This study was conducted to understand the use of a mobile app (titled Pathway) to help patients track depression symptoms, medications, side effects, and goals in addition to the usual care with their doctor. Investigators compared the effect of the app over 6 months and examine whether the app can increase engagement between patients and their doctor and help in the management of illnesses as patients started a new treatment for depression. The investigators hoped that using an app to facilitate management of depression symptoms, medication use, and side effects help patients and their providers understand their response to medications and lead to better response and improvements in depression.
A pre- and post- study design was utilized to assess the impact of implementing the Pathway Platform in the primary care setting. The Pathway Platform consists of a mobile app for patients and a care team interface that can be accessed through Epic (electronic medical record system). Eight primary care sites were identified to participate in the study. Care team members involved in depression management received education on evidence-based clinical practices for depression care, such as measurement-based care practices and shared- decision making. Clinics with behavioral resources also received additional education on behavioral health integration. Training on how to onboard patients to use the Pathway Platform and utilize electronic medical records to view data collected in the Pathway Platform was also provided. Study outcomes identified in this protocol are described among patients enrolled in the Pathway Platform (post-implementation cohort) as well as a similar group of patients from the same participating clinics prior to study implantation (pre-implantation cohort). Implementation success was evaluated by comparing study outcomes among these two cohorts. The primary outcome is PHQ-9 utilization over six months are compared between the pre- and post- implementation cohorts. Additional process measures compared include; shared-decision making, medication adjustments, referrals to behavioral health, primary care follow-up post hospitalizations, and depression remission and response. Data collected in the Pathway Platform is also used to explore pre-defined patient outcomes.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
89
The pathway platform intervention involves 3 components: 1. The patient facing app which will: a) Gather health information related to depression management and patient-Provider engagement. b) Clinical data collection; PHQ-9, WHO-5, PDQ-D-5, medication adherence and side effects, goal setting and goal tracking. c) Research data; Patient Activation Measure -13\[PAM-13\], CollaboRATE, and Work and Social Adjustment Scale \[WSAS\]. 2. Electronic Medical Record Integration - a) Data collected in the app is accessible to care team in real time. b) Provide a longitudinal summary to assist in decision making and depression management. 3. Educational Scaffolding - a) Training program describing how the Pathway Platform can support care team members in clinical processes related to measurement-based care and shared-decision making. b) Includes ongoing feedback with up to three audit cycles.
Advocate Christ Medical Center
Oak Lawn, Illinois, United States
Proportion of Patients Who Completed Patient Health Questionnaire
Proportion of patients who have at least 2 Patient Health Questionnaire (PHQ) scores documented in their medical record over the 6 month study period will be compared between pre- and post- Pathway app implementation to determine if there is a change in adherence to measurement based care practices following the implementation of the Pathway Platform in a primary care setting.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Process Outcome: Measurement-based Care
The proportion of patients reflecting measurement-based care informed major depression disorder treatment adjustments in their charts, defined as at lease one medication dose change, switch or add on medication.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Process Outcome: Shared-decision Making
The proportion of patients reflecting shared-decision making using the OPTION12 Tool framework.
Time frame: 6 months prior to and 6 months post-implementation of the Pathway Platform app
Process Outcome: Referrals to Behavioral Health
The proportion of patients with at least one referral will be compared.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Process Outcome: Total Number of Hospitalized Participants During Follow up Period
The number who receive follow-up within 7 days of discharge and within 30 days of discharge.
Time frame: 6 months prior to and 6 months post-implementation of the Pathway Platform app.
Process Outcome: Follow-up After Emergency Department Visit for Mental Illness
The proportion of adults who receive follow-up within 7 days of discharge and within 30 days of emergency department visit.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Process Outcome: Healthcare Resource Utilization, Hospital Admissions
The number of hospital admissions among patients receiving care at a clinic participating in this study.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Process Outcome: Number of Behavioral Related Hospitalizations
Time frame: 6 months prior to and 6 months post-implementation of the Pathway Platform app.
Process Outcome: Healthcare Resource Utilization, Emergency Room Admissions
The number of emergency room admissions among patients receiving care at a clinic participating in this study.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Process Outcome: Healthcare Resource Utilization, Outpatient Visits
The number of outpatient encounters among patients receiving care at a clinic participating in this study.
Time frame: 6 months prior to and 6 months post-implementation of the Pathway Platform app.
Process Outcome: Primary Care Physician (PCP) Visits
The costs associated with health care services among patients receiving care at a clinic participating in this study. Costs will be calculated using USA national average costs for inpatient and outpatient visits.
Time frame: 6 months prior to and 6 months post-implementation of the Pathway Platform app.
Patient Health Questionnaire-9 [PHQ-9] Score
Median Patient Health Questionnaire-9 \[PHQ-9\] scores \<=5 at the end of the study period. Scores from this nine item questionnaire can range from 0-27. Higher scores indicate greater severity of depression. The last measurement available will be used to calculate remission. For participants 'Baseline' refers to the PHQ9 value the patient entered on the day they downloaded the app. For pre-implementation controls 'Baseline' refers to the PHQ value from the EHR on the qualifying visit.
Time frame: Baseline to 6 months post-implementation of the Pathway app
Patient Health Questionnaire-9 [PHQ-9] Score Reduction
Number of patients with a 50 percent or greater reduction in PHQ-9 scores. Scores from this nine item questionnaire can range from 0-27. Higher scores indicate greater severity of depression. A 50 percent reduction in score reflects significant improvement in depression. The first and last scores available during the study period will be used to calculate response.
Time frame: Baseline to 6 months post-implementation of the Pathway app
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