"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.