navy mental health electronic data capture - 2014 cosc symposium

www.nccosc.navy.mil

Navy Mental Health Electronic Data Capture

Scott L. Johnston, PhD, ABPP CAPT, MSC, USNDirector, NCCOSC

Naval Center for Combat & Operational Stress Control (NCCOSC)

Disclaimer The opinions expressed in this article are the author's own and do not necessarily reflect the view of the United States Government, the United States Department of Defense, The United States Navy, or The United States Navy Bureau of Medicine and Surgery. 

The study protocol was approved by the Naval Medical Center San Diego Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.

I am an employee of the U.S. Government. This work was prepared as part of my official duties. Title 17 U.S.C. §105 provides that ‘copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C §101 defines U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

Objectives • Importance of Standard Measures

• Importance of Electronic Data Capture

• Electronic Data Capture Platforms

• Navy Psychological Health Pathways (PHP)

• Tri-Service Behavioral Health Data Platform (BHDP)

• Answer basic questions about patients

• Improve diagnostic and predictive accuracy

• Improve overall outcomes

• Provide a standardized mental health system

• Meet standard measures mandates

Slide 4 of

Importance of Standard Measures

• What are patients presenting with?

• Are patients getting better?

• What treatments are working?

Slide 5 of XX

Standard Measures: Answer Basic Questions About Patients

• Study 1: Basso et al., 2000 • Community MH setting, N= 200 psych patients • SCID+Med record > SCID > routine care

• Study 2: Miller et al., 2001• Inpatient setting, N= 56, N= 72• Traditional Dx assessment (TDA) vs Computer assisted Dx interview (CADI)• SCID = CADI; SCID/CADI both >> TDA for diagnostic accuracy• Dx agreement: TDA = 53.8% / SCID = 85.7% / CADI = 85.7%• TDA: interrater agreement = 45.5% kappa=0.24 (poor); CADI: interrater

agreement= 79.5% kappa=0.75 (excellent)• Diagnostic accuracy correlated with marked fewer inpatient days

• Study 3: Shear et al, 2000 • SCID vs chart diagnosis, N= 164• Anxiety concordance = 26% Depression concordance = 51%• Adjustment Disorder more likely given by clinician

Slide 6 of XX

Standard Measures:Improve Diagnostic Accuracy

Standard Measures: Improve Outcomes

Patients who received feedback had significantly better outcomes

Pre-test Feedback Post-test50

55

60

65

70

75

80

85

90

95

100

Pt not progressing– No feedback to providerPt not progressing– Provider given feedbackPt not progressing– Provider given feedback &clinical support toolsProvider and Pt received feedback

Slide 8 of

Outcome Rating Scale

Low level

High level

Magnitude of Change

• No control of Tx process

• No new techniques or Dx procedures

• Large changes in effect size (.80) just from use of feedback system

• Changes take time

• Provides aggregate reporting to clinic leadership

• Identifies access to care issues

• Advocates for EBT implementation

• Evaluates clinics and program

Standard Measures:Systemic Benefits

• Health Affairs Memo • Mandates specific

psychological health outcome measures

• Tri-services will use BHDP as the data collection tool, modified for each service

• Outcome measures will be integrated into mental health clinical processes

Standard Measures: Mandates

• BUMED CPG Compliance• PTSD1: All new patients should be screened for symptoms of

PTSD initially and then on an annual basis or more frequently if clinically indicated due to clinical suspicion, recent trauma exposure, or history of PTSD.

Standard Measures: Mandates

PTSD Checklist (PCL) (Civilian, Military, Specific Trauma)

Other Clinician Administered PTSD Scale (CAPS)

None Offered0%

20%

40%

60%

80%

100%

45

3 1

50

% o

f Pa

tient

s

Quantitative Assessment

Standard Measures: Mandates

Number of PTSD Patients

Location1Number of PTSD

Patients2# of Chart Reviews

NMW 2,366 80

NH BREMERTON 160 5

NH CAMP PENDLETON 808 20

NH GUAM 35 5

NH LEMOORE 36 5

NH OAK HARBOR 112 5

NH OKINAWA 158 5

NH TWENTYNINE PALMS 140 5

NH YOKOSUKA 88 5

NHC HAWAII 111 5

NMC SAN DIEGO 718 20

Number of PTSD Patients

Location1Number of PTSD

Patients2# of Chart Reviews

NME 2,872 125NH BEAUFORT 100 5NH CAMP LEJEUNE 895 20NH GUANTANAMO BAY 14 5NH JACKSONVILLE 214 10NH NAPLES 17 5NH PENSACOLA 271 10NH ROTA 9 5NH SIGONELLA 33 5NHC ANNAPOLIS 48 5NHC CHARLESTON 17 5NHC CHERRY POINT 97 5NHC CORPUS CHRISTI 129 5NHC GREAT LAKES 138 5NHC NEW ENGLAND 136 5NHC PATUXENT RIVER 59 5NHC QUANTICO 162 5NMC PORTSMOUTH 533 20

Manual Chart Reviews

Standard Measures: MandatesJoint Commission Requirement• Standard CTS 03.01.09 Outcome Measures

• Monitor progress of individual patients

• Aggregate data about care, treatment and service outcomes

• Evaluate effectiveness or care

Importance ofElectronic Data Capture • Reduces data entry error, program costs,

processing time, and increases ability to share data

• Allows providers to receive clinical data instantaneously

• Allows providers to monitor outcomes over time

• Allows for aggregate data analysis for learning about the population as a whole

Electronic Data Capture Platforms:Navy Psychological Health Pathways (PHP)

• Standardizes intakes

• Identical outcome measures at regular intervals

• Data in a central location; available to all providers

• Standard reports – regular frequency

• Program evaluation

ISR

Patient

Clinic

Patient

10 wks10 wks RSR TR

Patient Tx Team

PHP Patient Experience

OR

In Clinic At Home

PHP Web-Based Access

• 585 Registered Users

• 31 Clinics

• 9870 Initial Self Reports (ISR)

• 3825 Reassessment Self Reports (RSR)

• 5,469,356 Total Data Points

PHP Status

20

Patient Summary

Narrative Summary

Full Detail

QuarterlyReport

• Predict treatment responders

• Identify patients who discharge early

• Comparison of cohort sizes

• Level of care

• Evaluation of impact of programmatic changes

PHP Program Evaluation

• Effectiveness of outcomes across and within clinics

• Predictors of treatment success

• Effectiveness of combining modalities

• Relationship and influence of resilience on outcomes

• Influence of depression

• Relationship of MH Sx, social support and stressors

• Effectiveness of EMDR

• Relationship of stress and sleep in mTBI+ patients with and without PTSD

• Effect of childhood abuse and combat experiences on MH outcomes and resilience

• Comparison of service member deployed and non-deployed

• Relationship of sleep quality, caffeine intake and MH Sx

PHP Population Level Research:Presentations & Publications

• Common data elements across services

• Collect standardized clinical care data

• Provide patient/provider-centric clinical outcomes

• Aggregate data at DoD level

• Improve provider and command communication

Electronic Data Capture Platforms: Tri-Service Behavioral Health Data Platform (BHDP)

Provider Dashboard

Navy Mental Health Electronic Data Capture

Scott L. Johnston, PhD, ABPP CAPT, MSC, USNDirector, NCCOSC

Naval Center for Combat & Operational Stress Control (NCCOSC)

Questions?

Thank You

Navy Mental Health Electronic Data Capture

Scott L. Johnston, PhD, ABPP CAPT, MSC, USNDirector, NCCOSC

Naval Center for Combat & Operational Stress Control (NCCOSC)