Project Details - Ongoing
- Grant Number:U18 HS026151
- Funding Mechanism:
- AHRQ Funded Amount:$1,170,087
- Principal Investigator:
- Project Dates:8/1/2018 to 6/30/2021
- Care Setting:
- Medical Condition:
- Type of Care:
- Health Care Theme:
Major depressive disorder (MDD) is prevalent and associated with reduced quality of life and suicide. However, only 50 percent of patients in primary care receive recommended annual screening for MDD, and only 50 percent of patients with MDD in primary care receive adequate treatment. The Computerized Adaptive Test for Mental Health (CAT-MH) is a validated test that uses algorithms in real time to ask diagnostically informative questions and assesses mental health symptoms, including depression. In general, CATs could be ideal for engaging patients in providing patient-reported outcomes (PROs) because these tests are precise and brief.
Patient portals are secure websites that give patients access to their health information via a web connection. To date, however, portals have not been used proactively by healthcare systems to systematically collect PROs and integrate PROs into clinical care. Population-wide proactive collection of PROs would be valuable for identifying and managing patients with depression. This project will integrate the CAT-MH into an electronic health record (EHR) and evaluate the effectiveness of collecting depression symptoms via a patient portal. In two randomized controlled trials (RCTs), screening and depression remission rates will be compared between usual care symptom assessments during primary care visits versus portal-based symptom assessments in addition to usual care.
The specific aims of this project are as follows:
- To determine whether portal-based CAT-MH depression screening increases the number of screenings compared to usual care among primary care patients who are due for depression screening.
- To determine whether patients with active MDD who receive portal-based depression measurement have higher rates of MDD remission compared to patients with active MDD who receive usual care.
The project team hypothesizes that patients asked to complete assessments via the patient portal will have higher screening rates for depression, receive more timely treatment, and have greater rates of remission than patients only screened and treated during in-person visits. Findings from this project will identify barriers and solutions to integrating adaptive tests for PROs into EHRs and provide evidence for the use of patient portals to measure PROs. Use of patient portals to gather population-level PROs may provide a valuable new approach to engage and treat patients with MDD, particularly those who are less likely to attend clinic visits and more likely to present for costlier emergent care.