Introduction: Integrated care models have many benefits, including accessibility, patient satisfaction, reduction in stigma of mental health care, and improved coordination (Jackson et al., 2013, Miller-Matero et al., 2018). The warm handoff (WHO) is a technique often used in integrated care to improve patient engagement and better utilize the multidisciplinary team. Prior literature has noted barriers toward understanding the impact of WHOs, including variable implementation and complexities in an outpatient setting (Beehler, 2021), with a noted need for staff buy-in to implement such an approach (AHRQ, 2018). Given the existing literature and barriers, this study set out to examine perceptions and utilization of warm handoff model within high-volume resident driven integrated primary care/internal medicine clinic. Methods: Sample included 7 internal medicine attendings and 34 resident physicians. All participants completed an 8-item questionnaire assessing perceptions, utilization, and barriers of warm handoff services for integrated behavioral health, pharmacy, and case management services. Objective data on frequency of warm hand utilization by referring providers was additionally collected through system medical records. Results: 24% of providers selected that they provide warm handoffs weekly or more, 28% monthly, 35% rarely (once every few months), and 12% of providers have never provided a warm handoff. The most selected reasons for why the providers use warm handoffs included: extending care provided at a clinic visit (86%), to help patient understand the service (79%), team member can more immediately address patient need (76%), and improves access (76%). 98% of respondents identified the patients benefit from the warm handoff and 90% identified that the physician provider benefits from the warm handoff. When asked about barriers for warm handoffs, 78% of providers selected that they were too busy in clinic, 74% identified that patients were unable to wait, and 55% identified that multidisciplinary providers were too busy. The month prior to the lecture, the psychology team completed 19 warm handoffs (brief intro and full appointments). In the month following the lecture, the team completed 41 warm handoffs (brief intro and full appointments). Conclusions: This work highlights that understanding the perception of the warm handoffs from providers is helpful in addressing barriers. Further, it demonstrates that a brief educational didactic on the benefits of the warm handoff increase rates of warm handoffs in a busy resident driven academic internal medicine clinic.
Beehler, G. P. (2021). Researching warm hand-offs: Should we give a WHOot? [Editorial]. Families, Systems, & Health, 39(2), 173-176. https://doi.org/10.1037/fsh0000626
Fountaine, A. R., Iyar, M. M., & Lutes, L. D. (2023). Examining the utility of a telehealth warm handoff in integrated primary care for improving patient engagement in mental health treatment: Randomized video vignette study. JMIR Formative Research, 7. https://doi.org/10.2196/40274
Young, N. D., Mathews, B. L., Pan, A. Y., Herndon, J. L., Bleck, A. A., & Takala, C. R. (2020). Warm handoff, or cold shoulder? An analysis of handoffs for primary care behavioral health consultation on patient engagement and systems utilization. Clinical Practice in Pediatric Psychology, 8(3), 241-246. https://doi.org/10.1037/cpp0000360
Mitchell, D., Olson, A., Randolph, N. (2022). The impact of warm handoffs on patient engagement with behavioral health services in primary care. Journal of Rural Mental Health, 46(2), 82-87. https://doi.org/10.1037/rmh0000199
Tobin, E., Green, D., Nair, A., Willens, D. E., Miller-Matero, L. (2023, October 19). Improving follow-up with integrated psychological services in primary care. Grand Rounds. Detroit, MI, USA.