Skip Navigation
< Back
Service Delivery Innovation Profile

Computerized, Previsit Self-Assessment Enhances Communication Between Providers and Patients With Mental Illness


Tab for The Profile
Comments
(1)
   
Jump to: What They Did | Did It Work? | How They Did It | Adoption Considerations

Snapshot

Summary

A 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.

Evidence Rating (What is this?)

Suggestive: The evidence consists of patient questionnaires and physician focus groups that used the program.
begin do

Developing Organizations

University of California, Los Angeles; Veterans Administration (VA) Desert Pacific Mental Illness Research, Education and Clinical Center
end do

Date First Implemented

2003
begin pp

Patient Population

Vulnerable Populations > Mentally illend pp

What They Did

Back to Top

Problem Addressed

Care for patients with severe mental illness is often poor and not comprehensive because of 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 adherence, 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 human immunodeficiency virus, 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 Activity

The 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.
  • Assessment tool: The system consists of a Web-based survey that patients complete on a computer with a touchscreen monitor located in a private area adjacent to the waiting room. The survey questions are designed to assess a broad set of psychiatric vital signs, including the patient’s current functioning, interpersonal problems, psychosis, substance abuse, medication compliance, side effects, and preexisting conditions. The domains are based on BASIS-24© scales, which are patient self-reported measures of behaviors and functioning.
  • Completing the assessment: Typically patients are instructed to arrive at least 15 minutes early so that they can complete the survey. Office staff direct the patient to the computer and provide a brief explanation of the system. The computer application and interface are designed to make it as easy as possible for patients to complete the survey.
    • Clear instructions on how to use the system are provided to the patient at the computer.
    • To facilitate ease of use for those with cognitive issues, survey questions appear one at a time, with no drop-down menus.
    • Questions are read aloud by a recorded voice for users and then again after 60 seconds of inactivity.
    • Potential answers appear as buttons on the screen that patients “push” to answer the question. Where appropriate, graphical images and other visual cues are used to assist the patient in answering questions.
    • Patients move between questions by pressing the “next” button, and they can skip a question without answering it.
    • Using internal logic functions, the system asks only relevant questions based on the patient’s responses.
    • After patients complete the patient assessment system, a one-page summary is printed for the patient to give to the psychiatrist. The summary, which includes prompts for the physician, is designed to help psychiatrists and patients collaborate in reviewing the impact of current treatment and how best to move forward with the treatment plan.

References/Related Articles

Brown AH, Cohen AN, Chinman MJ, et al. EQUIP: Implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia. Implementation Sciences. 2008; 3(9). Available at: http://www.implementationscience.com/content/3/1/9.

Chinman 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]

Cohen AN, Chinman MJ, Hamilton AB, et al. Using patient-facing kiosks to support quality improvement at mental health clinics. Med Care. 2013;51(3 Suppl 1):S13-20. [PubMed]

Contact the Innovator

Alexander Young, MD, MSHS
Professor, UCLA
Director, Health Services Unit, VA Desert Pacific MIRECC
UCLA Health Services Center
10920 Wilshire Boulevard, Suite 300
Los Angeles, CA 90024
E-mail: ayoung@ucla.edu

Innovator Disclosures

Dr. Young has not indicated whether he has financial or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

Did It Work?

Back to Top

Results

Feedback 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 it helps to improve their communication with their psychiatrists.
  • Provider perceptions: Providers find the patient assessment system printout 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.

Evidence Rating (What is this?)

Suggestive: The evidence consists of patient questionnaires and physician focus groups that used the program.

How They Did It

Back to Top

Context of the Innovation

This innovation was implemented at a Veterans Affairs 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 Process

Key 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 adherence, 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 is 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 person can be a current staff member at the clinic; the time commitment is minimal, so an existing employee can be utilized.
begin fsxml

Funding Sources

Funding was provided by a grant from the U.S. Department of Veterans Affairs.end fs

Adoption Considerations

Back to Top

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 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.

Use By Other Organizations

Investigators at Dartmouth did similar work.

 
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]
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.
Service Delivery Innovation Profile Classification

Patient Population:
Stage of Care:
IOM Domains of Quality:
State:

Original publication: April 14, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 18, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: February 18, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.