Depression, Depressive Disorder, Major
Conditions
Brief summary
Currently, very little research exists on whether patient portals could be used to integrate patient-reported outcome (PRO) measurement into the electronic health record (EHR) and clinical practice, even though 87% of ambulatory care practices have EHRs and 88% of U.S. adults have access to the internet. To date, no randomized controlled trial has examined whether patient portals can be used to collect PRO measures. The goal of this study is to implement the integration of a computerized adaptive test (CAT) for patient-reported outcome (PRO) measurement of depression symptoms into an electronic health record (EHR) and evaluate the effectiveness of collecting CAT PROs via an EHR patient portal in two randomized controlled trials. This study will advance the science of implementation of patient-centered outcomes research into clinical practice, as well as the evidence for high quality, accessible care.
Detailed description
The overall goal of this proposal is to implement the integration of the Computerized Adaptive Test for Mental Health (CAT-MH) into an EHR for a healthcare system and evaluate the effectiveness of collecting CAT-MH PROs via an EHR-tethered patient portal (MyChart) vs. usual care in two randomized controlled trials. The first aim of this study will consist of a randomized controlled trial comparing screening rates among adult primary care patients with an active patient portal account (MyChart) and due for depression screening who receive usual care (CAT-MH screenings during routine clinic visits) vs. MyChart population-based CAT-MH screenings. The second aim of this study involves a randomized controlled trial comparing depression remission rates among patients with active moderate-to-severe MDD who receive usual care vs. MyChart CAT-MH measurement-based care. In addition, we will examine the resources needed to integrate the CAT-MH into the EHR and design the health IT strategy for collecting PROs via the patient portal.
Interventions
DIAGNOSTIC_TESTCAD-MDD/CAT-DI screening via MyChart
Patients will receive invitations via MyChart to complete the CAD-MDD to screen for major depressive disorder (MDD). For patients who screen positive for MDD, CAT-DI will launch automatically and assess depression severity. CAT-DI assigns a score of 0 to 100 in four severity categories (\<50=normal, 50 to 65=mild, 66 to 75=moderate, and \>75=severe).
DIAGNOSTIC_TESTCAD-MDD/CAT-DI screening during clinic visit
During routine in-clinic visits, medical assistants or providers will ask patients to complete the CAD-MDD to screen for major depressive disorder (MDD). For patients who screen positive for MDD, CAT-DI will launch automatically and assess depression severity. CAT-DI assigns a score of 0 to 100 in four severity categories (\<50=normal, 50 to 65=mild, 66 to 75=moderate, and \>75=severe).
OTHERCAT-DI monitoring via MyChart
Patients with active MDD will receive invitations via MyChart to complete the CAT-DI to assess MDD severity and remission. A normal CAT-DI score (\<50) will indicate that a patient's MDD is in remission.
OTHERPHQ-9 monitoring during clinic visits
During routine in-clinic visits, medical assistants or providers will ask patients to complete the PHQ-9 to assess MDD severity and remission. A PHQ-9 score \< 5 will indicate that a patient's MDD is in remission.
Sponsors
University of Chicago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
Patients randomized to MyChart will not be blinded to the intervention. Patients who are randomized to usual screening will not be informed about the intervention arm and, thus, will be blinded to trial assignment. PCPs will not be informed of the randomization; however, they will receive results whenever their patients complete the CAT-MH via MyChart.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years or older * considered an active clinic patient at the start date of the intervention * have an active MyChart account that is not managed by a proxy * receive care from a participating PCP * due for depression screening (screening arms) or active depression (monitoring arms)
Exclusion criteria
* under 18 years of age * bipolar disorder
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage of Patients screened for depression using the BPA by study arm | 12 months |
| Percentage of patients who have MDD remission | 12 months |
| Time to MDD remission | 12 months |
Secondary
| Measure | Time frame |
|---|---|
| Percentage of patients who start the CAT-MH assessment | 12 months |
| Percentage of patients who complete the CAT-MH assessment | 12 months |
| Percentage of positive screens | 12 months |
| Number of appointments scheduled and completed (primary care and psychiatry/psychology) | 12 months |
| Number of telephone encounters in the week following the positive depression screen | 12 months |
| Percentage of logins to MyChart in response to the email invitations | 12 months |
| Percentage of logins to MyChart in response to MyChart emails | 12 months |
| Percentage of opened MyChart depression symptom measurement messages | 12 months |
| Number of MyChart messages sent to PCPs by patients (or to patients by PCPs) following completion of the CAT-DI | 12 months |
| Percentage of patients who start CAT-DI assessments | 12 months |
| Depression severity scores (CAT-DI) | 12 months |
| Number of emergency department visits or hospitalizations due to MDD | 12 months |
| Percentage of opened MyChart depression screening messages | 12 months |
| Number of MyChart messages sent to PCPs by patients (or to patients by PCPs) following depression screening | 12 months |
Countries
United States
Outcome results
None listed