New research om warm handoffs

Warm handoffs are often recommended as a great way to get patients who need Behavioral Health services from the Primary Care Provider to the Behavioral Health Provider. Not only are they in our IBH-PC toolkit, they are one of my favorite tools. They have great face validity, and in my experience, they work extremely well. So, I was quite surprised to see this recent report.

Warm Handoffs and Attendance at Initial Integrated Behavioral Health Appointments

1. Christine A. Pace, MD, MSc1⇑, 
2. Katherine Gergen-Barnett, MD2, 
3. Alysa Veidis, RN, MSN, NP-BC3, 
4. Joanna D’Afflitti, MD, MPH1, 
5. Jason Worcester, MD1,
6. Pedro Fernandez, MD4 and 
7. Karen E. Lasser, MD, MPH1

+Author Affiliations

1. 1Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
2. 2Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
3. 3Commonwealth Care Alliance, Boston, Massachusetts
4. 4Department of Psychiatry, University of Texas Southwestern, Dallas, Texas

1. CORRESPONDING AUTHOR: Christine Pace, MD, MSc, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02117, Christine.pace@bmc.org

Abstract

Though integrated behavioral health programs often encourage primary care physicians to refer patients by means of a personal introduction (warm handoff), data are limited regarding the benefits of warm handoffs. We conducted a retrospective study of adult primary care patients referred to behavioral health clinicians in an urban, safety-net hospital to investigate the association between warm handoffs and attendance rates at subsequent initial behavioral health appointments. In multivariable analyses, patients referred via warm handoffs were not more likely to attend initial appointments (OR = 0.96; 95% CI, 0.79-1.18; P = .71). A prospective study is necessary to confirm the role of warm handoffs.

As the authors note, this is a retrospective analysis that is subject to unmeasured confounding, so a more complete story awaits an RCT. The article can be found online here.

- Ben Littenberg