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Feasibility of implementing computerized self-assessment in routine care settings serving patients with severe mental illness

Chinman MJ, Young AS, Hassell J, Magnabosco JL. Feasibility of implementing computerized self-assessment in routine care settings serving patients with severe mental illness. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.


Objectives: Implementing computerized patient self-assessment has improved patient care and outcomes for hypertension, obesity, renal disease, high cholesterol, and diabetes. It may also help patients with severe mental illness (SMI) because studies show that having timely clinical information is vital to successfully managing SMI. However, most care settings don’t routinely collect clinical information because it’s costly and time intensive. Audio computer-assisted self-interviewing (ACASI) could address these barriers by asking patients questions while waiting for appointments, but questions remain about its real-world feasibility. While reliable and valid for SMI in research settings, this study assessed ACASI’s feasibility in usual care with a mixed method formative evaluation, identifying factors that supported its adoption consistent with Mental Health QUERI goals of using informatics to improve care. Methods: 173 VA and 93 non-VA SMI patients and 8 VA and 6 non-VA psychiatrists from Los Angeles participated. Patients completed, up to three times, the ACASI survey of symptoms, drug use, medication adherence, and side-effects by internet using a touch-screen monitor with sound, called PAS. PAS generated a 1-page report summarizing results for each patient to be read by providers during appointments. At the end of a year, patients and psychiatrists completed PAS feedback surveys and psychiatrists at each clinic participated in focus groups to generate data on PAS’ feasibility, impact on care, adoption, and how to improve these factors. Surveys were analyzed with descriptive statistics; focus groups were analyzed with a modified grounded theory approach. Results: On surveys, patients reported the PAS was enjoyable, easy to learn and use, quick, and improved communication with providers. Providers reported the PAS was easy to use and improved care. In the focus groups, psychiatrists reported the PAS made information sharing during encounters more efficient and productive but could be improved with more detailed reports. Psychiatrists also reported that clinic leadership and the PAS’ design were important adoption facilitators. Implications: Patients and providers believed the PAS was feasible and improved communication and clinical encounters. Impacts: ACASI was feasible in routine care settings and improved patient care. Managers wanting to implement ACASI may improve its adoption and implementation by considering the factors identified by this formative evaluation.

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