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

The University of Chicago

Status: Completed

Conditions: Depressive Disorder, Major; Depression

Treatments: Diagnostic Test: CAD-MDD/CAT-DI screening via MyChart; Other: CAT-DI monitoring via MyChart; Other: PHQ-9 monitoring during clinic visits; Diagnostic Test: CAD-MDD/CAT-DI screening during clinic visit

Study type: Interventional

Funder types: Other

Identifiers

NCT03832283

QI18-90

Details and patient eligibility

About

Currently, very little research exists on whether patient portals could be used to integrate patient-reported outcome (PRO) measurement into the electronic health record (EHR) and clinical practice, even though 87% of ambulatory care practices have EHRs and 88% of U.S. adults have access to the internet. To date, no randomized controlled trial has examined whether patient portals can be used to collect PRO measures. The goal of this study is to implement the integration of a computerized adaptive test (CAT) for patient-reported outcome (PRO) measurement of depression symptoms into an electronic health record (EHR) and evaluate the effectiveness of collecting CAT PROs via an EHR patient portal in two randomized controlled trials. This study will advance the science of implementation of patient-centered outcomes research into clinical practice, as well as the evidence for high quality, accessible care.

Full description

The overall goal of this proposal is to implement the integration of the Computerized Adaptive Test for Mental Health (CAT-MH) into an EHR for a healthcare system and evaluate the effectiveness of collecting CAT-MH PROs via an EHR-tethered patient portal (MyChart) vs. usual care in two randomized controlled trials. The first aim of this study will consist of a randomized controlled trial comparing screening rates among adult primary care patients with an active patient portal account (MyChart) and due for depression screening who receive usual care (CAT-MH screenings during routine clinic visits) vs. MyChart population-based CAT-MH screenings. The second aim of this study involves a randomized controlled trial comparing depression remission rates among patients with active moderate-to-severe MDD who receive usual care vs. MyChart CAT-MH measurement-based care. In addition, we will examine the resources needed to integrate the CAT-MH into the EHR and design the health IT strategy for collecting PROs via the patient portal.

Enrollment: 4,161 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 years or older
• considered an active clinic patient at the start date of the intervention
• have an active MyChart account that is not managed by a proxy
• receive care from a participating PCP
• due for depression screening (screening arms) or active depression (monitoring arms)

Exclusion criteria

• under 18 years of age
• bipolar disorder

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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4,161 participants in 4 patient groups

Usual Care Depression Screening

Other group

Description:

Patients randomized to this intervention arm will receive usual care annual depression screening when they come in for a clinic visit and are due for screening. When the patient comes in for a visit, a best practice alert in the EHR will indicate that the patient requires depression screening. The CAD-MDD/CAT-DI screening during clinic visit will occur in a patient room, prior to their appointment with a primary care provider.

Treatment:

Diagnostic Test: CAD-MDD/CAT-DI screening during clinic visit

Population MyChart Depression Screening

Experimental group

Description:

Patients randomized to this intervention arm will continue to receive usual care annual depression screening when they come in for a clinic visit and are due for screening. In addition, they will receive email invitations to complete the CAD-MDD/CAT-DI screening via MyChart. Email invitations will be sent at preset intervals until depression screening is completed, or the end of the 1-year follow-up period, whichever comes first.

Treatment:

Diagnostic Test: CAD-MDD/CAT-DI screening via MyChart

Diagnostic Test: CAD-MDD/CAT-DI screening during clinic visit

Usual Care Depression Monitoring

Other group

Description:

Patients who have depression and are randomized to this intervention arm will receive usual care PHQ-9 monitoring during clinic visits. When the patient comes in for a visit, a best practice alert in the EHR will indicate that the patient requires depression assessment.

Treatment:

Other: PHQ-9 monitoring during clinic visits

Population MyChart Depression Monitoring

Experimental group

Description:

Patients who have depression and are randomized to this intervention arm will continue to receive usual care depression monitoring when they come for clinic visits. In addition, they will receive email invitations at preset intervals to complete the CAT-DI monitoring via MyChart. Invitations will be sent until major depressive disorder (MDD) remission is achieved, or the 1-year follow-up period ends, whichever comes first.

Treatment:

Other: CAT-DI monitoring via MyChart

Other: PHQ-9 monitoring during clinic visits