But My Patients Really Are More Difficult!

7 December 2017 07:14 AM   •   Greg Simon   •   0 comments

Comparisons of the quality or outcomes of care across providers or facilities often meet the objection: “But my patients really are more difficult!”

Do You Believe An Algorithm, Or Your Own Lying Eyes?

7 November 2017 09:45 AM   •   Greg Simon   •   0 comments

Our clinicians might wonder how an algorithm could outperform a face-to-face conversation. Out in the wider world, trust in algorithms and big data is not having a good year. I jokingly refer to this as “The Richard Pryor Problem,”...

Are we river pilots or rent seekers?

9 October 2017 02:58 PM   •   Greg Simon   •   2 comments

As researchers embedded in health systems, we should aspire to operate like river bar pilots. We have valuable local knowledge gained through years spent navigating our local waters. Researchers without that knowledge can be easily misled.

That’s Like Getting Struck by Lightning!

6 September 2017 02:43 PM   •   Greg Simon   •   0 comments

I am a converted skeptic regarding population-based suicide prevention. Until about 5 years ago, I would have argued that we lacked the two essential ingredients for effective prevention: accurate tools to identify people at risk and practical interventions to reduce that risk. I might have even said, “That’s like getting struck by lightning! How can you predict that?"

Can Health Services Defeat Epidemiology?

8 August 2017 01:52 PM   •   Greg Simon   •   0 comments

Can health services defeat epidemiology? This question is not inspired by the School of Public Health summer softball league. Instead it’s inspired by a conversation with my colleague Ed Boudreaux about screening for suicidal ideation as a tool for preventing suicide attempts and suicide deaths.

Social Determinants of Health: What's in a Name?

11 July 2017 08:56 AM   •   Greg Simon   •   11 comments

I have a beef with the name “Social Determinants of Health”. I absolutely agree with putting the word “social” right up front. It’s a fact that zip code often has a greater effect on health than genetic code. And the effects of social and environmental factors - such as trauma, loss, and deprivation - are especially relevant to mental health. It’s the specific word “determinants” that I’d want to change.

Who decides what a word means?

5 June 2017 10:41 AM   •   Greg Simon   •   18 comments

Our collaboration with MHRN health systems to improve depression care has emphasized the systematic use of standard outcome measures - like the PHQ9 depression scale. Front-line clinicians and health system managers often ask whether those standard questionnaires can accurately measure depression or predict suicidal behavior across diverse patient populations.

Coordinated Care for First-Episode Psychosis and the End of Gadgets

5 June 2017 09:46 AM   •   Greg Simon   •   38 comments

As MHRN investigators, we often hear from academic researchers hoping to study new psychotherapies or eHealth interventions in our healthcare systems.

Reducing Science Friction

7 December 2016 12:58 PM   •   Greg Simon   •   3 comments

At our recent MHRN investigator meeting, we were discussing the challenges of evaluating mobile health tools in real-world healthcare systems.

Should Suicide Prevention Be Adjusted for Race and Ethnicity?

10 October 2016 08:52 AM   •   Greg Simon   •   2 comments

Our MHRN Suicide Prevention Outreach Trial offers outreach and support interventions based on patients’ response to item 9 of the PHQ9 depression questionnaire. We reach out to patients who reported thoughts of death or self-harm “more than half the days” or “nearly every day” at a recent visit. This threshold for outreach is based on our previous research showing that those patients reporting frequent suicidal thoughts have an approximately 2.5% risk of suicide attempt over the following year. Now, several of our MHRN health systems are using the same threshold (a score of 2 or 3 on item 9 of the PHQ9) to identify patients needing additional assessment and follow-up.