Exploratory Research Project - CAT

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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.