Timothy E Burdick1, Rodger S Kessler. 1. Timothy E. Burdick MD MSc, Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, HB 7250, Hanover, NH 03755, Email: Timothy.E.Burdick@Hitchcock.org, Phone: 802-272-5931.
Abstract
OBJECTIVE: Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools on clinical outcomes. METHODS: A multidisciplinary team designed SBIRT workflows and CDS tools. We analyzed the outcomes using a retrospective descriptive convenience cohort with age-matched comparison group. Data extracted from the EHR were evaluated using descriptive statistics. RESULTS: There were 2 outcomes studied: 1) development and use of new BH screening tools and workflows; and 2) the results of use of those tools by a convenience sample of 866 encounters. The EHR tools developed included a flowsheet for documenting screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including changes in psychotropic medications, updated BH terms on the problem list, or referral for BH intervention. Clinical process outcomes changed even when screening was negative. CONCLUSIONS: Modified workflows for BH screening and CDS tools with clinical recommendations can be deployed in the EHR. Using SBIRT tools changed clinical process metrics even when screening was negative, perhaps due to conversations about BH not captured in the screening flowsheet. Although there are limitations to the study, results support ongoing investigation.
OBJECTIVE: Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools on clinical outcomes. METHODS: A multidisciplinary team designed SBIRT workflows and CDS tools. We analyzed the outcomes using a retrospective descriptive convenience cohort with age-matched comparison group. Data extracted from the EHR were evaluated using descriptive statistics. RESULTS: There were 2 outcomes studied: 1) development and use of new BH screening tools and workflows; and 2) the results of use of those tools by a convenience sample of 866 encounters. The EHR tools developed included a flowsheet for documenting screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including changes in psychotropic medications, updated BH terms on the problem list, or referral for BH intervention. Clinical process outcomes changed even when screening was negative. CONCLUSIONS: Modified workflows for BH screening and CDS tools with clinical recommendations can be deployed in the EHR. Using SBIRT tools changed clinical process metrics even when screening was negative, perhaps due to conversations about BH not captured in the screening flowsheet. Although there are limitations to the study, results support ongoing investigation.
Entities:
Keywords:
Electronic health records; SBIRT; behavioral medicine; clinical decision support systems; depression
Authors: Mac Baird; Alexander Blount; Stacy Brungardt; Perry Dickinson; Allen Dietrich; Ted Epperly; Larry Green; Douglas Henley; Rodger Kessler; Neil Korsen; Susan McDaniel; Ben Miller; Perry Pugno; Richard Roberts; Julie Schirmer; Deb Seymour; Frank Degruy Journal: Ann Fam Med Date: 2014 Mar-Apr Impact factor: 5.166
Authors: Joan S Ash; Dean F Sittig; Richard Dykstra; Adam Wright; Carmit McMullen; Joshua Richardson; Blackford Middleton Journal: Stud Health Technol Inform Date: 2010
Authors: Kurt C Stange; Paul A Nutting; William L Miller; Carlos R Jaén; Benjamin F Crabtree; Susan A Flocke; James M Gill Journal: J Gen Intern Med Date: 2010-06 Impact factor: 5.128
Authors: Tanisha Tate Woodson; Rose Gunn; Khaya D Clark; Bijal A Balasubramanian; Katelyn K Jetelina; Brianna Muller; Benjamin F Miller; Timothy E Burdick; Deborah J Cohen Journal: J Innov Health Inform Date: 2018-10-31
Authors: Van C Willis; Kelly Jean Thomas Craig; Yalda Jabbarpour; Elisabeth L Scheufele; Yull E Arriaga; Monica Ajinkya; Kyu B Rhee; Andrew Bazemore Journal: JMIR Med Inform Date: 2022-01-21