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2023 HSR&D/QUERI National Conference Abstract

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4048 — Mental Health Provider Perspectives on Impacts of a Mobile Health Application to Support VHA’s ‘Collect, Share, Act’ Model of Measurement-Based Care

Lead/Presenter: Bella Etingen,  COIN - Hines
All Authors: Etingen B (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital), Zocchi M (Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System) Higashi RT (Department of Population and Data Sciences, UT Southwestern Medical Center) Palmer JA (Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston) Richardson E (Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston) Bixler FR (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital) Ndiwane N (Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System) Patrianakos J (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital) McMahon N (Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System) Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System)

Objectives:
Measurement-based care (MBC) comprises collecting patient-reported outcomes (PRO) data using validated assessment tools and using that information to develop and modify treatment plans. VHA has developed technology platforms to support VHA’s ‘Collect, Share, Act’ model of MBC, including the Mental Health Checkup (MHC) mobile health application (app). At present, little is known about provider perspectives regarding the impacts that using MHC has on mental health care delivery, a gap we sought to address.

Methods:
We completed a mixed-methods, sequential explanatory evaluation of MHC. We invited 1,229 mental health providers who had logged into MHC > = 2 times to complete an online survey (n = 284; 23% response rate). Surveys assessed provider perceptions of impacts that MHC had on mental health care delivery, relationships with Veterans, and Veteran engagement in care and outcomes. We then completed qualitative semi-structured telephone interviews, including topics similar to the survey, with a purposefully selected subset of survey respondents (n = 20). Survey data were analyzed using descriptive statistics and responses among providers who had logged into MHC < 15 times vs. > = 15 times were compared using chi-square tests. Interview transcripts were content coded and analyzed using thematic analysis.

Results:
Most survey respondents were psychologists (64.0%) and about half had logged into MHC > = 15 times (53%). Our findings indicate how using MHC supports the various steps of VHA’s ‘Collect, Share, Act’ model of MBC. In terms of collection, approximately half of respondents agreed that MHC allowed them to collect assessment data from their patients more frequently than before (51%). Regarding sharing, half of respondents agreed that they more frequently discussed assessment results with Veterans because of MHC (50%) and used those results to inform discussions about Veteran goal-setting (50%). In terms of acting on data, approximately half of respondents agreed that MHC helped them make data-driven decisions about patient treatment (51%). Bivariate analyses indicated that a greater proportion of respondents who had logged into MHC > = 15 times agreed with the preceding statements (vs. those who had logged in < 15 times; Ps < .001). In interviews, providers further described how MHC addressed the components of ‘Collect, Share, Act’, including appreciation that MHC sends Veterans reminders to complete assessments and facilitates collecting PROs before clinical encounters, saving therapy time during appointments. Providers also described how discussing PRO data facilitated patient self-reflection and enhanced overall patient/provider communication. Providers also noted how using MHC helped them determine how Veterans were responding to treatment, and facilitated shared decision-making.

Implications:
Our findings indicate that MHC supported some providers working to implement VHA’s ‘Collect, Share, Act’ model of MBC. The app enhanced their ability to reach and engage Veterans, and to incorporate assessment data into clinical encounters. Still, many providers did not perceive that MHC was impactful on mental health care delivery, which may be highly related to how frequently they used the app.

Impacts:
Effective use of technologies like MHC could further the impacts of MBC, including the steps of VHA’s ‘Collect, Share, Act’ model. Such impacts may be best realized among providers who frequently use such apps, underscoring the importance of implementation efforts.