Major depressive disorder is a common mental disorder. Many pressing questions regarding depression treatment and outcomes exist, and new, efficient research approaches are necessary to address them. Connecting data across registries and other data collection efforts would yield a robust national data infrastructure to help address these questions, but a lack of harmonization in the outcome measures currently collected in research programs and clinical practice hinders the ability to connect these data sources. AHRQ recently funded a stakeholder-driven effort to use the Outcome Measures Framework (OMF) to develop a minimum set of standardized depression outcome measures for use in registries and clinical practice.
This new project builds on the prior effort by implementing the standardized depression outcome measures in two patient registries and five practices within a health system. The purpose of the project is to demonstrate that capturing the standardized depression outcome measures in the clinical workflow and submitting these data to different registries can improve clinical care, reduce the burden of registry participation, and increase the utility of registry data for research purposes.
The objectives of this project are to:
- Demonstrate that collection of the standardized outcome measures is feasible, sustainable, and useful for clinicians participating in primary care and mental health patient registries.
- Demonstrate that collection of the standardized outcome measures is feasible, sustainable, and useful for clinicians in a health system setting.
- Evaluate whether collection of the standardized measures increased the utility of registry data for research purposes.
The project team will address the first objective by calculating six standardized depression outcome measures (response, remission, recurrence, adverse events, suicide ideation and behavior, and mortality) in the American Board of Family Medicine’s PRIME Registry and the American Psychiatric Association’s PsychPRO.
The PRIME Registry was established to help provide family physicians and primary care clinicians a faster, easier way to evaluate practice performance, with built in tools for population health, risk stratification, empanelment and more, all designed to improve primary care practice and patient outcomes and reduce the burden of reporting for CMS payment programs (such as MIPS). The PRIME Registry has over 2,500 active clinicians participating from 47 States and data on 42 million patients.
PsychPRO, a national mental health registry, was established to help psychiatrists and mental health professionals validate quality patient care through measurement and analysis to discover opportunities for improvement, avoid payment penalties and instead achieve bonuses for meeting quality reporting requirements, deploy cutting-edge technology to minimize the burden of data collection and reporting, and achieve optimal patient outcomes using tools to measure, chart, and benchmark clinical care. The PsychPRO Registry has over 600 active clinicians participating from 46 States and data on over 180,000 patients.
Both registries will use routinely captured clinical data combined with regular collection of the PHQ-9 to calculate the measures and share the results with participating sites.
To address the second objective, the project team will develop an open-source Substitutable Medical Applications, Reusable Technologies (SMART) on FHIR app to extract the relevant data from electronic health records and any ancillary patient-reported outcome systems and display the measure results to the clinician within the clinical workflow. The app will be pilot tested at five practices within a health system.
Lastly, the project team will address the third objective by conducting a pilot data analysis using data from the PRIME Registry and PsychPRO. The project team will also develop a toolkit to support registries interested in sharing data with external researchers.