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Latest News





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Feedback-informed care: Mapping a new course for depression treatment

Feedback-informed care: Mapping a new course for depression treatment

With support from the Garfield Memorial Fund, MHRN researchers at KP Colorado and KP Washington are working with health system leaders to harness the power of big data to help customize and improve care for depression.


Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

Rebecca Rossom, MD, MS, led a study that was recently published in the Journal of Affective Disorders. The team examined PHQ9s completed by adult outpatients treated for mental health conditions in 2010-2012 at four Mental Health Research Network-affiliated healthcare systems. The goal was to examine suicidal ideation and attempts/deaths in order to determine whether item 9 of the Patient Health Questionnaire (PHQ9) predicted risk for suicide attempts and deaths across age groups. They found that those with nearly daily suicidal ideation (compared to those without) were:

  • 5-to-8 times more likely to attempt suicide and 3-to-11 times more likely to die by suicide within 30 days, and
  • 2-to-4 times more likely to attempt suicide and 2-to-6 times more likely to die by suicide within 365 days.

The study team also found that, for those with any level of suicidal ideation, the increased risk of suicide attempts and deaths persisted over two years. The absolute risk of suicide attempts generally declined with age, while the absolute risk of suicide death generally increased with age. However, the relationship between reported suicidal ideation and suicide attempts and deaths was similar across age groups. They concluded that suicidal ideation reported on the PHQ9 is a robust predictor of suicide attempts and death, regardless of age, and that healthcare systems should address both the immediate and sustained risk of suicide for patients of all ages.


MHRN provides resources to examine treatment patterns associated with first episode psychosis

MHRN provides resources to examine treatment patterns associated with first episode psychosis

MHRN provides resources to examine treatment patterns associated with first episode psychosis

Todd P. Gilmer, PhD, at the University of California, San Diego, is using MHRN resources to conduct a study, which will describe treatment for first-episode psychosis in a large commercially insured population using data from the OptumLabs Data Warehouse (OLDW). “Dr. Simon and his team have been very generous,” Dr. Gilmer said, “sharing both their research design and their programming code.  I am excited to be able to contribute to their important work examining first-episode psychosis by applying their methods to a national dataset.”

The proposed research will build on work that was initiated in four MHRN sites to identify individuals experiencing a first episode of psychosis and to describe their treatment patterns using administrative databases. The main goals for this project are 1) To identify individuals receiving treatment for first diagnosis of psychotic disorder, 2) To describe health care treatment patterns prior to first diagnosis of psychotic disorder, 3) To describe health care treatment patterns after first diagnosis of psychotic disorder, and 4) To estimate costs associated with specific patterns of treatment before and after first diagnosis of psychotic disorder. Although the proposed analysis are largely descriptive, we hypothesize that we will be able to identify treatment patterns (e.g. more intensive outpatient therapy and using of low-dose antipsychotic medication) that are associated with improved outcomes following the first diagnosis of psychotic disorder, such as lower rates of inpatient admissions and emergency room visits.  This work has the potential significantly inform and advance ongoing national efforts aimed at the prevention and early intervention of psychosis, leading to improved life trajectories for patients and potentially immediate and long-term cost savings to health plans.


Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy

Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy

Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy

Christine Lu, PhD, MSc, was selected to present her MHRN-related abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy. Her presentation, "Near Real-Time Surveillance for Consequences of Health Policies Using Sequential Analysis,” reports their follow-up study using the maxSPRT methods to examine the association between suicidality and FDA antidepressant warnings.


Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

Although clinicians are expected to routinely assess and address suicide risk, there is little guidance regarding the significance of visit-to-visit changes in suicidal ideation.

Since healthcare systems increasingly use PHQ9 in both primary care and specialty mental health clinics in patients reporting frequent thoughts of death or self-harm, questions have arisen:  Does an apparent decrease in suicidal ideation (i.e. decreasing score on PHQ9 item 9) actually imply a decrease in risk of subsequent suicidal behavior?  Does the apparent onset of suicidal ideation imply an increase in risk compared to pre-existing or “chronic” suicidal ideation?

A study led by Greg Simon, MD, MPH suggests that current suicidal ideation is a powerful indicator of near-term risk, independent of past reports of suicidal ideation.  Individuals who reported thoughts of death or self-harm at a prior visit remained at moderately increased risk even if they reported no such thoughts at the current visit. While the apparent onset of suicidal thoughts did predict significant risk, risk was actually highest for patients reporting sustained or repeated thoughts of death or self-harm.


MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

Rinad Beidas, PhD, at the University of Pennsylvania, is leading an MHRN-related project investigating how to implement an evidence-based program for firearm safety as a suicide prevention strategy for youth in primary care. The long-term goal of this two-year NIMH-funded project is to reduce death by suicide by increasing the use of evidence-based strategies in pediatric primary care while also promoting multi-level implementation strategies informed by a systematic and rigorous development approach. Currently the team is analyzing data collected from approximately 140 participating primary doctors at participating sites, Henry Ford Health System and Baylor Scott & White Health. Dr. Beidas recently presented preliminary results at the Society for Prevention Research Conference in DCIn 2018, the investigators plan to submit an R01 application to conduct a hybrid trial that will evaluate both the effectiveness of the adapted Safety Check in pediatric primary care as well as the implementation strategies used to implement it.


New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

New investigator, Melissa Harry, PhD, MSW, from Essentia Health, has joined the Mental Health Research Network (MHRN). Dr. Harry received her PhD in 2016 from the Boston College School of Social Work. She previously worked in child and adolescent mental health as a licensed social worker. Her doctoral research centered around experiences and outcomes with self-directed budgets for purchasing home and community-based long-term care services and supports for people with disabilities. She also studies the cross-cultural measurement invariance of mental health scales with a focus on indigenous cultures and is interested in intervention research, program evaluation, and secondary data analysis with complex data sets.


Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California

Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California

Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California

Stacy Sterling, DrPH, MSW is the new official site PI for MHRN at Kaiser Permanente Northern California (KPNC), replacing Enid Hunkeler, MA who retired in the fall of 2016. Dr. Sterling is with the Drug and Alcohol Research Team (DART) and the Behavioral Health Research Initiative at the Kaiser Permanente Northern California Division of Research. She received her doctoral training at the University of North Carolina, Gillings School of Global Public Health, and Master’s degrees in Public Health and Social Welfare at the University of California, Berkeley. Her research interests include developing and studying systems for implementing evidence-based, integrated behavioral health services into primary care, adolescent behavioral health prevention and early intervention, and mental health and alcohol and drug treatment outcomes and access.  She is the Principal Investigator of a Conrad N. Hilton Foundation-funded study to develop predictive models for adolescent substance use problem development, the Kaiser P.I. of a Hilton Foundation-funded trial of extended screening, brief intervention and referral to treatment (SBIRT) for adolescent behavioral health problems in pediatric primary care, the Kaiser P.I. of an NIH/NIAAA adolescent SBIRT trial in pediatric primary care and of an NIH/NIAAA survey of Pediatrician attitudes toward and practices of adolescent behavioral health risk screening and intervention; and of Robert Wood Johnson Foundation and Center for Substance Abuse Treatment-funded studies of adolescents in drug and alcohol treatment in Kaiser. She has overseen the implementation of region-wide alcohol SBIRT in KPNC adult primary care.


Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

The COMPASS Initiative is a national effort to disseminate and implement an evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease. Karen J. Coleman, PhD led a detailed description of the initiative in the August 2016 edition of General Hospital Psychiatry.It has been implemented in 18 medical groups and 172 clinics in 8 states. MHRN investigators associated with the COMPASS Initiative published four new publications on this ambitious initiative, covering a description of current conditions, an overview of the initiative, outcomes and key learnings. The goals of the initiative are to:

  1. Improve depression symptoms in 40% of patients.
  2. Improve diabetes and hypertension control rates by 20%.
  3. Increase provider satisfaction by 20%.
  4. Improve patient satisfaction with their care by 20%.
  5. Demonstrate cost savings.

 

The three other publications describe The impact of the COMPASS initiative, as well as a study to understand how care managers implemented COMPASS and if this implementation was related to health outcomes in their patients, and a study to describe primary care clinician’s self-reports of satisfaction, burnout and barriers associated with treating complex patients.


Check out our online repository for MHRN diagnoses codes!

Check out our online repository for MHRN diagnoses codes!

Check out our online repository for MHRN diagnoses codes!

The Mental Health Research Network (MHRN) created an online repository for MHRN diagnoses codes on GitHub and posted various specifications and codes. Everything is downloadable and free to the public.


MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

In September 2014, an MHRN-affiliated study began ground-breaking work on suicide prevention , with a goal to enroll 15,000 patients. We have now enrolled 6,500 participants and added a fourth data collection site: Kaiser Permanente Northwest.

This pragmatic trial of selective prevention should fill a major gap in current suicide prevention efforts, and the methods developed should dramatically accelerate future suicide prevention research. 


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New HEDIS measures: MHRN partners with health systems to prepare for next generation of NCQA/HEDIS measures

New HEDIS measures: MHRN partners with health systems to prepare for next generation of NCQA/HEDIS measures

NCQA has released preliminary specifications for a next generation of depression measures – focused on use of outcome measures (like the PHQ9) to assess quality and effectiveness of care.  MHRN investigators are partnering with our health systems to give feedback on measurement specifics, evaluate gaps in our current performance, and design appropriate quality improvement strategies.  Contact Leif Solberg (Leif.I.Solberg@HealthPartners.Com), Robert Penfold (penfold.r@ghc.org) or Greg Simon (simon.g@ghc.org) for more information.


Now available via webcast: How to work with MHRN

Now available via webcast: How to work with MHRN

Now available via webcast: How to work with MHRN

A webcast on how to work with MHRN is available for anyone interested in partnering with us. The webcast is from a session at the 23rd NIMH Conference on Mental Health Services Research (MHSR), which brought together leading mental health services researchers, clinicians, mental health advocates, and federal and nonfederal partners. The conference highlighted opportunities for the next generation of high-impact research to drive mental health care improvement.


MHRN-affiliated health systems receive funding to lead a research consortium as part of NIH's All of Us Precision Medicine Initiative Cohort Program

MHRN-affiliated health systems receive funding to lead a research consortium as part of NIH's All of Us Precision Medicine Initiative Cohort Program

MHRN-affiliated health systems receive funding to lead a research consortium as part of NIH's All of Us Precision Medicine Initiative Cohort Program

A team of MHRN-affiliated health systems and investigators recently received NIH funding to lead a five-member Healthcare Provider Organization research consortium to expand the geographic reach and diversity of enrollment and engagement in the NIH's All of Us Precision Medicine Initiative (PMI) Cohort Program.

The consortium, led by co-PIs Brian K. Ahmedani, PhD and Christine Johnson, PhD, is a landmark research effort with a goal to advance personalized health care by studying how individual differences in lifestyle, clinical history, environment and genetics influence a person's health, disease risk, and optimal prevention and treatment approaches.

More information on this program can be found on the following websites: the NIH reporter website and the program’s lead site, Henry Ford Health System


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HealthPartners and Park Nicollet EHR integration expands research capability

HealthPartners and Park Nicollet EHR integration expands research capability

HealthPartners and Park Nicollet fully integrated their electronic health records systems on September 1st.  HealthPartners Institute researchers will be able to include patients seen at Park Nicollet clinics in the MHRN Suicide Prevention Outreach Trial this month. Early next year they will be able to include patients in an MHRN pragmatic trial of decision support designed to address excess cardiovascular risk in people with severe mental illness


MHRN welcomes new NIMH Program Official, Michael Freed, PhD

MHRN welcomes new NIMH Program Official, Michael Freed, PhD

MHRN welcomes a new Program Official at NIMH, Michael Freed, PhD.  Dr. Freed recently joined NIMH from the U.S. Department of Defense, where, as research director, he worked to transform behavioral health care across the military health system, assisted with research priority setting, and helped design a system to expedite the translation of research findings into practice. Dr. Freed is a licensed and practicing psychologist and holds academic appointments in the Department of Psychiatry and the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences. As part of a cooperative agreement with NIMH, MHRN will be partnering with Dr. Freed on future work.

 


Two new Mental Health Scientific Investigators, Joe Glass, PhD and Cara Lewis, PhD, join the Group Health Research Institute

Two new Mental Health Scientific Investigators, Joe Glass, PhD and Cara Lewis, PhD, join the Group Health Research Institute

Two new Mental Health Scientific Investigators, Joe Glass, PhD and Cara Lewis, PhD, join the Group Health Research Institute

The Group Health Research Institute (GHRI) welcomes two new mental health scientific investigators: Joe Glass, PhD and Cara Lewis, PhD.

Joe Glass, PhD is a health services researcher with an interest in mental health and a particular focus on alcohol and drug addiction research. His primary research interests are: understanding why people don’t seek treatment, how to link more people with services, and how to reduce disparities in who receives services. Dr. Glass is currently a principal investigator on a grant from the National Institute on Alcohol Abuse and Alcoholism, “Racial and ethnic disparities in alcohol outcomes and health services.”

 


Cara Lewis, PhD studies dissemination and implementation science in GHRI’s MacColl Center for Health Care Innovation. Her research interests include integrating evidence-based interventions into care for mental illness. Dr. Lewis is currently a principal investigator on two grants from the National Institute of Mental Health. One is a randomized trial comparing standardized and tailored approaches to implementing measurement-based care for depression. The other is a study to develop measures of acceptability, feasibility, and appropriateness of behavioral health services and to advance pragmatic measures for informing practical implementations.


Description of an effort to prevent suicide among patients served by MHRN care systems

Description of an effort to prevent suicide among patients served by MHRN care systems

Description of an effort to prevent suicide among patients served by MHRN care systems

 Rebecca Rossom, MD and other MHRN partners recently published a column in Psychiatric Services in collaboration with health system partnersdescribing their efforts to prevent suicide among patients served by MHRN care systems.

The column describes the practice changes, the effectiveness, and the exploratory research undertaken by MHRN partners when they found a sustained elevated risk of suicide attempts among patients who reported suicidal ideation on the nine-item Patient Health Questionnaire.

The authors report the following challenges:

  • Differences between health care system  and  funding agency  priorities
  • Balancing research needs with clinical needs
  • Perceived potential disruption to health systems due to study implementation or research findings.

The authors describe potential solutions to challenges confronted by embedded researchers, including finding common ground between what healthcare systems and funding agencies find compelling, choosing study designs that balance research and clinical tensions, and implementing studies in ways that minimize disruption to the health system.  When engaged scholarship is done well, the ultimate reward is the opportunity to both participate in transforming care and measure the impact. 


MHRN Investigators presenting at NIMH Mental Health Services Research Conference

MHRN Investigators presenting at NIMH Mental Health Services Research Conference

NIMH’s 23rd Mental Health Services Research conference is scheduled for August 1-3, 2016 in Bethesda, MD.  MHRN investigators will be presenting results of our current research and identifying partners for future projects.  We are planning a concurrent session for potential research partners – describing our health systems, data resources, and research capabilities.