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: 10672413
• 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/10672413
• 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 Care; Principal Investigator; Process; Process Measure; Provider; Psychiatry; Quality of life; Questionnaires; Randomized; Reporting; Reproducibility; Research; Site; Surveys; Symptoms; Systems Integration; Testing; Text; Text Messaging; Time; Translations; Visit; Work; anxiety symptoms; anxiety treatment; application programming interface; arm; clinical implementation; collaborative care; comorbidity; depressive symptoms; discrete data; effectiveness study; effectiveness-implementation randomized trial; electronic data; electronic health record system; 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; treatment and outcome; 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 焦虑和抑郁在神经系统疾病和其他慢性疾病中普遍存在 专业护理，这些合并症通常被低估了，目的地影响更大 关于结果比主要的慢性病。临床医生与时间有关的筛查障碍有助于 不足。癫痫是一个关键例子，有充分记录的焦虑和抑郁症的不足 任务高患病率和影响以及数据表明患者优先治疗，并且宁愿 在神经病学诊所治疗抑郁和焦虑症。需要工具和策略来减少燃烧 神经病学诊所和其他专科环境中的焦虑和抑郁筛查，缩小护理差距和 促进对基于证据的干预措施的多中心实施和有效性研究 协作护理模型涉及焦虑和抑郁仪器的重复症状监测。 我们的小组使用电子健康记录成功地在第三次癫痫中心实施了筛查 （EHR）基于工具，使患者可以在短暂的护士工作人员激活后对仪器进行自我完成。更多 比四倍的筛选，但是由于护士的激活步骤，还有很大的差距 缩放包括缺乏EHR/研究数据库集成以及在每个潜力上进行自定义EHR的需求 未来多中心研究的站点。支持独立患者自我完成的互操作工具是 需要通过症状监测和规模实施策略来支持多中心干预试验。 在此提案中，我们旨在开发和完善可互操作的动画和抑郁筛查工具。 具体而言，在AIM 1中，我们将评估比较筛选完成（主要）和过程测量 基于EHR患者门户网站的方法可互操作，基于REDCAP的方法，用于提供验证的焦虑 和癫痫患者的抑郁仪。这将在n = 220的随机研究中完成 每个手臂比较4种交付模态的个人（Twilio文本与Redcap调查与EHR门户 提醒与标准EHR门户网站问卷调查的问卷）。在AIM 2中，我们将评估和 实施EHR和研究系统的可重复方法，将EPIC EHR流程数据与 REDCAP通过套件Flowsheets应用程序编程接口（API）。我们还将发展并传播 通过EPIC的REDCAP完成双向集成的双向集成的治理过程 AddFlowSheetValue API。 该R03项目将对支持下一步的大规模赠款应用程序有助于 主要研究者检查神经病学和筛查中的协作护理模型有效性 执行。该提案在由专科医生治疗的慢性条件下与高度相关 翻译，克服了涉及EHR的临床实施研究中翻译的关键障碍。

项目成果

Integrated psychological care services within seizure settings: Key components and implementation factors among example services in four ILAE regions: A report by the ILAE Psychiatry Commission.

癫痫发作环境中的综合心理护理服务：四个 ILAE 地区示例服务的关键组成部分和实施因素：ILAE 精神病学委员会的报告。

• DOI: 10.1111/epi.17647
• 发表时间: 2023
• 期刊: Epilepsia
• 影响因子: 5.6
• 作者: Gandy,Milena;Michaelis,Rosa;Acraman,Jayne;Donald,KirstenA;Fitzpatrick,Michael;LaFranceJr,WCurt;Margolis,SethA;Modi,AvaniC;Reuber,Markus;Tang,Venus;Thayer,Zoe;Verity,Kirsten;Wagner,JanelleL;Wilmshurst,Jo;Whittaker,Sarah