An EPIC transition: Rapid conversion of a measurement feedback system in behavioral health

Digital Health · 2025-05-01

Measurement-based care (MBC), while an evidence-based clinical practice, can be difficult to integrate into behavioral healthcare settings. Even when MBC has been successfully implemented in an organization, there are many challenges that create a need for rapid adaptation. As measurement feedback systems (MFSs) are increasingly hosted on dynamic digital platforms, there is always a risk of technological changes and adaptations, whether the system is prepared for them or not. This point of view is focused on managing organizational changes to continue use of MBC through a case example in adult behavioral healthcare. A hospital policy change, informed by financial considerations, led to the rapid de-implementation of the external MFS platform in favor of a system integrated into the electronic health record (EHR). Our team responsively developed a plan for maintaining MBC through this transition including written guidelines and face-to-face training to support clinical staff, while determining the best way to maintain research gains and collect data in the EHR. This manuscript discusses the challenges in switching MBC platforms and the downstream consequences of this policy change from clinical, training, and research perspectives.

Comparative Risk of Developing Interstitial Cystitis With Childhood Gastrointestinal, Urological, Autoimmune, or Psychiatric Disorders

Neurourology and Urodynamics · 2025-06-25 · 2 citations

AIMS: Interstitial cystitis (IC) is a chronic urological condition associated with significant discomfort, posing diagnostic and therapeutic challenges. Although its etiology remains unclear, early-life conditions such as gastrointestinal (GI) disorders, urological anomalies (UA), psychiatric disorders (PD), and autoimmune diseases (AD) have been hypothesized as potential risk factors for developing IC in adulthood. This study aims to investigate these associations by conducting a retrospective cohort analysis utilizing data from the TriNetX US Collaborative Network, encompassing over 118 million patient records. METHODS: The study and control groups were established across four categories of childhood disorders, with IC incidence monitored over a 14-year period. Statistical methodologies, including propensity score matching and Kaplan-Meier survival analysis, were employed to compare outcomes between cohorts. RESULTS: Findings indicate that childhood GI and UA conditions significantly elevate the risk of IC in adulthood, with irritable bowel syndrome (IBS) and urinary tract infections (UTIs) exhibiting risk ratios of 2.9 and 3.2, respectively. Gender disparities were also noted, with females exhibiting higher incidences of diseases included, particularly UA and AD during adolescence. Additionally, individuals with these early-life conditions demonstrated a higher prevalence of comorbidities, underscoring the complex interplay of health factors contributing to IC pathogenesis. CONCLUSIONS: These findings suggest that childhood GI and UA conditions may serve as predictive markers for IC, emphasizing the need for targeted early interventions and preventative care strategies. By identifying at-risk populations, this study provides valuable insights into early detection and management approaches, potentially mitigating the long-term burden of IC on affected individuals. TRIAL REGISTRATION: This paper includes an observational retrospective study. No clinical trial has been conducted.

Use of Patient-Reported Outcome Measures to Assess the Effectiveness of Hybrid Psychiatric Visits

Psychiatric Services · 2024-06-12

OBJECTIVE: Little empirical evidence exists to support the effectiveness of hybrid psychiatric care, defined as care delivered through a combination of telephone, videoconferencing, and in-person visits. The authors aimed to investigate the effectiveness of hybrid psychiatric care compared with outpatient waitlist groups, assessed with patient-reported outcome measures (PROMs). METHOD: Participants were recruited from an adult psychiatry clinic waitlist on which the most common primary diagnoses were unipolar depression, generalized anxiety disorder, and bipolar disorder. Patients (N=148) were randomly assigned to one of two waitlist groups that completed PROMs once or monthly before treatment initiation. PROMs were used to assess symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and daily psychological functioning (Brief Adjustment Scale-6 [BASE-6]). Patient measures were summarized descriptively with means, medians, and SDs and then compared by using the Kruskal-Wallis test; associated effect sizes were calculated. PROM scores for patients who received hybrid psychiatric treatment during a different period (N=272) were compared with scores of the waitlist groups. RESULTS: PROM assessments of patients who engaged in hybrid care indicated significant improvements in symptom severity compared with the waitlist groups, regardless of the number of PROMs completed while patients were on the waitlist. Between the hybrid care and waitlist groups, the effect size for the PHQ-9 score was moderate (d=0.66); effect sizes were small for the GAD-7 (d=0.46) and BASE-6 (d=0.45) scores. CONCLUSIONS: The findings indicate the clinical effectiveness of hybrid care and that PROMs can be used to assess this effectiveness.

Assessing the impact of COVID-19 on outpatient psychiatric population well-being and symptomology utilizing COVID-19 Events Checklist (CEC) and Measurement Based Care

Journal of Patient-Reported Outcomes · 2024-11-21 · 2 citations

BACKGROUND: This study examines the impact of SARS-CoV-2 (i.e., coronavirus, COVID, COVID-19) using data from a measurement-based care (MBC) system utilized in an outpatient psychiatric clinic providing telemedicine care. A novel Patient Rated Outcome Measure (PROM), the COVID-19 Events Checklist (CEC) was administered in a hospital system based ambulatory clinic beginning April 2020 to track COVID-19-19's impact on patients' mental, emotional, and health-related behaviors during the pandemic. The study (1) provides descriptive CEC data, and (2) compares CEC results with PROMs evaluating anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire; PHQ-9), and psychological distress (Brief Adjustment Scale-6; BASE-6). METHODS: This retrospective observational study included patient intake data collected from April 2020 to March 2021. Patient (N = 842) reports on the CEC's five domain questions were aggregated to calculate average reports of COVID-19 related impacts at intake over the initial 12 months of the pandemic. Trends in COVID-19 related impacts were examined, and non-aggregated scores on the PHQ-9, GAD-7, and BASE-6 were compared to primary dichotomous (yes/no) CEC survey questions via Wilcoxon rand sum testing. RESULTS: Results capture the relationship between COVID-19 exposure, COVID-19- related sequelae and behaviors, and psychological symptom severity. Specifically, Wilcoxon rank-sum tests indicate that social determinants of health (SDOH), negative mental health impacts, and positive coping skill use were significantly associated with psychological symptomatology including overall psychological functioning via the BASE-6, anxiety via the GAD-7, and depressive symptoms via the PHQ-9. Results regarding SDOH were as follows: BASE-6 (w = 44,005, p < 0.001), GAD-7 (w = 44,116, p < 0.001), and PHQ-9 (w = 43,299, p < 0.001). Regarding negative mental health outcomes, the results were: BASE-6 (w = 38,374, p < 0.001), GAD-7 (w = 39,511, p < 0.001), and PHQ-9 (w = 40,154, p < 0.001). As the initial year of the pandemic elapsed, incoming patients demonstrated increased rates of suspected or confirmed exposure to COVID-19, (+2.29%, t = 3.19, p = 0.01), reported fewer negative impacts of COVID-19 on SDOH (-3.53%, t= -2.45, p = 0.034), and less engagement in positive coping strategies (-1.47%, t = -3.14, p = 0.010). CONCLUSIONS: Psychosocial factors related to COVID-19 are discussed, as well as opportunities for further research on the relationship between psychological symptomatology and the impact of COVID-19 on health-related behaviors.

Improving measurement-based care implementation in adult ambulatory psychiatry: a virtual focus group interview with multidisciplinary healthcare professionals

BMC Health Services Research · 2023 · 7 citations

• Medicine
• Nursing
• Medical education

BACKGROUND: Measurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method. METHODS: Semi-structured focus group interviews were conducted with clinicians (n = 18) and staff (n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC. RESULTS: The clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice. CONCLUSION: The virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.

Noninferiority Clinical Trial of Adapted START NOW Psychotherapy for Outpatient Opioid Treatment

Research Square · 2023-08-11

Background: Medications for opioid use disorder (MOUD) such as buprenorphine is effective for treating opioid use disorder (OUD). START NOW (SN) is a manualized, skills-based group psychotherapy originally developed and validated for the correctional population and has been shown to result in reduced risk of disciplinary infractions and future psychiatric inpatient days with a dose response effect. We investigate whether adapted START NOW is effective for treating OUD in a MOUD office-based opioid treatment (OBOT) setting in this non-inferiority clinical trial. Methods: Patients enrolled in once weekly buprenorphine/suboxone MOUD OBOT were eligible for enrollment in this study. Participants were cluster-randomized, individually-randomized, or not randomized into either START NOW psychotherapy or treatment-as-usual (TAU) for 32 weeks of therapy. Treatment effectiveness was measured as the number of groups attended, treatment duration, intensity of attendance, and overall drug use as determined by drug screens. Results: 137 participants were quasi-randomized to participate in SN (n = 79) or TAU (n = 58). Participants receiving START NOW psychotherapy, when compared to TAU, had comparable number of groups attended (16.5 vs. 16.7, p = 0.80), treatment duration in weeks (24.1 vs. 23.8, p = 0.62), and intensity defined by number of groups attended divided by the number of weeks to last group (0.71 vs. 0.71, p = 0.90). SN compared to TAU also had similar rates of any positive drug screen result (81.0% vs. 91.4%, p = 0.16). This suggests that adapted START NOW is noninferior to TAU, or the standard of care at our institution, for treating opioid use disorder. Conclusion: Adapted START NOW is an effective psychotherapy for treating OUD when paired with buprenorphine/naloxone in the outpatient group therapy setting. Always free and publicly available, START NOW psychotherapy, along with its clinician manual and training materials, are easily accessible and distributable and may be especially useful for low-resource settings in need of evidence-based psychotherapy.

Non-Inferiority Clinical Trial of Adapted START NOW Psychotherapy for Office-Based Opioid Treatment

SSRN Electronic Journal · 2022-01-01

Effects of COVID-19 on Patients in Adult Ambulatory Psychiatry: Using Patient-Rated Outcome Measures and Telemedicine

Telemedicine Journal and e-Health · 2022 · 12 citations

• Medicine
• Psychiatry
• Clinical psychology

MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.

Nuclear weapons and the Atlantic Alliance

2020-10-16 · 4 citations

The “crude” atomic bombs of the 1940s have been followed in both countries by a fantastic proliferation of weapons and delivery systems, so that today the two parts of a still-divided Europe are targeted by many thousands of warheads both in the area and outside it. An equally disturbing phenomenon is the gradual shift in the balance of argument that has occurred since the need to address the problem was first asserted in 1977. Then the expression of need was European, and in the first instance German; the emerging parity of long-range strategic systems was asserted to create a need for a balance at less than intercontinental levels. The uniqueness of the West German position can be readily demonstrated by comparing it with those of France and the United Kingdom. The two nations have distance, and in one case water, between them and the armies of the Soviet Union; they also have nuclear weapons.

The President's Choice: Star Wars or Arms Control

2019-07-19

The Star Wars program is bound to exacerbate the competition between the superpowers in three major ways. It will destroy the Anti-Ballistic Missile (ABM) Treaty; it will directly stimulate both offensive and defensive systems on the Soviet side; and as long as it continues it will darken the prospect for significant improvement in the currently frigid relations between Moscow and Washington. The defense of the ABM Treaty is thus a first requirement for all who wish to limit the damage done by the Star Wars program. The Congress should encourage the Administration toward a new and more vigorous effort to insist on respect for the ABM Treaty by the Soviet government as well. One of the most unfortunate aspects of the Star Wars initiative is that it was launched without any attempt to discuss it seriously, in advance, with the Soviet government.