics that are given access to eConsults, the primary care providers in
those clinics will have the option of ordering an eConsult on behalf of their patients,
which will include specific questions about a particular patient's care. The request is
routed to the service region's psychiatry pool, and the psychiatrists have the option of
responding. If they choose to respond, the psychiatrist responds with their recommendations
within one business day, and the PCP proceeds with care accordingly. The psychiatrist
receives 0.75 work relative value units (wRVUs) for providing this service. All
communications for the eConsult are routed through Allina's Epic system. Although patients
will not be billed for eConsults over the course of the proposed research, some insurance
plans do cover it and evidence of eConsult effectiveness may impel other insurers to cover
the service.

The study will have two components. First, the investigators will collect web survey data
from the primary care providers to assess how access to eConsults affects providers'
perceptions of their support and skill for delivering mental health services to their
patients. Second, the investigators will assess the effects of receiving eConsults at the
patient level, by using data from the Electronic Medical Record system.

Inclusion Criteria:

- For the provider surveys, we will recruit all of the primary care providers who work
in Allina's primary care clinics to participate in the surveys

- For the patient-level analysis, we will examine data from all patients seen in
Allina's primary care clinics during the study period. We will include children and
adults.

Exclusion Criteria:

- We will exclude patients from the patient-level analysis who have opted that their
secondary data not be used by Allina for research purposes.