Visn 4 mirecc va philadelphia

Assessment and Management of Depression, Anxiety, and Alcohol Problems in Primary Care: The BHL Program

• VISN 4 MIRECC

• VA Philadelphia

• University of Pennsylvania

Development of a Sustainable Clinical Innovation

Development Principals

• Adaptability

• Efficiency

• Targets need

• Scalable

Inception Key issues

• Scope: Cognition, depression, anxiety, alcohol

• Functions: Triage, decision support, monitoring

• Flexibility: ability to profile patients

• Enrollment: how to get patients to come

BHL Clinical Process

Inception Other issues

• Scalability

• Ease of use

• Interface with CPRS

Initial Beta Version

• Small scale: self programmed in access

• Limited features: interview only, expanded to registration function

• Enrollment: partnership with primary care around screening

Contracting out

• No to CPRS integration – a big decision

• Interviewing software firms

• Developing design features for the programming: scalability, integration of change, building on

• Development of a mechanism to track, test, and deploy changes

Quality Control

• Data: range checks, limited input, limited capacity to change values (administrator)

• Input: staff training

• Acceptability: provider use, patient satisfaction, completion rates

• Algorithms: comparison to clinical interviews, randomized trials of key components, long term outcomes

• Program: EPRP measures, acceptability, management

Core Assessment Module

• During the last 12 months

• 3779 patients were referred (from 2 VAMCs)
• 81.7% had a complete assessment
• PTSD (84%)
• Alcohol or drug problems (73%).
• no differences in completion rates between the Medical Center and CBOCs.

Treatment Components

• Core Assessment – comprehensive

• Depression Module

• 2, 6, 9 Weeks
• Adherence, Depressive symptoms, Side effects

• Watchful Waiting

• 8 weekly calll

• Alcohol Brief intervention and followup

• Referral management

Addressing Quality Indicators

Web Resources

• http://www.va.gov/visn4mirecc/bhl/ (Behavioral Health Laboratory)