Optimizing Implementation of an IT Behavioral Health Screening Platform in Primary Care

Context: Individuals experiencing mental health disorders face worse outcomes and reduced life expectancies. While primary care practices see the largest numbers of patients with various mental health disorders, historically, they have struggled to integrate behavioral healthcare and best practices are still being established. Care Optimization for Person’s Emotions, Mood, and Other Related Experiences (COPE MORE) is a project intended to improve assessment for mental health disorders within primary care by identifying behavioral health concerns and providing appropriate resources.

Objective: Tridiuum, an IT behavioral health platform, enables rapid identification of behavioral health indicators through validated screening instruments, assigns risk scores using an automated tool, and sends alerts about patients with severe mental health concerns. The goal of this study is to evaluate the implementation of an IT platform for behavioral health screening in primary care.

Study Design: This was an implementation study over 15 months.

Setting: The study took place at an inner-city, academic Family Medicine practice. Population Studied: All patients over the age of 18 who presented to the practice during the implementation period were included.

Intervention: The IT platform was initially distributed on iPads in the office. The distribution method was subsequently modified to text and email communications 24 hours prior to appointments.

Outcome Measures: The primary outcome measure was the number of completed screens, and the secondary measure was the sustainability of the screening method.

Results: During the first 2 months of in-office iPad surveys, 102 and 101 screens were completed, respectively. After surveys began being sent out via text and email 24 hours prior to appointment times, the number of completed screens increased to 194 and 215, respectively. This represents a 101.5% increase in the number of completed screens after the new distribution method was implemented despite the number of visits to the practice holding consistent.

Outcomes: Compared to in-office iPad distribution, sending surveys to patients led to a 101.5% increase in the number of patients screened (rates forthcoming). Additionally, when screens were offered on an in-office iPad, there was a steep decline in the number of patients screened month over month. This suggests that text and email may be more effective for distribution of behavioral health screening tools.