Implementation and Evaluation of escreening at the VA San Diego Healthcare System

Transcription

1 Implementation and Evaluation of escreening at the VA San Diego Healthcare System James Pittman, Elizabeth Floto, Laurie Lindamer, and Niloofar Afari

2 Introduction Millions of Veterans access VA Mental Health Self-report Screening Screening for mental and physical health symptoms is needed to provide timely care and to monitor progress and outcomes Clinical Care escreening Technology Research

3 escreening Functions Designed for use in multiple settings Web-based and device agnostic 2-way Electronic Medical Record communication Scoring and synchronization of screens in real-time

4 escreening Functions cont. Personalized feedback for Veterans based on their responses Dynamic progress reporting gives the ability to provide summary of progress over time in Veteran summary and CPRS note (e.g., PHQ-9 scores over time) Dashboard interface and forms editor allows users to: a) adapt scoring logic of existing screens; b) create new screens; c) edit content for Veteran summary and CPRS note; and d) generate data reports for veterans, clinics, or system-wide

5 Clinical Value Ideal for high volume settings like Primary Care and Mental Health clinics to meet benchmarks for mental health screening while reducing Veteran burden and increasing breadth of clinical care Ability to assist in treatment planning and monitoring treatment outcomes Potential to connect to other existing systems such as MyHealtheVet to allow Veterans to complete screening from anywhere with an internet connection

6 Research Value Already existing database of newly enrolling veterans» Comprehensive patient-reported assessment of psychosocial, mental, and physical health symptoms» Nearly half with 6 month prospective data» One of the largest samples of women and Latinos» Permission to contact for additional studies» 17 manuscripts completed or in progress» 8 grant applications supported through pilot data or potential participants New prospective participant registry and data repository

7 Pilot Implementation: Specific Aims Assess Veteran satisfaction with the use of the electronic system in comparison to the paper screening Compare accessibility, rate of screening completion between escreening and paper screening Examine the impact on clinical care between escreening and paper screening

8 Design Paper screening (n=795, March through November, 2012) escreening (n=577, December, 2012 through September, 2013) VS

9 Demographics Mean Age Paper Screening n (%) escreening n (%) 31.26(8.16) 32.02(7.91) Male Gender 521(84.3%) 498(86.3%) Ethnicity Hispanic/Latino 123(31.9%) 151(28.2%) Branch of Service Navy/Coast Guard 328(56.1) 287(52.2) Marines 164(27.1) 175(31.8) National Guard 2(0.3) 1(0.2) Army 76(12.6) 74(13.5) Air Force 15(2.5) 13(2.4) Employment Status Unemployed 451(74.5%) 330(75.0%) Full time 107(17.7%) 80(18.2%) Part time 47(7.8%) 30(6.8%) Number of Deployments None** 11(1.9) 86(19.5) 1* 245(41.2) 209(47.9) 2** 184(31.0) 89(20.2) 3-4** 122(20.5) 51(11.6) 5 or more** 32(5.4) 6(1.4) There were no significant differences, except for the number of deployments Veterans who completed escreening had higher rates of never having been deployed (χ 2 (1, N = 1158) = 9.558, p <.001) Trends:» Women» Hispanic/Latinos» Navy and Marines

10 Satisfaction Investigator designed 5-item likert scale» Measuring how satisfactory, comprehensible, reasonable in length, useful in communication about healthcare needs, and useful in improving care the process screening was Veterans who completed escreening were slightly more satisfied (M = 14.86, SD = 3.91) with the screening process that those who completed the paper screening (M = 14.35, SD = 3.59), although this difference did not reach significance.

11 Accessibility Proportion of consented Veterans with documented mandated screens in medical record at 6 months, by type of screening. Paper Screening escreening n = 795 n =577 Clinical Screen n (%) n (%) P value TBI 708(89.0) 574(99.5) <.001 Alcohol Use 729(91.6) 572(99.3) <.001 PTSD 740(93.1) 567(98.4) <.001 Depression 734(93.0) 574(99.7) <.001

12 Impact on Clinical Care Clinical Care Outcome N Paper Screening Rate of 1 or more Consults, % escreening P value (23.0) 192(33.3) <.001 Number of Consults per Veteran, M (SD) Rate of Primary Care followup, % Days to Primary Care followup, M (SD) Rate of Suicide Risk Assessment for those with Risk, % Days to Suicide Risk Assessment for Those with Risk, M (SD) Rate of Same Day Suicide Risk Assessment for Those with Suicidal Ideation, % (.718).480(.794) (76.1) 450(86.7) < (27.54) 25.37(24.11) (75.3) 213(85.9) (20.77) 6.31(16.23) (48.9) 44(69.8).026

13 escreening s Reach escreening named as a Gold Status Best Practice by the VA Undersecretary for Health, Dr. Shulkin Current sites» San Diego» Long Beach» Las Vegas» Palo Alto Interest spans the VA Healthcare System» Lebanon, PA» Ann Arbor, MI» Bedford, MA

14 Thank you!