PDF(Pubmed)
Abstract：
UNASSIGNED: Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation.
UNASSIGNED: This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites.
UNASSIGNED: Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients.
UNASSIGNED: There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.
UNASSIGNED: This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites.
UNASSIGNED: Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients.
UNASSIGNED: There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.
摘要：
■基于行为测量的护理（MBC）可以改善患者的治疗效果，并且作为识别和减轻心理健康治疗中潜在差异的关键学习卫生系统（LHS）工具也得到了发展。然而,关于在安全网设置中远程行为MBC的吸收知之甚少，或远程MBC实施中可能出现的差异。
■本研究使用电子健康记录数据来研究远程MBC症状测量工具在三个成人门诊精神病诊所实施的前6个月中，诊所和患者水平的完成率的变化。安全网卫生系统。还使用在三个站点之一的重复调查来衡量提供者报告的MBC采用障碍。
■在收到MBC测量请求的1219名患者中，完成至少一项因诊所而异的措施的摄取：普通成人诊所，38%(n=696人中的262人)；物质使用诊所，28%(n=73/265)；过渡诊所，17%(258的n=44)。与白人患者相比，黑人和葡萄牙或巴西患者的摄取较低。老年患者的摄取也较低。西班牙语护理与患者水平的低得多有关。在临床调整后，患者水平的摄取差异仍然存在，心理健康诊断，和发送的度量请求数。提供商将就诊时间和工作流程中的带宽作为与患者讨论MBC结果的最大一致障碍。
■患者和临床水平的MBC摄取存在显著差异。从LHS数据基础设施的角度来看，安全网卫生系统可能需要解决对适应MBC的可能方法的需求，以更好地适应其人群和临床需求，或确定有针对性的实施策略，以缩小已确定的差异人群的数据差距。
■本研究使用电子健康记录数据来研究远程MBC症状测量工具在三个成人门诊精神病诊所实施的前6个月中，诊所和患者水平的完成率的变化。安全网卫生系统。还使用在三个站点之一的重复调查来衡量提供者报告的MBC采用障碍。
■在收到MBC测量请求的1219名患者中，完成至少一项因诊所而异的措施的摄取：普通成人诊所，38%(n=696人中的262人)；物质使用诊所，28%(n=73/265)；过渡诊所，17%(258的n=44)。与白人患者相比，黑人和葡萄牙或巴西患者的摄取较低。老年患者的摄取也较低。西班牙语护理与患者水平的低得多有关。在临床调整后，患者水平的摄取差异仍然存在，心理健康诊断，和发送的度量请求数。提供商将就诊时间和工作流程中的带宽作为与患者讨论MBC结果的最大一致障碍。
■患者和临床水平的MBC摄取存在显著差异。从LHS数据基础设施的角度来看，安全网卫生系统可能需要解决对适应MBC的可能方法的需求，以更好地适应其人群和临床需求，或确定有针对性的实施策略，以缩小已确定的差异人群的数据差距。
