Mental disorders affect 45 million Americans and result in an annual loss of $193 billion and total costs of at least $317 billion. While numerous psychosocial empirically supported therapies (ESTs) exist, few clinicians are adequately trained to deliver them. The overarching goal of this project is to develop a comprehensive software solution that effectively and efficiently facilitates the delivery of psychosocial ESTs for mental health problems. To ensure significant reach and public health impact, Practice Ground will be designed using industry standards for commercial success. Specifically, Practice Ground will be built as a third-party module that seamlessly integrates into electronic health records (EHRs) and optimizes users' workflow. Practice Ground aids delivery of ESTs by integrating the following components: dynamic progress monitoring, clinical decision support, rich visual displays of client outcomes, online training modules in ESTs, just-in-time training for guided real-time assistance in delivering ESTs, educational videos, and a client portal. In Phase I, we developed and tested the usability, acceptability, and feasibility of an online progress tracker (OPT) prototype. OPT was specifically selected because of its design and workflow complexities. We also adapted an existing training course on progress monitoring (PM) to an online training format. Proof of concept was determined in two phases: (1) extensive feedback from target end-users (clinicians, clients) and other stakeholders (clinic directors, program managers) throughout software development (formative evaluation); and (2) a within-subjects pilot study (N=25) of the final prototype (summative evaluation). Consistent with initial hypotheses, OPT significantly increased progress monitoring over time and significantly reduced barriers to use. In addition, we self-funded continued work on OPT for a second year (Phase I-A) in order to complete a commercial-ready, HIPAA-compliant product for launch in July, 2014. We met and exceeded original aims. In Phase II, we intend to complete the development of PracticeGround using an agile development process to ensure usability and optimize workflow. We will populate it with ESTs for depression, insomnia, bipolar disorder, PTSD, and suicide risk intervention and management, loosely integrate PracticeGround into PracticeFusion and NetSmart using HL7, and develop a systems architecture design for tight integration of PracticeGround into EPIC, PracticeFusion, and NetSmart in Phase III. We will conduct feasibility field tests at three sites that focus on: usability and satisfaction, frequencyof use across clients in their caseload, and barriers to use. We will then conduct an 18-week randomized controlled trial (N=80) comparing PracticeGround (n=40) to care-as-usual (n=40) in depressed outpatient clients. Primary outcomes include: depression, psychological distress, treatment satisfaction (clients and clinicians), and treatment drop out. Secondary clinician outcomes include: extent of PracticeGround use with clients across clinicians' caseload.
Our ultimate goal is to facilitate the delivery of empirically-supported treatments (ESTs) for mental disorders and to improve client mental health outcomes. Toward this end, this Phase II SBIR proposal seeks to complete the development and testing of PracticeGround, a comprehensive software system designed to integrate with electronic health records, and that contains multiple methods of training clinicians in ESTs and delivering ESTs to clients, continuous progress monitoring of client outcomes, and clinical support tools to guide clinicians and clients through delivery of the necessary EST.
