Research Project

Study Overview

The Collaborative Care Model (CoCM)  integrates behavioral health and primary care using a treat-to-target model involving patient-reported outcome measurements of depression, anxiety, and substance use. Despite the model’s effectiveness, patient attrition is common. Our objective is to improve patient engagement with CoCM by implementing a new clinical decision support system (CDSS) designed to facilitate action towards addressing patients’ goals and concerns. This study will overcome clinical translational science challenges associated with patients’ goals and concerns being neither fully documented nor available to support care, improvement, and research.

Aim 1: Tool design and build

With clinicians and patients, we will use human-centered co-design principles to (a) enhance the existing CoCM pre-visit questionnaire (PVQ) to capture patient-reported goals and concerns, and (b) build a patient-level clinical decision support system (CDSS) that visualizes PVQ responses and clinical information within the electronic health record to be used during the CoCM encounter by clinicians and patients. 

Aim 2: Facilitated Implementation and Evaluation

Intervention rollout will involve coaching CoCM behavioral health clinicians  to use the CDSS through monthly learning collaborative sessions and individual  support. Using a hybrid type-1, effectiveness-implementation design, we will evaluate the effectiveness of CoCM coupled with the CDSS on practice- and patient-level outcomes, compared to CoCM alone in a stepped-wedge cluster randomized trial (three 6-month periods, two practices per cluster). The primary effectiveness outcome of increased engagement will be measured by the proportion of patients with two or more depression and anxiety assessments. The primary implementation outcomes include patient and clinician satisfaction and barriers and facilitators to implementation, assessed through semi-structured interviews. Secondary outcomes include: response to treatment; shared decision-making, communication, and clinician goal setting behaviors; acceptability, appropriateness, and feasibility; and reach, adoption, implementation, and maintenance of CoCM+CDSS.

Study Team