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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
4,161
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).
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).
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.
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.
University of Chicago
Chicago, Illinois, United States
Percentage of Patients screened for depression using the BPA by study arm
Time frame: 12 months
Percentage of patients who have MDD remission
Time frame: 12 months
Time to MDD remission
Time frame: 12 months
Percentage of logins to MyChart in response to the email invitations
Time frame: 12 months
Percentage of opened MyChart depression screening messages
Time frame: 12 months
Number of MyChart messages sent to PCPs by patients (or to patients by PCPs) following depression screening
Time frame: 12 months
Percentage of patients who start the CAT-MH assessment
Time frame: 12 months
Percentage of patients who complete the CAT-MH assessment
Time frame: 12 months
Percentage of positive screens
Time frame: 12 months
Number of appointments scheduled and completed (primary care and psychiatry/psychology)
Time frame: 12 months
Number of telephone encounters in the week following the positive depression screen
Time frame: 12 months
Number of emergency department visits or hospitalizations due to MDD
Time frame: 12 months
Percentage of logins to MyChart in response to MyChart emails
Time frame: 12 months
Percentage of opened MyChart depression symptom measurement messages
Time frame: 12 months
Number of MyChart messages sent to PCPs by patients (or to patients by PCPs) following completion of the CAT-DI
Time frame: 12 months
Percentage of patients who start CAT-DI assessments
Time frame: 12 months
Depression severity scores (CAT-DI)
Time frame: 12 months
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