Project Name:
 Automated Virtual Follow-Up to Reduce Premature Treatment Discontinuation

Grant Number:
 U19MH092201 (Pilot study under MHRN II)

Principal Investigator:
Robert Penfold, PhD

Principal Investigator Contact Information: 


Funding Period:
07/2017 – 06/2019

Recent developments in health informatics have created the potential for more efficient and more targeted outreach programs to address dropout from depression treatment.  First, electronic medical records databases allow real-time evaluation of patients who are "overdue" for prescription refills and follow-up visits.  Second, increasing use of standardized depression severity measures (such as the PHQ9), allow efficient identification of those at risk for unfavorable outcomes.  Third, increasing use of patient-provider online messaging will permit much more efficient outreach communication.  We are conducting a pilot study of a semi- automated outreach program for adult outpatients who appear to have dropped out of acute-phase depression treatment (either pharmacotherapy or psychotherapy). Participants with missed antidepressant refills or missed psychotherapy sessions are emailed a short questionnaire to ask about their intentions for treatment as well as a PHQ9, GAD2, and AUDIT-C. Feedback on patients’ answers is delivered immediately in a web-based format.

Participating Sites:                                       
Kaiser Permanente Washington (Lead Site)
Kaiser Permanente Colorado

Robert Penfold, PhD
Arne Beck, PhD

Major Goals:
Conduct a pilot study of a completely automated outreach program for adult outpatients who appear to have dropped out of acute-phase depression treatment (either pharmacotherapy or psychotherapy).

Description of study sample:
The study population will include up to 2400 adult patients in participating health systems who initiate medication or psychotherapy treatment for depression.   

Current Status:
Health record data were used to identify KP adult members eligible for outreach with a new depression diagnosis who have started therapy and appear to have discontinued prematurely, but do not have a recorded good outcome (most recent PHQ9 on record total score is >=10). A secure outreach message, including a link to an externally hosted questionnaire in Research Electronic Data Capture (REDCap) was sent to identified subjects through (i.e., MyChart).

The study questionnaire was comprised of (2) standard assessments used for depression and suicide risk screening and a number of treatment- specific questions.

  • PHQ9- standard assessment measuring depression severity
  • CSSR-S- standard assessment measuring severity of suicidal ideation/ behavior
  • Depression Treatment Discontinuation Questions

Subjects who returned the questionnaire were provide tailored feedback, ranging from “glad to hear that you are planning to continue care” to “we’d like to see you feeling better/we want to make sure that you are receiving the care you need- please consider scheduling an appt.” The web-based consent process and survey were hosted on KPCO’s internal instance of Research Electronic Data Capture (REDCap)

  • All patient recruitment and outreach activities are complete.
  • Data collection is complete.
  • During the recruitment phase we identified and enrolled 988 subjects meeting study criteria for initiating psychotherapy
  • After ongoing monitoring of enrolled subjects, 657 subjects were flagged as potentially discontinuing psychotherapy treatment early.
  • Subjects flagged by the automated algorithm as potential ‘early discontinuers’ were manually reviewed for meeting ‘discontinuation of treatment’ study criteria. 
  • After manual review, 518 qualified subjects were outreached through the electronic health record with an invitation to complete the depression treatment questionnaire. 
  • 70 of the 518 qualified subjects who were sent an invitation to complete the depression treatment questionnaire- responded.
  • 63 fully completed AND 7 people who consented but did not fully complete all components of the questionnaire.

Study Registration:
N/A – study hasn’t started yet



Lessons Learned:

What’s next?