Date of Award

2026

Document Type

Dissertation

Degree Name

Doctor of Nursing (ND)

First Advisor

Dr. Sueanne Davidson

Abstract

Timely access to mental health care remains a challenge for new Veterans entering primary care at the Meridian Community-Based Outpatient Clinic (CBOC). Although a Microsoft Teams warm hand-off referral system to Primary Care Mental Health Integration (PCMHI) was available, referrals were inconsistently initiated, limiting use of psychiatric mental health nurse practitioners (PMHNPs) and reducing opportunities for same-day access. This quality improvement project examined whether revising the educational training process for CBOC staff would improve referral efficiency and increase same-day PCMHI encounters for new Veterans. Guided by Orem’s Self-Care Framework, the intervention consisted of monthly educational sessions from June to December 2025 that emphasized PCMHI services, appropriate use of the warm hand-off chat, and the importance of timely referrals. A pre–post design was used, with 23 weeks of pre-intervention data and 28 weeks of post-intervention data extracted from the Corporate Data Warehouse. Two metrics were analyzed: Patients with a Qualifying Same-Day Encounter and New PCMHI Patients with Initial In-Person Encounter. Descriptive statistics, Mann–Whitney U tests, and Poisson regression models revealed no significant change in same-day encounters (U = 337.5, p = .758; Exp(B) = 0.873, p = .553) and a significant decrease in new PCMHI initial in-person encounters post-intervention (U = 174, p = .004; Exp(B) = 1.727, p < .001). Although the intervention improved staff awareness and standardized referral expectations, it did not increase same-day access and was associated with fewer new PCMHI encounters. Contributing factors included inconsistent provider engagement, workflow variability, and high demand from established Veterans seeking re-engagement. Findings underscore the need for enhanced tracking, sustained education, and system-level workflow adjustments to ensure new Veterans are consistently offered same-day PCMHI services. Future efforts should incorporate qualitative feedback, expand training across additional CBOCs, and strengthen interdisciplinary communication to optimize referral efficiency and timely mental health access for Veterans.

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