Project Details -

Ongoing

Patients with both physical and mental health conditions often require care coordination from care managers (CMs). However, many CMs report lacking sufficient training and resources to support patients with their mental health, particularly depression, which is more common among adults with chronic medical conditions. This gap is exacerbated by limited specialty mental healthcare resources, long waitlists for services, and other barriers to care. Despite the availability of evidence-based, digital mental health (DMH) technologies to guide CMs, DMH implementation is often unsuccessful in real-world, ambulatory care settings due to technological obsolescence after lengthy research trials and incompatibility with existing clinical workflows.

To address this issue, researchers at Northwestern University will adapt and implement a DMH intervention to increase access to and improve coordination of mental health services in an ambulatory care setting as well as develop an implementation guide to support replication and sustainability in other healthcare systems.

The specific aims of the research are as follows:

Adapt a digital mental health platform and service model to address implementation barriers within care coordination.
Develop and subsequently optimize a multicomponent implementation strategy.
Conduct a randomized rollout effectiveness-implementation trial of the DMH platform and a sustainment pilot period in the four regional teams of the Ambulatory Care Coordination service.

To achieve these aims, the research team will employ a user-centered design approach to adapt an existing DMH platform and service model, including design feedback workshops and usability testing with CMs and patients. The research team will also convene a Stakeholder Advisory Board to iteratively develop and refine a set of implementation strategies to inform the rollout of a rapid-cycle randomized trial to assess the efficacy of the DMH intervention. The intervention will be evaluated based on efficacy, reach, acceptability, feasibility, fidelity, adoption, and cost compared to treatment as usual. Following the trial, the research team will transition all key implementation functions to the study site’s CM staff and monitor intervention effectiveness during a 6-month sustainment pilot. Lessons learned will be compiled into an implementation guide for use by other integrated healthcare systems.

The findings of this research will demonstrate the utility of tailored approaches to implementing DMH technologies and inform potential scaling of such interventions into a broader range of healthcare settings.

Digital Tools to Support Care Coordination for People with Depression

Theme:

Optimizing Care Delivery for Clinicians

Subtheme:

Optimizing Data Visualization to Improve Care

Adaptation of a digital mental health intervention has the potential to improve the coordination of and access to mental health services in ambulatory care settings.

Coordinating scarce mental health services to improve depression care

Care coordinators are typically nurses or social workers who provide guidance and resources to patients who have difficulty managing their healthcare. Unfortunately, care coordinators often struggle to find mental health services—especially for depression management—as resources are limited, waitlists for services are long, and stigmas prevent patients from asking for help.

Technology helping care managers to manage patients’ mental health

As a clinical psychologist, Dr. Emily Lattie is well aware of how important care coordination services are to patients who have acute or chronic health conditions along with depression. To overcome challenges supporting patients, she and her Northwestern University based team are adapting and implementing a digital mental health intervention that is packaged within a patient management system for depression to increase access to and improve coordination of mental health services in ambulatory care coordination.

The enhanced system, referred to as a technology-enabled service (TES), will include the IntelliCare platform, which includes a patient-facing app targeting specific psychological strategies, and a care coordination dashboard. The adaptation of the IntelliCare technology, service protocols, and development of implementation strategies will result in a TES that helps patients develop self management skills and provides care managers with information and tools to manage the patient’s mental health, thereby improving healthcare quality and patient outcomes.

“We know that stress from health conditions affects people’s mental health and their quality of life. We also know that having poor mental health or a lot of stress makes it a lot more challenging to manage physical health conditions. So people often wind up in this unfortunately challenging cycle. By providing training support services to professionals like care coordinators, who work with folks who often experience challenges, we’re able to find another entry point to help people.”
- Dr. Emily Lattie

Increasing access to mental health care

The team will study how the TES (1) increases access to care for depression for patients in four teams implementing the intervention, and (2) impacts depression severity. It will also develop an implementation guide to support replication and sustainability in other healthcare systems. As Dr. Lattie noted, “While this research was proposed before the COVID-19 pandemic, this work has become more timely than ever as we’ve been having an increasing mental health crisis on our hands in the United States.”