1. Jenny reese pro project implementation lead
Implementing Patient Reported Outcomes for Mental Health Screening: Identifying At-Risk Pregnant and Postpartum Patients
Jenny reese
pro project implementation lead

2. Agenda Introduction to mEVAL/patient-reported outcomes (PROs)
How the University of Utah Health uses PROs
Example of electronically collecting PROs in maternal mental health

3. When considering your overall health, what’s most important to
Introduction
When considering your overall health, what’s most important to
YOU?

4. -Donald Berwick, CMS Administrator
Introduction
In the past, we have focused on only measures and outcomes the hospital or physician cares about…
Now, we are focusing on measures and outcomes the patient cares about
“The ultimate measure by which to judge the quality of a medical effort is whether it helps patients and their families as they see. Anything done in health care that does not help a patient or family, is, by definition, waste, whether or not the professions and their associations traditionally hallow it.”
-Donald Berwick, CMS Administrator

5. Pros at university of Utah health
Every Clinic Asks:
General Health
Physical Function
Depression
Specialty Clinics May Ask:
1) Disease/diagnosis-specific

6. Pros at university of Utah health
Patient completes assessment at home.
Patient receives to complete assessment at home.
Medical assistant drops PRO scores into patient’s electronic health record through a dot phrase (.PROPWDEPRESSION).
Patient does not complete assessment at home.
Front desk employee prompted to have patient fill out assessment in clinic.
Nurse and provider review patient PRO scores and discuss with patient during the clinic visit.
Patient fills out assessment in clinic on iPad.

7. Pros at university of Utah health

8. Pros at university of Utah health

9. Pros at university of Utah health

10. Pros at university of Utah health

11. Pros at university of Utah health

12. Clinical Integration of pros at university of Utah health
Barriers
Successes

13. Current resources

14. Example
Maternal Mental Health and Patient Reported Outcomes: Identifying At-Risk Pregnant and Postpartum Patients

15. AIM EPDS Static set of questions Computer adaptive 10 questions
PROMIS depression
Static set of questions
10 questions
Used widely for 30 years
Primarily completed on paper
Computer adaptive
4-8 questions
Newer instrument
We asked patients both instruments to understand coverage of patients identified as at risk for each instrument
Asked every 8 weeks
Average completion time of 4-5 minutes

16. methods
EPDS
PROMIS depression
Patients who scored 10 or higher
Patients who scored 65 or higher
From April 2016 to April 2017, 1,330 unique patients were screened at University of Utah Health in OBGYN clinics with both the EPDS and PROMIS depression instrument on the same day.

17. results
There were 28 (2.1%) patients were identified as at risk for depression using the PROMIS depression screen, while 262 (19.7%) patients were identified as at risk for postpartum depression using the EPDS screen.
Overall, 27 (2%) patients were identified as at risk on both instruments.

18. Conclusion
The EPDS identified a higher percent (19.7%) of patients at risk for depression when compared to the PROMIS depression (2.1%)
A combination of screenings may be necessary to provide the overall best care for patients and to identify the highest percent of patients at risk
The automated iPad/ system made it possible to quickly compare the EPDS to the PROMIS depression and identify the best screening options for at-risk pregnant and postpartum patients

19. Future possibilities More timely interventions Targeted interventions
Additional resources

20. Questions?