Development of a cloud-based, self-report SUD… (R44DA056161) – Project Grant to Telesage Research, Inc.

Abstract: During 2021, there were over 82 million adults in the US who had a diagnosable substance use disorder and/or a mental health disorder. Fewer than 20% of those in need of substance use treatment received services, while fewer than half of adults in need of mental health care received services (sahmsa). Individuals with behavioral health (BH) disorders are often not identified. There are not enough specialists to treat them, and many patients are unwilling to seek out or accept treatment. Already, 47% of BH medications are prescribed by primary care providers (pcps), but with an average of only 15.7 minutes of contact, pcps are unable to complete thoughtful BH evaluations. Ideally, pcps would be able to build rapport, drill down on pertinent positive symptoms, assess current impairments, work collaboratively with patients to choose the best treatments, document the encounter, and bill enough to make the effort financially viable. In phase i, we developed and tested the new item banks and algorithms (sage background) needed to complete a biopsychosocial assessment and integrated them with our existing diagnostic symptom screener for BH (sage-SR-core), resulting in a decision support tool called the sage-primary care system (sage-PCS). Designed in collaboration with pcps as well as community members, the system iteratively selects pertinent items from a bank of over 900 items, to quickly screen for the specific symptoms of 10 suds and up to 35 additional DSM-5-TR disorders. Among the 8,000+ people who started the sage-SR-core in the past 6 months, 89% completed IT. (the core is of similar length and format to the sage-PCS.) the sage-PCS can be used alone or along with the PHQ-9, GAD-7, dast-10, and/or audit-10. Instant reports for both pcps and patients include clear summaries of pertinent-positive target symptoms and past experiences. Patient reports provide educational material and additional clinic-approved referral options. Clinician reports include possible DSM-5-TR diagnoses, individualized treatment planning options, and narrative referral notes. In phase II, we will further enhance the sage-PCS and demonstrate its value in routine primary care, using rigorous quantitative outcome measures. This hybrid implementation and effectiveness study will use a randomized cluster design at 6 primary care clinics in the pacific northwest. In this study we will administer the four established screeners mentioned above to 24,000 participants. The 12% (roughly 2,500) that we expect to screen positive on at least one screener will be given the sage-PCS. We hope to (a) optimize implementation of the sage-PCS in different primary care settings, (b) improve patient awareness of their difficulties relating to BH, (c) increase access to SUD/mental health services for those in need, (d) improve SUD/mental health outcomes at the clinics, (e) provide specific referral options, and (f) demonstrate that the sage-PCS will help clinics generate additional billing revenue to make the intervention self-sustaining. From a technical perspective the software could easily be deployed to clinics across north america.

Development of a cloud-based, self-report SUD intake system enabling primary care clinicians to routinely complete, implement, document, and bill for biopsychosocial assessments

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