Turning EHRs into Assets for Mental Health and Uniting Practice (Team Up)

将电子病历转化为心理健康资产和联合实践（团队合作）

• 批准号: 8838261
• 负责人: Deborah Jill Cohen
• 金额: $ 22.05万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838261
• 关键词: Address; Adoption; Alcohol or Other Drugs use; Area; Behavior; Caring; Chronic Disease; Clinic; Clinical; Clinical Trials; Collaborations; Communication; Comorbidity; Computer software; Data; Development; Documentation; Effectiveness of Interventions; Electronic Health Record; Evolution; Goals; Health; Health Personnel; Health Professional; Healthcare; Human; Individual; Information Systems; Intervention; Light; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Outcome; Outcome Measure; Patient Monitoring; Patients; Policies; Population; Primary Health Care; Process; Process Measure; Provider; Psyche structure; Quality of Care; Randomized Controlled Trials; Research; Research Support; Risk; Sampling; Services; Solutions; Support System; System; Technology; Testing; Work; base; behavior change; behavioral health; care delivery; clinical practice; cost; design; emotional experience; experience; health care delivery; health information technology; improved; innovation; medical specialties; multidisciplinary; novel; physical conditioning; primary care setting; safety net; severe mental illness; tool; user centered design

DESCRIPTION (provided by applicant): Strong evidence shows that mental and physical co-morbidities are common and compound the risk for undesirable health outcomes. It is well established that service fragmentation is a significant barrier to effective care and a major drive of cost. Reorienting to an integrated care delivery model appears the most tenable solution for long-term sustainability and change. However, despite higher rates of EHR adoption and utilization, there is an abyss when it comes to health information technology (HIT) that is specifically designed to simultaneously support the individual work of mental health professionals and the new collaborations required for delivering integrated mental health and primary care services. OCHIN Inc., a Health Center Controlled Network comprising 60 health centers in 11 states nationally recognized for pioneering the use of HIT to improve the coordination and delivery of healthcare to safety net clinic populations, is at the vanguard of addressing the information and HIT needs of those practicing in new integrated care models. OCHIN's hosted Epic EHR includes a new suite of scalable integration functions ("BH Navigator") that, while initially created for use in mental health specialty centers, is being expanded to support integration in primary care settings. Informed by the Primary Care Change Model, the Technology Acceptance Model (TAM) and user-centered design best practices this study will examine how OCHIN's BH Navigator and primary care practices are co- evolving to support integration of mental health in primary care by accomplishing the following specific aims: Aim 1: Inform OCHIN's BH Navigator development to improve effective utilization in primary care practices; Aim 2: Demonstrate the feasibility of an intervention that includes concurrent implementation of the adapted BH Navigator, practice workflow redesign and provider behavior change in six primary care practices; and Aim 3: Design a practice-based randomized-controlled trial, for a subsequent R01, to test the effectiveness of the intervention we develop in improving clinical processes and outcome measures. A highly experienced, multidisciplinary team will carry out this study, and use an observational mixed method design to study use of the BH Navigator in order to support its continued evolution. We will conduct a pre-post feasibility test of an intervention that includes workflow redesign, provider behavior change and implementation of the refined BH Navigator in six practices and among a sample of patients with depression and depression and co-morbid chronic disease. The result will be thorough study of an innovative and novel technological solution in the Epic EHR, and the practice and provider changed needed to optimize use of this tool. The intervention we develop and test can be used as a model for documenting, sharing, and monitoring patients' mental and physical health needs and holds promise for integrating current information systems and supporting integrated clinical practice. This study will shed new light on how EHRs and practices must change to effectively transform how mental health and primary care providers work together to deliver higher quality and more comprehensive services.

描述（由申请人提供）：强有力的证据表明，精神和身体共病是常见的，并加剧了不良健康结果的风险。众所周知，服务分散是有效护理的重大障碍，也是成本的主要驱动力。调整方向，采用综合护理模式似乎是长期可持续性和变革的最可行的解决办法。然而，尽管电子健康记录的采用率和利用率较高，但在卫生信息技术（HIT）方面存在着一个深渊，该技术专门用于同时支持精神卫生专业人员的个人工作和提供综合精神卫生和初级保健服务所需的新合作。OCHIN Inc.，一个由11个州的60个健康中心组成的健康中心控制网络，由于率先使用HIT来改善对安全网诊所人群的医疗保健的协调和提供而被全国认可，是解决那些在新的综合护理模式中实践的人的信息和HIT需求的先锋。OCHIN托管的Epic EHR包括一套新的可扩展集成功能（“BH Navigator”），最初用于心理健康专业中心，目前正在扩展以支持初级保健环境中的集成。根据初级保健变化模型、技术接受模型（TAM）和以用户为中心的设计最佳实践，本研究将研究OCHIN的BH Navigator和初级保健实践如何共同发展，以通过实现以下特定目标来支持初级保健中的心理健康整合：目标1：告知OCHIN的BH Navigator开发，以提高初级保健实践中的有效利用;目标2：证明干预的可行性，包括同时实施适应BH导航器，实践工作流程重新设计和提供者行为改变六个初级保健实践;和目标3：设计一个基于实践的随机对照试验，为随后的R 01，以测试我们开发的干预措施在改善临床流程和结局指标方面的有效性。一个经验丰富的多学科团队将开展这项研究，并使用观察性混合方法设计来研究BH Navigator的使用，以支持其持续发展。我们将对干预措施进行前后可行性测试，包括工作流程重新设计，提供者行为改变以及在六种实践中以及抑郁症和抑郁症以及合并慢性疾病的患者样本中实施改进的BH Navigator。其结果将是对Epic EHR中创新和新颖的技术解决方案的深入研究，以及优化该工具使用所需的实践和提供商。我们开发和测试的干预措施可用作记录、共享和监测患者身心健康需求的模型，并有望整合当前的信息系统，支持综合临床实践。这项研究将揭示EHR和实践必须如何改变，以有效地改变精神卫生和初级保健提供者如何共同提供更高质量和更全面的服务。