"Nice to Meet You": A Quality Improvement Project to Increase Warm Handoffs

Objective: Low rates of behavioral health (BH) engagement and poor follow-up can exacerbate youth mental health difficulties. Warm handoffs, when a primary care provider (PCP) introduces the patient to the BH care provider in an integrated setting, have been shown to improve the rate of BH follow-up appointments. This 1-year study describes a quality improvement (QI) project conducted at a large, urban pediatric primary care practice, with aims of (a) improving the percentage of warm handoffs performed for pediatric patients referred to behavioral health by 100% and (b) increasing the proportion of warm handoffs completed per primary care provider (PCP) for 60% of all PCPs. Methods: Using QI methods, a multidisciplinary team implemented tests of change via Plan-Do-Study-Act cycles (PDSAs) and completed a run chart of number of warm handoffs to assess performance. A balancing measure was used to determine impact of increased warm handoffs on behavioral health provider's sessions. Results: The percentage of warm handoffs doubled compared to the baseline period (37% vs. 18%), and there were significant differences in follow-up rates between referred patients who received a warm handoff (73.1%) and those who did not (49.5%), regardless of whether the same BH provider conducted the warm handoff and follow-up visit, or whether two different BH providers were involved. Additionally, the number of warm handoffs per PCP increased for over 70% of total PCPs. Conclusions: This project demonstrated (a) the utility of using QI procedures to meet our aims and (b) the importance of warm handoffs in an integrated setting. Implications for Impact Statement This QI project focused on increasing warm handoffs in primary care because they improve behavioral health (BH) follow-up appointments. A warm handoff is a practice by which the primary care provider (PCP) introduces the patient to the BH care provider during the patient's medical visit. Using QI methods, this project increased the percentage of warm handoffs received among referred pediatric patients to BH by over 100% and increased the proportion of warm handoffs completed per PCP for at least 60% of PCPs. Increasing warm handoffs to BH providers should be considered a best practice to help address the potentially chronic effects of untreated childhood mental health disorders.