Implementation and Evaluation of the Pathway Platform: A Digitally Enabled Care Pathway to Improve Depression Key Performance Indicators and Patient Outcomes in Primary Care Clinics
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 89
- 试验地点
- 1
- 主要终点
- Proportion of Patients Who Completed Patient Health Questionnaire
研究概览
简要总结
This study was conducted to understand the use of a mobile app (titled Pathway) to help patients track depression symptoms, medications, side effects, and goals in addition to the usual care with their doctor. Investigators compared the effect of the app over 6 months and examine whether the app can increase engagement between patients and their doctor and help in the management of illnesses as patients started a new treatment for depression. The investigators hoped that using an app to facilitate management of depression symptoms, medication use, and side effects help patients and their providers understand their response to medications and lead to better response and improvements in depression.
详细描述
A pre- and post- study design was utilized to assess the impact of implementing the Pathway Platform in the primary care setting. The Pathway Platform consists of a mobile app for patients and a care team interface that can be accessed through Epic (electronic medical record system). Eight primary care sites were identified to participate in the study. Care team members involved in depression management received education on evidence-based clinical practices for depression care, such as measurement-based care practices and shared- decision making. Clinics with behavioral resources also received additional education on behavioral health integration. Training on how to onboard patients to use the Pathway Platform and utilize electronic medical records to view data collected in the Pathway Platform was also provided. Study outcomes identified in this protocol are described among patients enrolled in the Pathway Platform (post-implementation cohort) as well as a similar group of patients from the same participating clinics prior to study implantation (pre-implantation cohort). Implementation success was evaluated by comparing study outcomes among these two cohorts. The primary outcome is PHQ-9 utilization over six months are compared between the pre- and post- implementation cohorts. Additional process measures compared include; shared-decision making, medication adjustments, referrals to behavioral health, primary care follow-up post hospitalizations, and depression remission and response. Data collected in the Pathway Platform is also used to explore pre-defined patient outcomes.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosis with major depressive disorder or reference to "clinical depression" in patient charts.
- •Recently prescribed monotherapy antidepressant medication (defined as new start, medication switch, or dose change in the past 3 months.)
- •Patients with inadequate response or tolerability concerns determined based on A PHQ-2 score of 3 or greater or a PHQ-9 score of 5 or more, recorded in medical records in the past 6 weeks or during screening,
- •Able and willing to provide informed consent
- •Able to use the Pathway Platform based on clinician's judgment, e.g. owns an iPhone version 5 or later or smartphones with Android operating systems, have an active data plan or regular WiFi access
排除标准
- •Missing PHQ-2 score in the past 6 weeks and/or unable to perform PHQ-2 at index visit
- •Diagnosis with bipolar depression, schizophrenia, and/or schizoaffective disorder
- •Patient no longer under primary care for depression and has transitioned to a psychiatric care team (i.e., Psychiatrist, Advance Practice Psychiatric Nurse, Psychiatric Nurse Practitioner, Psychiatric Physician Assistant).
- •Lack of functional English literacy (indicated by primary language in electronic medical record).
研究组 & 干预措施
Pathway Platform application use
Study participants will download the Pathway app to their mobile device. This app will gather patient health data, present standardized questionnaires and research data collection tools. Subject responses will be visible to their provider via interface with the electronic medical record.
干预措施: Pathway Platform mobile app (Other)
结局指标
主要结局
Proportion of Patients Who Completed Patient Health Questionnaire
时间窗: Baseline to 6 months post-implementation of the Pathway app
Proportion of patients who have at least 2 Patient Health Questionnaire (PHQ) scores documented in their medical record over the 6 month study period will be compared between pre- and post- Pathway app implementation to determine if there is a change in adherence to measurement based care practices following the implementation of the Pathway Platform in a primary care setting.
次要结局
- Process Outcome: Measurement-based Care(Baseline to 6 months post-implementation of the Pathway app)
- Process Outcome: Shared-decision Making(6 months prior to and 6 months post-implementation of the Pathway Platform app)
- Process Outcome: Referrals to Behavioral Health(Baseline to 6 months post-implementation of the Pathway app)
- Process Outcome: Total Number of Hospitalized Participants During Follow up Period(6 months prior to and 6 months post-implementation of the Pathway Platform app.)
- Process Outcome: Follow-up After Emergency Department Visit for Mental Illness(Baseline to 6 months post-implementation of the Pathway app)
- Process Outcome: Healthcare Resource Utilization, Hospital Admissions(Baseline to 6 months post-implementation of the Pathway app)
- Process Outcome: Number of Behavioral Related Hospitalizations(6 months prior to and 6 months post-implementation of the Pathway Platform app.)
- Process Outcome: Healthcare Resource Utilization, Emergency Room Admissions(Baseline to 6 months post-implementation of the Pathway app)
- Process Outcome: Healthcare Resource Utilization, Outpatient Visits(6 months prior to and 6 months post-implementation of the Pathway Platform app.)
- Process Outcome: Primary Care Physician (PCP) Visits(6 months prior to and 6 months post-implementation of the Pathway Platform app.)
- Patient Health Questionnaire-9 [PHQ-9] Score(Baseline to 6 months post-implementation of the Pathway app)
- Patient Health Questionnaire-9 [PHQ-9] Score Reduction(Baseline to 6 months post-implementation of the Pathway app)