Franco Melissa I, Staab Erin M, Zhu Mengqi, Deehan William, Moses John, Gibbons Robert, Vinci Lisa, Shah Sachin, Yohanna Daniel, Beckman Nancy, Laiteerapong Neda
Department of Medicine, University of Chicago, Chicago, IL 60637, United States.
UChicago Medicine, Chicago, IL 60637, United States.
JAMIA Open. 2024 Sep 24;7(3):ooae094. doi: 10.1093/jamiaopen/ooae094. eCollection 2024 Oct.
To integrate a computerized adaptive test for depression into the electronic health record (EHR) and establish systems for administering assessments in-clinic and via a patient portal to improve depression care.
This article reports the adoption, implementation, and maintenance of a health information technology (IT) quality improvement (QI) project, Patient Outcomes Reporting for Timely Assessment of Life with Depression (PORTAL-Depression). The project was conducted in a hospital-based primary care clinic that serves a medically underserved metropolitan community. A 30-month (July 2017-March 2021) QI project was designed to create an EHR-embedded system to administer adaptive depression assessments in-clinic and via a patient portal. A multi-disciplinary team integrated 5 major health IT innovations into the EHR: (1) use of a computerized adaptive test for depression assessment, (2) 2-way secure communication between cloud-based software and the EHR, (3) improved accessibility of depression assessment results, (4) enhanced awareness and documentation of positive depression results, and (5) sending assessments via the portal. Throughout the 30-month observational period, we collected administrative, survey, and outcome data.
Attending and resident physicians who participated in the project were trained in depression assessment workflows through presentations at clinic meetings, self-guided online materials, and individual support. Developing stakeholder relationships, using an evaluative and iterative process, and ongoing training were key implementation strategies.
The PORTAL-Depression project was a complex and labor-intensive intervention. Despite quick adoption by the clinic, only certain aspects of the intervention were sustained in the long term due to financial and personnel constraints.
将抑郁症计算机自适应测试整合到电子健康记录（EHR）中，并建立在诊所和通过患者门户网站进行评估的系统，以改善抑郁症护理。
本文报告了一项健康信息技术（IT）质量改进（QI）项目“抑郁症生活及时评估患者结果报告”（PORTAL - Depression）的采用、实施和维护情况。该项目在一家为医疗服务不足的大都市社区提供服务的医院初级保健诊所进行。一个为期30个月（2017年7月至2021年3月）的QI项目旨在创建一个嵌入EHR的系统，以便在诊所和通过患者门户网站进行自适应抑郁症评估。一个多学科团队将5项主要的健康IT创新整合到了EHR中：（1）使用抑郁症评估的计算机自适应测试，（2）基于云的软件与EHR之间的双向安全通信，（3）改善抑郁症评估结果的可及性，（4）提高对阳性抑郁症结果的认识和记录，以及（5）通过门户网站发送评估。在整个30个月的观察期内，我们收集了行政、调查和结果数据。
参与该项目的主治医生和住院医生通过在诊所会议上的演示、自我指导的在线材料以及个人支持，接受了抑郁症评估工作流程的培训。建立利益相关者关系、采用评估和迭代过程以及持续培训是关键的实施策略。
PORTAL - Depression项目是一项复杂且劳动密集型的干预措施。尽管诊所很快采用了该项目，但由于财务和人员限制，从长期来看，只有干预措施的某些方面得以持续。
