Comparison of Asynchronous Telepsychiatry vs. Synchronous Telepsychiatry in Skilled Nursing Facilities (CATeleST) ABSTRACT Access to psychiatric consultation is a critical problem in Skilled Nursing Facilities (SNFs), especially in rural settings. This SNF study population is an AHRQ priority population including people with chronic care needs and end-of-life healthcare, and also meets the Healthy People 2020 key topics of dementia and mood disorders in older adults. The Center for Medicare and Medicaid Services (CMS) recognizes this problem and reimburses for Synchronous Telepsychiatry (STP) in rural settings, but not in metropolitan regions. Many facilities struggle with access to psychiatrists and several have contracted with our health system to provide STP services. Despite the availability of STP, it is underutilized due to administrative barriers. Asynchronous Telepsychiatry (ATP) utilizes recorded video transmitted and stored through encrypted data portals and allows for a more timely and flexible delivery of high-quality psychiatric consultations. ATP is more patient-centered because nursing facility staff and family members participate actively in the interviewing and video-recording processes. By addressing psychiatric symptoms that would otherwise be untreated until emergency or inpatient treatment is needed, ATP may improve health care quality (AHRQ Priority #1) and SNF residents' quality-of-life In 2015, we obtained an internal grant and designed study protocols (approved by the UC Davis IRB) that have allowed us to complete a pilot study to test the methodology and feasibility of using ATP in SNFs for this trial. We have successfully completed 20 ATP and 20 STP baseline evaluations at two SNF sites. We found both ATP and STP lead to reductions of inappropriate antipsychotic medication usage and therefore improved patient safety (AHRQ Priority #2). As we have successfully piloted the procedures necessary to compare ATP vs. STP in SNF populations, we now plan to conduct a large scale comparative study of ATP vs. STP (n=250) in order to test our hypothesis that ATP is as clinically effective as STP but is more accessible, administratively simple and cost-effective. We plan to collaborate with 6 SNFs and follow each participant for a total of 12 months in this 5 year study. 1