Clinical Information Systems: Depression Registry

1. Clinical Information Systems: Depression Registry Allison Smith, M PA New York University Nance Roy Sarah Lawrence College

2. Registries cannot exist in isolation Serrano et al, 2012

3. Questions to Consider • What percentage of students seen at your center with depression are identified and treated? • What percentage of students with depression receive evidence-based treatment? • What percentage of students with depression achieve remission within 3 months? • What percentage of students with depression drop out of school for a semester or permanently?

4. Population Health • Health outcomes of a group of individuals, including the distribution of such outcomes within the group • Care delivery is only one factor that influences outcomes (public health interventions, social environmental factors, physical environment) • Population health management is fundamental to the transformation of healthcare delivery and requires new infrastructure for delivering care • For every provider, this means knowing what’s going on with all your patients and taking action to proactively achieve the best outcomes.

6. Who is Your Population? Groups of patients generally defined by: • age and/or gender criteria who share the need for a defined set off preventive or screening services • abnormal or unexpected results of screening tests, who share a need for follow-up services • diagnosis, who are a medical condition, often chronic, and who share a need for a class of services often referred to as “disease management”

8. Change ConceptsClinical Information System • Use Excel registry to enter all assessments at pre-specified time frames • Proactively use registry reminders to facilitate customized care management and follow-up for patients • Use registry to track quality improvement over time using graphical charting

9. AHRQ Definition of Registry “A collection of uniform data (clinical or other) used to evaluate outcomes in specific populations for scientific, clinical, or policy purposes.”

10. Disease Registry A disease (chronic) registry: • Lists the names of a practice’s patients/clients who have a given chronic illness • Tracks when those patients are due for services • Helps assess whether their measures are within an acceptable range

11. Disease Registries • Disease registries have been used for many conditions including: • Asthma • Cancer • Diabetes • Depression • Hypertension

12. History • Long precedent for use and effectiveness in cancer • 1926: First Cancer Registry at Yale-New Haven • 1935: First state, centralized cancer registry in Connecticut • 1973: Surveillance, Epidemiology, and End Results (SEER) program of NCI, first national cancer registries • Pioneered by Group Health of Puget Sound in the early 1980s for diseases other than cancer

13. Case Example: Sweden • 1991: Sweden’s Register of Information and Knowledge and Swedish Heart Intensive Care Admissions (SWEDE-HEART ) study • Used registry to collect data from 74% of major hospitals of patients who suffer a myocardial infarction (80% of patients in Sweden) • Tracked 30-day and 1-year mortality rates and monitors adherences to process measures such as European clinical guidelines • Data made available to providers and general public • Results: decreased average 30-day mortality by 65% & 1-year mortality rate by 49% • 2009: $70 million annual investment by Swedish government in disease registries • Projected reduction in healthcare costs of $7 billion over 10 years • 2011: 90 government supported registries that cover >25% of national expenditures Molina-Ortiz et al, 2012

14. NCDP Registry • System Requirements: Office 2010 & Windows 7 • Excel-based Registry with care management functionality • Functionalities • Reminders for PHQ-9s • Individual Patient & Aggregate Reports • No direct interface with EHR • Considerations

15. Care Manager: Document and Track Progress • Track patient and clinician contact information • Track initial assessments and treatment plans • Track follow-up contacts, treatment plan updates, treatment response, and relapse prevention plans • Produce regular follow-up and treatment reminders • Summarize individual patient progress • Summarize entire caseload

16. Demo of NCDP Registry

17. ABOUT SLC • Suburban campus, just north of NYC • 1500 undergraduates, 400 graduate students

18. About SLC Health Services • Co-located Shared EMR • Primary Care: 4 FTE Counseling: 5.5 FTE • Health Services sees large # of students each year who are struggling with mood disorders • 40% of student body seen by counseling center annually • 80% of student body seen by medical center annually

19. NCDP Applied at SLC • Screen all students who present to counseling and primary care • During the 2008-09 and 2009-10 academic years, 23% of the student body was treated for depression AND reported having significant difficulty getting to class, doing their work, studying and getting along with others

20. The Power of Data • Ties the work of the counseling and health center to the larger mission of the College • Facilitates collaboration with offices across campus • Facilitates collaboration with dons and faculty • Provides validation for new initiatives • Improves care delivery • Importance to stakeholders

21. Working the NCDP Model “System” Sub-group Level • Example: targeted concern/need to reach male students • Screening for 117 consecutive male students in primary care • 22/117 or 18% screen positively for depression • ALL 22 arenew cases,not known to counseling • All 22 are successfully triaged, referred, and engaged in treatment

22. SLC (NCDP) FINDINGS: CLINICAL MEASURES

23. OUTCOME MEASURES

24. SLC IMPLICATIONS FOR STUDENT AFFAIRS PROFESSIONALS • Significant reductions in depression and increases in functioning were evident in students engaged in SELF-CARE MANAGEMENT ONLY (i.e. exercise, sleep hygiene, meditation/yoga, study skills, pleasurable activities) • Self care management is something student affairs professionals, dons and faculty alike can implement with students • Demonstrated positive impact on social connectedness, friendships and psychological well-being

25. SLC FIRST YEAR EXPERIENCE WORKSHOP • a collaborative among sports and fitness staff, multicultural affairs, disability services, residential life and health services, with staff from each office leading one of the modules • Generated as result of NCDP data re: efficacy of self-management in reducing depression and increasing functioning • 8 week workshop required of all first years • Each week focuses on developing a set of self management skills as well as focus on developing a sense of community among first years • Initial assessment reveals workshop had an overall positive effect: -took away a set of self management strategies for coping with stress -increased the likelihood that students will access services on campus -helped to foster beginning connections among first year class • New Revision: partner with film dept to create on line video course

26. SUMMARYNCDP DATA: IMPACT ON SLC COMMUNITY • Retention = major cost savings • Validation of connection between student well-being and academic, social and emotional functioning and retention • Collaborative expansion with other offices on campus • Targets outreach efforts