1034 — Patient-Facing Kiosks for Veterans with Schizophrenia: Reducing Risk by Dynamically Identifying Service Needs

Cohen AN, VA Desert Pacific MIRECC; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy; Chinman MJ, VA VISN4 MIRECC; RAND; Hamilton AB, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy; VA Desert Pacific MIRECC; Whelan F, UCLA; Young AS, VA Desert Pacific MIRECC; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy;

Objectives:
The Blueprint for Excellence posits that VHA must "build tools for use at the point of care to dynamically identify and manage patients who need specific interventions that improve health outcomes and efficiency." The EQUIP study developed such a tool for patients with schizophrenia, a population at high risk for early mortality due to the consequences of obesity.

Methods:
In a controlled trial, eight VA medical centers were assigned to intervention or usual care for 13 months. The intervention included patient-facing kiosks located in clinic waiting rooms next to a scale. At every clinic visit, before seeing the clinician, patients responded to kiosk questions regarding weight and weight service utilization. A Summary Report printed following the last question, which patients used at their clinical encounter to prioritize service needs and coordinate care. Mixed methods evaluated the impact of the kiosks on utilization of and retention in weight services.

Results:
571 overweight patients with schizophrenia were included. Compared with usual care, the intervention resulted in individuals being more likely to use weight services (chi square = 10.5, p < .01), getting services more than 5 weeks sooner (t = 2.0, p = .05), and using 3 times more visits (t = -4.6, p < .01). When compared to the year prior, patients at intervention sites saw a three-fold increase in treatment visits. Usual care resulted in no change. In terms of acceptability, the majority of patients who completed the qualitative substudy responded affirmatively that they enjoyed using the kiosks (76%) and liked getting a Summary Report (71%). Patients noted that kiosk questions promoted self-reflection: "It asked questions that made you think about changing things about yourself;" "It kept me in check with myself."

Implications:
VHA has a particular obligation to Veterans with serious mental illness. Routine reporting of symptoms and service needs can be completed by these patients, especially when aided by health information technology that is adapted for their cognitive deficits, limited literacy and computer experience.

Impacts:
Patient-facing kiosks are feasible, acceptable and inexpensive. Kiosks identify patients who need services, drive referrals and utilization. Mental disorders rank among the most substantial causes of death worldwide with 2/3rds from natural causes and kiosks could be an important transformative tool.