Development of a cloud-based, self-report SUD intake system enabling primary care clinicians to routinely complete, implement, document, and bill for biopsychosocial assessments for the underserved

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Project Summary The US healthcare delivery system suffers from intractable problems that increasingly prevent it from identifying and treating people suffering from SUDs. Primary care clinicians, the front line of our health care delivery system, have neither adequate tools nor incentives to evaluate SUDs and co-occurring mental health disorders. The result is chronic under-diagnosis and under-treatment, in addition to the associated adverse personal and societal impacts. These shortcomings disproportionately affect individuals from underserved populations who already have poor access to health care resources. We propose to develop and test a new Primary Care-SUD-Intake System (P-SUD-IS) that is intended to address the problem of under-diagnosis by changing primary care clinician behavior and motivating clients with previously undiagnosed SUDs to seek help. The P-SUD-IS will be a HIPAA-compliant, user-friendly, automated, and cloud-based system, and, if successful, will reduce the time needed for primary care clinicians to complete and bill for a biopsychosocial assessment. The P-SUD-IS will assess and record family SUD history, personal SUD history, educational history, occupational history, social history, current social supports, and willingness to participate in treatment. Diagnosis and a mental status exam will be conducted using TeleSage’s existing validated DSM-5 self-report diagnostic system (SAGE), which will be integrated into the new P-SUD-IS. Responses to all questions will be used to provide clinicians with detailed electronic reports that can be entered into the client’s EHR. This system is in no way intended to replace the clinician. As a decision-support tool, the P-SUD-IS is intended to help clinicians without specialized training in behavioral health and SUDs use all available resources to complete a biopsychosocial assessment. This study will assess whether underserved primary care clients might be willing and able to complete the P-SUD-IS. Questions will be written at a 5th grade reading level and read aloud using a native text-to- speech application. The client will receive a highly customized electronic report with educational & self-help information as well as links to relevant on-line referral systems. The P-SUD Intake System will generate a report containing actionable information that will make it easier for primary care clinicians to determine if a referral is warranted, and for them to provide the referral documentation that will be most helpful. The new strategy needs to fit within the normal workflow of primary care clinics so as not to cause disruptions. Our goal is for the clinician to be able to look at the report for 2-3 minutes, ask the client specific questions informed by the report, discuss options with the client, finalize the treatment plan, write orders, and bill a sufficient amount for a biopsychosocial assessment to make the whole process economically feasible. By making primary care SUD assessments cost effective and feasible, the P- SUD-IS will have a large impact on the underserved and undiagnosed.