 Snapshot
SummaryA computer-assisted patient assessment system allows patients who have severe mental illness to document important clinical information while waiting for appointments. This information, which is reviewed by clinicians before the visit commences, helps the provider to better understand the patient’s current status and the impact of the treatment regimen and serves as a guide to patient-provider communication during the limited time available for the appointment itself. Both patients and providers have found the system easy to use, and patients believe that it enhances the quality of their communications with clinicians.
Suggestive: The evidence consists of patient questionnaires and physician focus groups that used the program.
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begin doDeveloping OrganizationsLos Angeles County Department of Mental Health; Veterans Affairs (VA) Health Services Research and Development Center for the Study of Healthcare Provider Behavior
end doDate First Implemented2003
begin ppPatient Population
Geographic Location > Metropolitan area; Vulnerable Populations > Mentally ill end pp |
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Problem AddressedCare for patients with severe mental illness is often poor and not comprehensive due to the failure to routinely collect important information that is needed to effectively assess, treat, and communicate with the patient.
- Failure to adequately assess mentally ill patients: A formal assessment is critical to the ability of clinicians to provide effective treatment to patients with mental illness. However, in most settings, clinicians lack the information needed to conduct a comprehensive, up-to-date assessment. For example, medical records often do not have pertinent information such as medication compliance, comorbidities, and other patient-specific data necessary to assess health status and improve care. Also, without easy access to relevant information, routine patient assessments can be quite time-consuming and difficult to integrate into a short patient visit, as too much time is spent eliciting relevant background information from the patient.
- Problem especially acute for the severely mentally ill: Patients with severe mental illness are at increased risk for HIV, substance abuse, homelessness, and other severe medical conditions. This enhanced risk makes it especially important for clinicians to routinely monitor their symptoms, any side effects from medications, and other issues.1
Description of the Innovative ActivityThe computer-assisted patient assessment system is an audio, computer-assisted self-interviewing aid that is completed by patients in the provider’s office before a scheduled appointment. Information from the assessment helps the provider to understand key issues about the patient’s condition and guides patient-provider communication during the visit.
References/Related ArticlesChinman, M, Hassell, J, Magnabosco, J, et al. The feasibility of computerized patient self-assessment at mental health clinics. Adm Policy Ment Health. 2007;34(4):401-9. [PubMed]
Available at: http://www.springerlink.com/content/wtg4g17j25l0147t/
Chinman M, Young AS, Schell T, et al. Computer-assisted self-assessment in persons with severe mental illness. J Clin Psychiatry. 2004;65(10):1343-51. [PubMed]
Contact the InnovatorMatthew Chinman, PhD
West Lost Angeles VA MIRECC
11301 Wilshire Blvd. (210A)
Los Angeles, CA 90073
(310) 393-0411 x4287
E-mail: chinman@rand.org
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ResultsFeedback questionnaire results suggest that patients believe that the patient assessment system is easy to learn and use and that it improves communication between patients and providers; providers believe it is having a modest positive impact on the quality of care.
- Patient perceptions: Patients report in the questionnaire that the patient assessment system is easy and enjoyable to use, it did not take too much time, and that it helps to improve communication with their psychiatrists.
- Provider perceptions: Providers find the patient assessment system printout to be easy to use, and they believe the system has had a small, positive impact on the quality of care. Physicians also have suggested that the system could be more valuable if it were more detailed and comprehensive.
Suggestive: The evidence consists of patient questionnaires and physician focus groups that used the program.
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Context of the InnovationThis innovation was implemented at a VA mental health clinic and a Los Angeles County Department of Mental Health facility. Each facility provides general mental health services to more than 500 patients with a variety of serious mental illnesses.
Planning and Development ProcessKey steps in the planning and development process include the following:
- Programming: A programmer worked inhouse to develop the Web-based assessment tool. The program was developed to assess various psychiatric "vital signs," or a broad set of measures about a patient including psychosis, substance abuse, medication compliance, side effects, and preexisting measures.
- Upfront testing: The clinics tested the application with patients to evaluate its ease of use. This testing led to the conclusion that many patients were uncomfortable with computer technology and use of the keyboard, which in turn led to the decision to modify the original application to incorporate a touchscreen monitor.
- Implementation assistance: Research assistants were initially available at the two clinics to help clinicians and patients get used to using the system.
Resources Used and Skills Needed
- Equipment: A computer with a touchscreen monitor, headphones, and speakers are needed for patients to complete the assessment. The total cost of the system is roughly $2,000.
- Space: A desk or space is needed outside of the waiting room to house the equipment and afford the patient some privacy.
- Staffing: A staff person is needed to guide the patients into the room and to provide them with a brief overview of the program. This can be a current staff member at the clinic; the time commitment is minimal, so an existing employee can be utilized.
begin fsxmlFunding SourcesFunding was provided by a grant from the VA.
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Getting Started with This Innovation
- Test and, when necessary, adapt the existing system to ensure that patients are comfortable using it based on their computer knowledge and cognitive abilities.
- Solicit feedback from clinicians on the content of the tool, including what questions are asked and the format of the printout.
- Allocate adequate space for the system in an area that offers some privacy, taking into account the logistics of using the touchscreen system.
- Educate existing staff about the basic operation and purpose of the system so that they are able to help patients using it.
Sustaining This Innovation
- Monitor ongoing use of the system and the printout, and seek ongoing feedback on ways to improve. Patients and providers need to see value if they are to continue using the system.
- Develop a guide to help clinicians interpret the printed assessment quickly and easily to facilitate use of the system.
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1 Blank MB, Mandell DS, Aiken L, et al. Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatr Serv. 2002;53(7):868-73. [PubMed] |
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Original publication: April 14, 2008.
Last updated: May 11, 2009.
Date verified by innovator: April 22, 2009.
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