‘A Pandemic on Top of COVID-19’.

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‘A Pandemic on Top of COVID-19’

SPH alum Paola Peynetti Velázquez is part of a Cambridge Health Alliance team that formed a telepsychiatry program in just five days to avoid an interruption in mental health services during the pandemic.

September 28, 2020
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When the surge of COVID-19 cases abruptly forced a statewide shutdown in Massachusetts earlier this year, the performance improvement and psychiatry departments at Cambridge Health Alliance (CHA) sprang into action.

Paola Peynetti Velázquez

While many units within the 140,000-patient, safety-net health system needed to shift their focus to COVID-19 and minimize non-essential in-person care, these departments recognized the urgent need for continued psychiatry services for patients, as the pandemic would inevitably exacerbate mental distress.

In just five days at the end of March, School of Public Health alum Paola Peynetti Velázquez (SPH’17) and a team of CHA medical and administrative staff members designed a telepsychiatry program and converted all non-urgent, outpatient mental health appointments into a telehealth format.

“We knew there was going to be a pandemic on top of COVID-19—a pandemic of mental health conditions all around the world,” says Peynetti Velázquez, who has served as the senior performance improvement advisor in CHA’s Quality and Safety Department since she completed the BA/MPH program (at the Frederick S. Pardee School of Global Studies and SPH) in December 2016. “We knew that the prevalence of anxiety, stress, depression, trauma, substance use, and other conditions would increase in our communities and we wanted to make sure that we could continue to care for established patients and accommodate new demand. Our goal was to create a process that ensured safe, timely and quality mental healthcare for all patients, and we accomplished that.”

Peynetti Velázquez is the lead author of a commentary published in the July 2020 issue of the journal NEJM Catalyst Innovations in Care Delivery that offers strategies and recommendations on how healthcare organizations can transform their mental health services into virtual spaces in the age of social distancing.

Co-authored by CHA colleagues on the newly formed telepsychiatry implementation team, the commentary details the rapid process of switching in-patient care to phone and video appointments, using Lean methods. From March 27 to March 31, after being asked by CHA´s Pandemic Incident Command Center to ensure continuity of outpatient mental health care virtually, the team collaborated with psychiatry managers, staff, and providers, as well as staff from marketing, interpreter services, and IT to develop and translate patient communication content, validate confidentiality and safety of workflow, create FAQ documents, and hold multiple training sessions for providers and appointment schedulers.

But the transition to digital services did not occur without a steep learning curve for all involved, Peynetti Velázquez says.

“The patients, providers, and schedulers are all equally important stakeholders in this process,” she says. “If the scheduler is not prepared to introduce the concept of a video visit to the patient, or they don’t document correctly what [type of virtual visit] the patient wants, then this process wouldn’t work.”

Communicating all information clearly—and in multiple languages—is also paramount, as more than 40 percent of CHA’s patient population speaks a primary language other than English.

“It’s a vulnerable population that faces a lot of barriers with access to technology, access to the Internet, and digital literacy,” says Peynetti Velázquez, adding that many patients do not own a computer and have never used a smart phone. In the initial feedback from providers, “one provider decided to conduct visits with a patient only by phone, because the patient told him they would use their whole month’s worth of data in just one video visit.”

The benefits of telepsychiatry are vast; it lends for convenient and flexible care, without the stress of travel time or long waits in a doctor’s office. The program led to “a reduction of no-shows, stability in volume of visits, and an opportunity to consider strategies that will enhance seamless delivery of equitable and quality care for all,” the authors write in the NEJM article. CHA has been working on a system to create a standard workflow for telehealth across all service lines, says Peynetti Velázquez.

She and members of the team also recently presented the telepsychiatry program in two webinar series, including the HHS: Telemedicine Hack—Bonus Hack, organized by US Health and Human Services and the National Consortium of Telehealth Resource Centers on September 3, and the GMH@Harvard Webinar, hosted by the Harvard Global Mental Health Initiative on September 10.

Peynetti Velázquez says the practice-based courses she took at SPH, including mHealth with James Wolff, associate professor of global health and Operations Management in Health Care with her current boss and former SPH professor, Gouri Gupte, director of performance improvement at CHA and a co-author of the NEJM Catalyst article, gave her real-world skills and tools to solve complex problems to improve the care of vulnerable populations. SPH is well-represented among CHA staff, says Peynetti Velázquez.

“The whole performance improvement team is made up of BUSPH alums,” she says. “We also host practicum students, and students from the practice-based courses do consulting work with us, so this collaboration has been fantastic for the students and for our team.”

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‘A Pandemic on Top of COVID-19’

  • Jillian McKoy

    Senior Writer and Editor

    Jillian McKoy is the senior writer and editor at the School of Public Health. Profile

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