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

项目摘要 在过去的十年中，卫生保健系统和卫生信息技术都得到了发展 患者使用互联网的情况。这一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)，并使用患者门户将PRO集成到临床护理中。有耐心的 门户网站是安全的网站，让患者通过网络连接访问他们的健康信息。早些时候 研究发现，使用门户网站的患者有更高的满意度和参与度。到目前为止， 然而，医疗保健系统并没有主动使用门户来系统地收集专业人员。 在全人群范围内主动收集专业人员将对识别和管理患有 抑郁症。在初级保健中，严重抑郁障碍(MDD)非常普遍，并与 生活质量下降和自杀。然而，只有50%的初级保健患者得到了推荐 每年进行一次筛查，只有50%的MDD患者得到了适当的治疗。系统地测量 MDD症状可导致更多的治疗和更大的缓解率；然而，许多提供者确实如此 而不是常规地测量症状。心理健康计算机化适应性测验(CAT-MH)是最近发展起来的 抑郁症症状测量方面的创新，可以进行有效的评估。猫-MH是一种 经过验证的测试，使用算法实时提出最具诊断性信息的问题，并 评估精神健康症状，包括抑郁。总的来说，猫可能是吸引病人的理想选择。 因为这些测试既非常精确又非常简短；然而，到目前为止，很少有猫这样做 已被整合到EHR中。这项研究的目标是将CAT-MH整合到医疗保健的EHR中 系统并评估通过患者门户(MyChart)收集抑郁症状的有效性。 在两个随机对照试验中，通常在门诊期间收集数据。在目标1中，在初级保健患者中 谁应该进行抑郁症筛查，我们将确定MyChart CAT-MH抑郁症筛查是否 (基于人口的护理)与通常的护理相比，增加了筛查的数量。在目标2中， 初级保健活动的MDD患者，我们将确定患者是否接受MyChart抑郁症 与以下患者相比，测量(基于测量的护理)的MDD缓解率更高 接受通常的护理。基于这些目标，这笔赠款将提供有关障碍和解决办法的重要信息。 将专业人员的适应性测试整合到EHR中，以及患者门户功能的证据 提供积极主动的基于人群的患者报告结果衡量标准。

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.