Exploratory Research Project - CAT

CATS(探索性项目)：摘要 意义：约45%自杀身亡的人曾去看过他们的初级保健提供者 (PCP)在他们去世前一个月和前一年的77%，使初级保健诊所成为至关重要的 用于识别自杀风险的环境。然而，在这方面，自杀风险筛查的一致性和质量 由于提供者对评估、讨论、 和管理自杀，除了自杀念头外，还需要考虑更广泛的症状和风险因素， 以及相互竞争的医疗要求和无数强制筛查的负担。计算机化适应性测验 (猫)在解决这些障碍以及识别和跟踪心理健康方面具有变革的潜力 条件，包括初级保健中的自杀风险。 调查人员：我们的多学科团队由自杀预防和初级保健专家组成 (Davis-Martin，Mullin)；电子病历集成、健康信息学和以用户为中心的设计(Tulu)；用户体验 (Djamasbi)；医疗保健工作流程重新设计(Johnson)；实施科学(Davis-Martin，Johnson)； 经济学(Singh)、隐私/伦理(Nebeker)和猫(Gibbons)将共同努力实现这些目标。 创新：使用CATS解决自杀的初始检测、量化和纵向监控 初级保健中的一系列精神健康指标所蕴含的风险是新的。我们将为以下内容创建一个包 初级保健诊所的下游系统范围部署，使患者能够轻松接触到完整的CAT 通过多种模式，并优化CATS结果显示，以最大限度地发挥临床效用。 方法：我们将研究现有的CAT-MHTM在三个护理环境中的实施情况，使用关键的信息者 与临床管理人员和提供商进行面谈，以确定临床工作流程中的差异、障碍 部署，以及实现有效的EHR集成、HIPAA合规性、用户接受度和 临床应用。我们将把CAT-MHTM集成到UMASS EHR测试环境中，反映各种工作流程 并识别结果显示。初级保健、医疗和行为健康临床医生(n~10)的样本将进行测试 替代方案，在UMassiCELS中，有标准化的患者。我们将捕获CAT-MHTM结果显示利用率 使用眼球跟踪技术，并使用直通技术识别设计的优点/缺点。我们 将在一个初级保健诊所与临床医生和实际患者一起测试部署CAT-MHTM的可行性 EPIS框架用于指导实施，CQI方法用于确定最合适的临床工作流程。 实施措施将包括可接受性、可用性、可行性、可达性、忠诚度和简单的成本计算。 环境：UMASS、WPI和ATT在许多联邦资助的项目上成功地进行了合作 (R44MH118780、R44DA049448、NSF-IIS-1065298)。 影响：这项研究将被用作后续实施试验R01的试点数据，该试验将研究 实施最新的CAT-MHTM，并将工作流程纳入马萨诸塞州大学剩余的初级保健实践。

CATS (EXPLORATORY PROJECT): ABSTRACT Significance: Approximately 45% of individuals who die by suicide had a visit with their primary care provider (PCP) in the month prior to their death and 77% in the year prior, making primary care clinics a crucial environment for identifying suicide risk. However, consistency and quality of screening for suicide risk in this setting vary widely by provider and clinic because of differences in providers’ comfort with assessing, discussing, and managing suicide, the need to consider broader symptoms and risks factors in addition to suicidal ideation, and the burden of competing medical demands and myriad mandated screenings. Computerized adaptive tests (CATs) have transformative potential for addressing these barriers and identifying and tracking mental health conditions, including suicide risk in primary care. Investigators: Our multi-disciplinary team comprised of specialists in suicide prevention and primary care (Davis-Martin, Mullin); EHR integration, health informatics and user-centered design (Tulu); user experience (Djamasbi); healthcare workflow redesign (Johnson); implementation science (Davis-Martin, Johnson); economics (Singh); privacy/ethics (Nebeker); and CATs (Gibbons) will work together to accomplish the Aims. Innovation: Using CATs to address initial detection, quantification, and longitudinal monitoring of suicide risk embedded in a range of mental health indicators in primary care is novel. We will create a package for downstream system-wide deployment for primary care clinics that enables easy patient access to complete CATs through multiple modalities and optimizes CATs results presentation for maximum clinical utility. Approach: We will study existing implementations of CAT-MHTM in three care settings, using key informant interviews with clinical administrators and providers, to identify variations in clinical workflows, barriers to deployment, and strategies for achieving effective EHR integration, HIPAA compliance, user acceptance, and clinical utility. We will integrate CAT-MHTM into the UMass EHR test environment, reflecting various workflows and result displays identified. A sample of primary care medical and behavioral health clinicians (n~10) will test alternatives, in the UMass iCELS, with standardized patients. We will capture CAT-MHTM result display utilization with eye tracking technology and identify strengths/weaknesses of designs using talk-through techniques. We will test the feasibility of deploying CAT-MHTM with clinicians and actual patients in one primary care clinic using the EPIS framework to guide implementation and a CQI approach to determine the best fitting clinical workflow. Implementation measures will include acceptability, usability, feasibility, reach, fidelity and simple costing. Environment: UMass, WPI, and ATT have successfully collaborated on numerous federally funded projects (R44MH118780, R44DA049448, NSF-IIS-1065298). Impact: This study will be used as pilot data for the subsequent implementation trial R01 that will study the implementation of the updated CAT-MHTM and workflows into the remaining primary care practices at UMass.