Developing Interoperable tools for anxiety and depression screening

开发用于焦虑和抑郁筛查的可互操作工具

• 批准号: 10512151
• 负责人: Heidi Munger Clary
• 金额: $ 7.75万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10512151
• 关键词: Anxiety; Applications Grants; Caring; Chronic; Clinic; Clinic Visits; Clinical; Collection; Custom; Data; Data Collection; Databases; Depression screen; Discipline of Nursing; Effectiveness; Electronic Health Record; Electronic Mail; Eligibility Determination; Epilepsy; Evidence based intervention; Future; Health; High Prevalence; Individual; Intervention Trial; Investigation; Link; Manuals; Measures; Medical; Mental Depression; Methods; Modality; Modeling; Monitor; Multicenter Studies; Neurologist; Neurology; Nursing Staff; Outcome; Outcome Measure; Patient Outcomes Assessments; Patients; Persons; Primary Health Care; Principal Investigator; Process; Process Measure; Provider; Psychiatry; Quality of life; Questionnaires; Randomized; Reporting; Reproducibility; Research; Site; Surveys; Symptoms; System; Systems Integration; Testing; Text; Text Messaging; Time; Translations; Treatment outcome; Visit; Work; anxiety symptoms; anxiety treatment; application programming interface; arm; base; clinical implementation; collaborative care; comorbidity; depressive symptoms; discrete data; effectiveness implementation trial; effectiveness study; electronic data; evidence base; implementation research; implementation strategy; implementation study; implementation trial; instrument; interoperability; medical specialties; nervous system disorder; patient health information; patient portal; patient screening; primary outcome; programs; recruit; screening; systems research; theories; tool; uptake

Project Summary Anxiety and depression are prevalent in neurological disorders and other chronic conditions requiring specialty care, and these comorbidities are often under-recognized and undertreated, despite greater impact on outcomes than the primary chronic condition. Clinician time-related barriers to screening contribute to undertreatment. Epilepsy is a key example, with well-documented undertreatment of anxiety and depression despite high prevalence and impact, and data indicating that patients prioritize treatment and prefer to be treated in a neurology clinic for depression and anxiety. Tools and strategies are needed to reduce burden of anxiety and depression screening in neurology clinics and other subspecialty settings, to close care gaps and facilitate multicenter implementation and effectiveness studies of evidence-based interventions such as collaborative care models that involve repeated symptom monitoring with anxiety and depression instruments. Our group successfully implemented screening in a tertiary epilepsy center using electronic health record (EHR)-based tools enabling patient self-completion of instruments after brief nursing staff activation. This more than quadrupled screening, but a substantial gap remained due to the nursing activation step, and barriers to scaling included lack of EHR/research database integration and need for custom EHR build at each potential site for future multicenter studies. Interoperable tools facilitating independent patient self-completion are needed to support multicenter intervention trials with symptom monitoring and scale implementation strategies. Thus, in this proposal we aim to develop and refine interoperable tools for anxiety and depression screening. Specifically, in Aim 1 we will evaluate screening completion (primary) and process measures comparing interoperable, REDCap-based methods to EHR patient portal-based methods for delivering validated anxiety and depression instruments to epilepsy patients. This will be accomplished in a randomized study with N=220 individuals per arm comparing 4 delivery modalties (Twilio text vs. REDCap survey vs. EHR portal questionnaires with reminder vs. standard EHR portal questionnaires). In Aim 2, we will evaluate and implement a reproducible approach to EHR and research system integration of Epic EHR flowsheet data with REDCap via Kit Flowsheets Application Programming Interface (API). We will also develop and disseminate a governance process to accomplish bidirectional integration for EHR flowsheet data with REDCap via Epic’s AddFlowsheetValue API. This R03 project will be instrumental to support next-step larger scale grant applications for the principal investigator examining collaborative care model effectiveness in neurology settings and screening implementation. The proposal is relevant across chronic conditions treated by subspecialists and highly translational, overcoming key roadblocks to translation in clinical implementation research involving the EHR.

项目摘要 焦虑和抑郁普遍存在于神经性疾病和其他需要 专科护理，这些合并症往往得不到充分认识和治疗，尽管影响更大 而不是主要的慢性病。临床医生对筛查的时间相关障碍导致 不适当的治疗。癫痫是一个关键的例子，焦虑和抑郁的治疗不足是有据可查的。 尽管患病率和影响力很高，而且有数据表明，患者优先考虑治疗并倾向于 因抑郁和焦虑在神经科诊所接受治疗。需要工具和战略来减轻 在神经科诊所和其他专科环境中进行焦虑和抑郁筛查，以弥合护理差距和 促进循证干预措施的多中心实施和有效性研究，例如 协作护理模式，包括使用焦虑和抑郁仪器重复监测症状。 我们小组成功地使用电子健康记录在三级癫痫中心进行了筛查 基于电子病历(EHR)的工具，使患者能够在短暂的护理人员激活后自行完成器械。这更多 比四倍筛查，但由于护理激活步骤，仍然存在很大差距，并存在障碍 扩展包括缺乏EHR/研究数据库集成，以及需要根据每个潜力定制EHR构建 未来多中心研究的地点。促进独立患者自我完成的可互操作工具包括 需要通过症状监测和规模实施战略支持多中心干预试验。 因此，在这项提案中，我们的目标是开发和改进用于焦虑和抑郁筛查的可互操作工具。 具体地说，在目标1中，我们将评估筛选完成(主要)和过程措施的比较 可互操作的、基于RedCap的方法到基于EHR患者门户的方法，用于提供经过验证的焦虑 向癫痫患者发放抑郁仪。这将在N=220的随机研究中完成 每臂人员比较4种交付方式(Twilio Text与RedCap调查与EHR门户网站 带有提醒的调查问卷与标准的电子病历门户调查问卷相比)。在目标2中，我们将评估和 实施可复制的EHR方法并研究Epic EHR流程图数据与 RedCap通过套件流程表应用程序编程接口(API)。我们还将制定和传播一项 通过EPIC实现EHR流程图数据与RedCap双向集成的治理流程 AddFlowsheetValue接口。 该R03项目将有助于支持下一步更大规模的赠款申请 首席研究员在神经科环境和筛查中检查协作护理模式的有效性 实施。该提案与由专科医生治疗的慢性疾病相关，并高度 翻译，克服涉及EHR的临床实施研究中翻译的关键障碍。