Implementation and Use of a Client-Facing Web-Based Shared Decision-Making System (MyCHOIS-CommonGround) in Two Specialty Mental Health Clinics

Molly Finnerty,Deborah Layman,Kimberly Hoagwood,Qingxian Chen,Daisy Ng-Mak,Krithika Rajagopalan,Elizabeth Austin,Edith Kealey

doi:10.1007/s10597-018-0341-x

Abstract

Electronic shared-decision making programs may provide an assistive technology to support physician–patient communication. This mixed methods study examined use of a web-based shared decision-making program (MyCHOIS-CommonGround) by individuals receiving specialty mental health services, and identified qualitative factors influencing adoption during the first 18 months of implementation in two Medicaid mental health clinics. T-tests and χ2 analyses were conducted to assess differences in patient use between sites. Approximately 80% of patients in both clinics created a MyCHOIS-CommonGround user profile, but marked differences emerged between clinics in patients completing shared decision-making reports (79% vs. 28%, χ2(1) = 109.92, p < .01) and average number of reports (7.20 vs. 3.60, t = − 3.64, p < .01). Results suggest high penetration of computer-based programs in specialty mental health services is possible, but clinic implementation factors can influence patient use including leadership commitment, peer staff funding to support the program, and implementation strategy, most notably integration of the program within routine clinical workflow.

Highlights

Shared decision-making is a model of physician–patient communication often paired with decision aids that involve both patients and physicians in decision-making processes (Charles et al 1997)
There is little or no published data on the penetration of applications designed for individuals with serious mental illness, the proportion of individuals receiving mental health services who become users when it is implemented in their service setting (Bonfils et al 2016; Deegan et al 2008, 2017; Deegan 2010; Druss et al 2014; Goscha and Rapp 2015; Kipping et al 2016; Korsbek and Tønder 2016; Salyers et al 2017; Stein et al 2013; van der Krieke et al 2014)
Our results indicate that a high level of penetration of a Health Information Technology (HIT)-based shared decision-making program is possible in this service setting, with approximately 80% of all clinic patients creating a My Collaborative Health Outcome Information System (MyCHOIS)-CommonGround user profile, personalizing the application with their treatment goal, wellness activities, and early warning signs of relapse

Summary

Introduction

Shared decision-making is a model of physician–patient communication often paired with decision aids that involve both patients and physicians in decision-making processes (Charles et al 1997). There is little or no published data on the penetration of applications designed for individuals with serious mental illness, the proportion of individuals receiving mental health services who become users when it is implemented in their service setting (Bonfils et al 2016; Deegan et al 2008, 2017; Deegan 2010; Druss et al 2014; Goscha and Rapp 2015; Kipping et al 2016; Korsbek and Tønder 2016; Salyers et al 2017; Stein et al 2013; van der Krieke et al 2014). We examine the implementation processes in these pilot clinics to explore the relationship between clinic implementation strategies and penetration rates, in preparation for a larger scale implementation

Methods

Results

Conclusion