Patient Outcomes Reporting for Timely Assessments of Life with Depression: PORTAL-Depression

项目摘要 在过去的十年中，医疗保健系统的健康信息技术已经扩展， 患者使用互联网。这种同步增长为医疗保健系统提供了一个独特的机会， 收集患者报告的结果（PRO），并通过使用患者门户网站将PRO整合到临床护理中。患者 门户网站是使患者能够通过网络连接访问其健康信息的安全网站。早期 研究发现，使用门户网站的患者具有更高的满意度和参与度。到目前为止， 然而，门户还没有被健康护理系统主动地用于系统地收集PRO。 在人群范围内主动收集PRO对于识别和管理具有以下特征的患者是有价值的： 萧条在初级保健中，重性抑郁症（MDD）非常普遍，与 生活质量下降和自杀。然而，只有50%的患者在初级保健接受建议， 每年筛查，只有50%的MDD患者得到充分治疗。系统测量 MDD症状可能导致治疗增加和缓解率提高;然而，许多提供者 不定期测量症状。计算机化心理健康自适应测验（CAT-MH）是一项新的心理健康测试。 抑郁症症状测量的创新，可以进行有效的评估。CAT-MH是一种 经验证的测试，使用实时算法提出最具诊断信息的问题， 评估心理健康症状，包括抑郁症。一般来说，CAT可能是吸引患者的理想选择 因为这些测试既非常精确又非常简短;然而，到目前为止，很少有CAT 已纳入EHR。本研究的目标是将CAT-MH整合到医疗保健的EHR中 系统，并评估通过患者门户网站（MyChart）与 两项随机对照试验中临床访视期间的常规采集。在目标1中，在初级保健患者中 谁是由于抑郁症筛查，我们将确定是否MyChartCAT-MH抑郁症筛查 与常规护理相比，（基于人口的护理）增加了筛查次数。在目标2中， 活动性MDD的初级保健患者，我们将确定接受MyChart抑郁症的患者 测量（基于测量的护理）的患者相比， 接受常规护理。有了这些目标，这笔赠款将提供有关障碍和解决方案的基本信息， 将PRO的自适应测试集成到EHR中，以及患者门户网站的能力的证据， 提供主动的基于人群的患者报告结局测量。

PROJECT ABSTRACT In the last decade, there has been expansion of both health information technology by healthcare systems and internet use by patients. This simultaneous growth provides a unique opportunity for healthcare systems to collect patient-reported outcomes (PROs) and integrate PROs into clinical care by using patient portals. Patient portals are secure websites that give patients access to their health information via a web connection. Early studies have found that patients who use portals have higher levels of satisfaction and engagement. To date, however, portals have not been used proactively by healthcare systems to systematically collect PROs. Population-wide proactive collection of PROs would be valuable for identifying and managing patients with depression. In primary care, major depressive disorder (MDD) is highly prevalent and is associated with reduced quality of life and suicide. However, only 50% of patients in primary care receive recommended annual screening, and only 50% of patients with MDD are treated adequately. Systematic measurement of MDD symptoms can lead to increased treatment and greater rates of remission; however, many providers do not routinely measure symptoms. The Computerized Adaptive Test for Mental Health (CAT-MH) is a recent innovation in depression symptom measurement that could allow for efficient assessments. The CAT-MH is a validated test that uses algorithms in real-time to ask the most diagnostically informative questions and assesses mental health symptoms, including depression. In general, CATs could be ideal for engaging patients in providing PROs because these tests are both very precise and very brief; however, to date, few CATs have been integrated into EHRs. This study's goals are to integrate the CAT-MH into an EHR for a healthcare system and evaluate the effectiveness of collecting depression symptoms via a patient portal (MyChart) vs. usual collection during clinic visits in two randomized controlled trials. In Aim 1, among primary care patients who are due for depression screening, we will determine whether MyChart CAT-MH depression screening (population-based care) increases the number of screenings, compared to usual care. In Aim 2, among primary care patients with active MDD, we will determine whether patients who receive MyChart depression measurement (measurement-based care) have higher rates of MDD remission, compared to patients who receive usual care. With these aims, this grant will provide essential information on the barriers and solutions to integrating adaptive tests for PROs into EHRs, as well as evidence for the capability of patient portals for providing proactive population-based patient-reported outcome measurement.