Latest News

Latest News





What if researchers could create customized evidence-based treatment protocols to improve mental health?

What if researchers could create customized evidence-based treatment protocols to improve mental health?

Do patients diagnosed with skin conditions have a higher risk of suicide?

NIH recently awarded Susan Shortreed, PhD and Erica Moodie, PhD, with a 4-year grant to develop customized treatment plans for depression as well as to develop methods to generate these plans.

Her team will use electronic health care record data to select patient characteristics for customizing treatment, assessing bias from differences between people who take different medications, and calculating how many people are needed to accurately compare customized treatment plans.

The goal is to create improved statistical tools, which address current limitations, in order to create customized treatment protocols that will have immediate impact for people living with depression, ultimately leading to customized treatment protocols for people living with a wide variety of mental health conditions.


Highlights from 24th Mental Health Services Research Conference: MHSR 2018

Highlights from 24th Mental Health Services Research Conference: MHSR 2018

Do patients diagnosed with skin conditions have a higher risk of suicide?

The National Institute of Mental Health (NIMH) sponsored the 24th Mental Health Services Research Conference: MHSR 2018 on August 1-2, 2018, in Rockville, Maryland.

This biennial conference is organized by the Services Research and Clinical Epidemiology Branch at NIMH to promote areas of high priority for services research and to identify opportunities with potential for significant impact on the health and well-being of people with mental disorders.

MHRN investigators presented two symposia: one describing research regarding first-episode psychosis and one describing research to assess and address suicide risk. Jennifer Boggs, MSW was selected to participate in the new investigator workshop.


Do patients diagnosed with skin conditions have a higher risk of suicide?

Do patients diagnosed with skin conditions have a higher risk of suicide?

Do patients diagnosed with skin conditions have a higher risk of suicide?

Research suggests that patients diagnosed with skin conditions may have a higher risk of comorbid psychiatric conditions and suicide-related outcomes. To examine this theory in the US general population, Deepak Prabhakar, MD, MPH, led a study to examine the risk of suicide death in patients with dermatologic conditions using a retrospective case-control study conducted in 8 US health systems. A total of 2,674 individuals who died by suicide (cases) were matched with 267,400 general population control individuals. Overall, 619 cases and 54364 controls with skin conditions were analyzed.

After adjusting for age, sex, and any mental health or substance use condition, the authors did not find an association between death by suicide and any skin condition, and the study provides no evidence of increased risk of death by suicide in individuals with major skin disorders in the US general population.


Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

Henry Ford Health System has begun enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

A team of MHRN-affiliated health systems, including Henry Ford, Baylor Scott & White, and Essentia, recently received NIH funding to lead a five-member Healthcare Provider Organization research consortium to expand the geographic reach and diversity of enrollment and engagement in the NIH's All of Us Precision Medicine Initiative (PMI) Cohort Program.

The consortium, led by co-PIs Brian K. Ahmedani, PhD and Christine Johnson, PhD, is a landmark research effort with a goal to advance personalized health care by studying how individual differences in lifestyle, clinical history, environment and genetics influence a person's health, disease risk, and optimal prevention and treatment approaches.

More information on this program can be found on the following websites: the NIH reporter website and the program’s lead site, Henry Ford Health System


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MHRN Scientific Interest Group (SIG) on Perinatal Mental Health – new members welcome!

MHRN Scientific Interest Group (SIG) on Perinatal Mental Health – new members welcome!

A new MHRN Scientific Interest Group (SIG) has recently been formed to:

  • Promote a research agenda focused on perinatal mental health,
  • Facilitate collaboration among investigators,
  • Work on developing data infrastructure to support multisite perinatal mental health research projects,
  • Provide a forum for discussing research ideas and updating grant applications, projects, and papers.

SIG members meet regularly by phone and at an annual in-person meeting. New SIG members are always welcome! Contact Arne Beck, PhD, Director of Quality Improvement and Strategic Research, Kaiser Permanente, Colorado Region, or visit our website to learn more about taking part in this SIG.


MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior

MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior

MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior

Since firearms account for half of all suicide deaths in the United States, many assume that reducing access to firearms among at-risk patients will reduce suicide mortality, and attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior. To examine this theory, Jennifer M. Boggs,led an MHRN manuscript, as part of the Treatment Utilization Before Suicide study, to identify the proportion of suicide deaths that could potentially be prevented by limiting firearm access for people with a mental health condition or a history of suicidal behavior.

Using medical records and claims information, the team identified a group who had a history of any mental health or substance use condition, diagnosed at any medical or mental health visit in the year preceding death. They then identified a second group who had a history of previous suicide attempts (these were not mutually exclusive groups).
More people without a mental health or substance-use condition used firearms in their death than did people with those conditions (671 vs. 627). Also, more people without a previous suicide attempt used firearms in their death than did those with a previous attempt (1189 vs. 109). In fact, among people who died by suicide, only 4.1% had previously attempted suicide and used a firearm; 23.5% had a mental health or substance use condition and used a firearm.

Their findings indicate that, even if successful, current efforts to limit firearm access only for people with a mental health condition (including substance use disorders) or those who previously attempted suicide would prevent few suicide deaths by firearm. The authors suggest that prevention of firearm suicide should be expanded beyond the exclusive focus on patients with mental health conditions to include other persons at risk for suicide. Findings also highlight the importance of expanding attention beyond firearms—especially for persons with mental health or substance use conditions—to include other common means of suicide.


Funding received to evaluate the Zero Suicide Model across learning healthcare systems

Funding received to evaluate the Zero Suicide Model across learning healthcare systems

Funding received to evaluate the Zero Suicide Model across learning healthcare systems

Brian Ahmedani PhD and Greg Simon, MD, MPH lead a recently funded 5-year MHRN study to evaluate the Zero Suicide Model across learning healthcare systems. The study is based upon Henry Ford Health System’s Perfect Depression Care (PDC) Zero Suicide Initiative, which demonstrated a sustained decrease in the suicide rate of nearly 80% among behavioral health patients.

The 2012 National Strategy for Suicide Prevention promoted this initiative and its adoption of Zero Suicides as an aspirational goal of healthcare systems across the US. The Suicide Prevention Resource Center developed the resources and tools to prepare US health systems for local implementation of the National ZS Model (NZSM).

Funded by NIMH, the study aims to do the following:

  • Collaborate with health system leaders to develop electronic health record (HER) metrics to measure specific quality improvement targets and care processes tailored to local NZSM implementation.
  • Examine the fidelity of the specific NZSM care processes implemented in each system.
  • Investigate suicide attempt and mortality outcomes within and across NZSM system models.

Acknowledging that suicidal individuals often fall through multiple cracks in a fragmented healthcare system, the NZSM calls for a systematic, comprehensive approach across health service settings.  The NZSM approach involves local implementation of a series of evidence-based clinical interventions in four areas:

  • Identifying those at risk (IDENTIFY)
  • Initiating and maintaining engagement in care (ENGAGE)
  • Delivering effective treatments (TREAT)
  • Assuring appropriate care transitions (TRANSITION)

This project aims to fill a major research need by evaluating the separate and cumulative benefits of implementing specific components of the NZSM in large integrated healthcare systems within various service settings and patient populations.


Suicide Prevention Trial: Over 10,000 enrolled!

Suicide Prevention Trial: Over 10,000 enrolled!

Suicide Prevention Trial: Over 10,000 enrolled!

The Pragmatic Trial of Population-based Programs to Prevent Suicide Attempt, led by Greg Simon, MD, MPH has enrolled over 10,000 participants. Visit the MHRN website for more information on this project, which aims to conduct a large, pragmatic trial to examine two population-based programs to prevent suicide attempt.


Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding

Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding

Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding

In 2015 MHRN began a project to use population-based data from large health systems to develop evidence-based suicide attempt risk calculators for mental health and primary care clinicians. The models developed by the project were a substantial advance over existing risk prediction or risk stratification tools, however there were limitations. In 2017 NIMH awarded MHRN a supplement to extend this work, address some of these limitations, and do the following:

  • Expand and enhance the risk prediction dataset to: include larger numbers of observations with data regarding self-reported suicidal ideation (PHQ9 Item 9), include additional encounters and events following the transition from ICD9 to ICD10 diagnoses, and allow more detailed consideration of the timing of predictor events (diagnoses, encounters, prescription fills)
  • Expand sampling to include emergency department and inpatient encounters
  • Evaluate alternative modeling approaches, including classification- or tree-based approaches such as Classification and Regression Trees (CART), Mixed Effects Regression Trees (MERT), and Random Forest.
  • Rapidly disseminate all methods, tools and results to a wide range of stakeholders including health systems, researchers, and EHR vendors.

This research will make several significant and unique contributions to suicide prevention research, including:

  • An unprecedented sample size of patients, visits, and suicidal behavior outcomes
  • A population-based sample including mental health and primary care visits from seven health systems
  • Integration of electronic health records data (diagnoses, prescriptions) with systematically collected data regarding suicidal ideation
  • Inclusion of more diverse and detailed predictors than any previous research in this area

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Feedback-informed care: Mapping a new course for depression treatment

Feedback-informed care: Mapping a new course for depression treatment

With support from the Garfield Memorial Fund, MHRN researchers at KP Colorado and KP Washington are working with health system leaders to harness the power of big data to help customize and improve care for depression.


Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

Rebecca Rossom, MD, MS, led a study that was recently published in the Journal of Affective Disorders. The team examined PHQ9s completed by adult outpatients treated for mental health conditions in 2010-2012 at four Mental Health Research Network-affiliated healthcare systems. The goal was to examine suicidal ideation and attempts/deaths in order to determine whether item 9 of the Patient Health Questionnaire (PHQ9) predicted risk for suicide attempts and deaths across age groups. They found that those with nearly daily suicidal ideation (compared to those without) were:

  • 5-to-8 times more likely to attempt suicide and 3-to-11 times more likely to die by suicide within 30 days, and
  • 2-to-4 times more likely to attempt suicide and 2-to-6 times more likely to die by suicide within 365 days.

The study team also found that, for those with any level of suicidal ideation, the increased risk of suicide attempts and deaths persisted over two years. The absolute risk of suicide attempts generally declined with age, while the absolute risk of suicide death generally increased with age. However, the relationship between reported suicidal ideation and suicide attempts and deaths was similar across age groups. They concluded that suicidal ideation reported on the PHQ9 is a robust predictor of suicide attempts and death, regardless of age, and that healthcare systems should address both the immediate and sustained risk of suicide for patients of all ages.


MHRN provides resources to examine treatment patterns associated with first episode psychosis

MHRN provides resources to examine treatment patterns associated with first episode psychosis

MHRN provides resources to examine treatment patterns associated with first episode psychosis

Todd P. Gilmer, PhD, at the University of California, San Diego, is using MHRN resources to conduct a study, which will describe treatment for first-episode psychosis in a large commercially insured population using data from the OptumLabs Data Warehouse (OLDW). “Dr. Simon and his team have been very generous,” Dr. Gilmer said, “sharing both their research design and their programming code.  I am excited to be able to contribute to their important work examining first-episode psychosis by applying their methods to a national dataset.”

The proposed research will build on work that was initiated in four MHRN sites to identify individuals experiencing a first episode of psychosis and to describe their treatment patterns using administrative databases. The main goals for this project are 1) To identify individuals receiving treatment for first diagnosis of psychotic disorder, 2) To describe health care treatment patterns prior to first diagnosis of psychotic disorder, 3) To describe health care treatment patterns after first diagnosis of psychotic disorder, and 4) To estimate costs associated with specific patterns of treatment before and after first diagnosis of psychotic disorder. Although the proposed analysis are largely descriptive, we hypothesize that we will be able to identify treatment patterns (e.g. more intensive outpatient therapy and using of low-dose antipsychotic medication) that are associated with improved outcomes following the first diagnosis of psychotic disorder, such as lower rates of inpatient admissions and emergency room visits.  This work has the potential significantly inform and advance ongoing national efforts aimed at the prevention and early intervention of psychosis, leading to improved life trajectories for patients and potentially immediate and long-term cost savings to health plans.


Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy

Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy

Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy

Christine Lu, PhD, MSc, was selected to present her MHRN-related abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy. Her presentation, "Near Real-Time Surveillance for Consequences of Health Policies Using Sequential Analysis,” reports their follow-up study using the maxSPRT methods to examine the association between suicidality and FDA antidepressant warnings.


Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

Although clinicians are expected to routinely assess and address suicide risk, there is little guidance regarding the significance of visit-to-visit changes in suicidal ideation.

Since healthcare systems increasingly use PHQ9 in both primary care and specialty mental health clinics in patients reporting frequent thoughts of death or self-harm, questions have arisen:  Does an apparent decrease in suicidal ideation (i.e. decreasing score on PHQ9 item 9) actually imply a decrease in risk of subsequent suicidal behavior?  Does the apparent onset of suicidal ideation imply an increase in risk compared to pre-existing or “chronic” suicidal ideation?

A study led by Greg Simon, MD, MPH suggests that current suicidal ideation is a powerful indicator of near-term risk, independent of past reports of suicidal ideation.  Individuals who reported thoughts of death or self-harm at a prior visit remained at moderately increased risk even if they reported no such thoughts at the current visit. While the apparent onset of suicidal thoughts did predict significant risk, risk was actually highest for patients reporting sustained or repeated thoughts of death or self-harm.


MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

Rinad Beidas, PhD, at the University of Pennsylvania, is leading an MHRN-related project investigating how to implement an evidence-based program for firearm safety as a suicide prevention strategy for youth in primary care. The long-term goal of this two-year NIMH-funded project is to reduce death by suicide by increasing the use of evidence-based strategies in pediatric primary care while also promoting multi-level implementation strategies informed by a systematic and rigorous development approach. Currently the team is analyzing data collected from approximately 140 participating primary doctors at participating sites, Henry Ford Health System and Baylor Scott & White Health. Dr. Beidas recently presented preliminary results at the Society for Prevention Research Conference in DCIn 2018, the investigators plan to submit an R01 application to conduct a hybrid trial that will evaluate both the effectiveness of the adapted Safety Check in pediatric primary care as well as the implementation strategies used to implement it.


New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

New investigator, Melissa Harry, PhD, MSW, from Essentia Health, has joined the Mental Health Research Network (MHRN). Dr. Harry received her PhD in 2016 from the Boston College School of Social Work. She previously worked in child and adolescent mental health as a licensed social worker. Her doctoral research centered around experiences and outcomes with self-directed budgets for purchasing home and community-based long-term care services and supports for people with disabilities. She also studies the cross-cultural measurement invariance of mental health scales with a focus on indigenous cultures and is interested in intervention research, program evaluation, and secondary data analysis with complex data sets.


Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California

Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California

Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California

Stacy Sterling, DrPH, MSW is the new official site PI for MHRN at Kaiser Permanente Northern California (KPNC), replacing Enid Hunkeler, MA who retired in the fall of 2016. Dr. Sterling is with the Drug and Alcohol Research Team (DART) and the Behavioral Health Research Initiative at the Kaiser Permanente Northern California Division of Research. She received her doctoral training at the University of North Carolina, Gillings School of Global Public Health, and Master’s degrees in Public Health and Social Welfare at the University of California, Berkeley. Her research interests include developing and studying systems for implementing evidence-based, integrated behavioral health services into primary care, adolescent behavioral health prevention and early intervention, and mental health and alcohol and drug treatment outcomes and access.  She is the Principal Investigator of a Conrad N. Hilton Foundation-funded study to develop predictive models for adolescent substance use problem development, the Kaiser P.I. of a Hilton Foundation-funded trial of extended screening, brief intervention and referral to treatment (SBIRT) for adolescent behavioral health problems in pediatric primary care, the Kaiser P.I. of an NIH/NIAAA adolescent SBIRT trial in pediatric primary care and of an NIH/NIAAA survey of Pediatrician attitudes toward and practices of adolescent behavioral health risk screening and intervention; and of Robert Wood Johnson Foundation and Center for Substance Abuse Treatment-funded studies of adolescents in drug and alcohol treatment in Kaiser. She has overseen the implementation of region-wide alcohol SBIRT in KPNC adult primary care.


Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

The COMPASS Initiative is a national effort to disseminate and implement an evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease. Karen J. Coleman, PhD led a detailed description of the initiative in the August 2016 edition of General Hospital Psychiatry.It has been implemented in 18 medical groups and 172 clinics in 8 states. MHRN investigators associated with the COMPASS Initiative published four new publications on this ambitious initiative, covering a description of current conditions, an overview of the initiative, outcomes and key learnings. The goals of the initiative are to:

  1. Improve depression symptoms in 40% of patients.
  2. Improve diabetes and hypertension control rates by 20%.
  3. Increase provider satisfaction by 20%.
  4. Improve patient satisfaction with their care by 20%.
  5. Demonstrate cost savings.

 

The three other publications describe The impact of the COMPASS initiative, as well as a study to understand how care managers implemented COMPASS and if this implementation was related to health outcomes in their patients, and a study to describe primary care clinician’s self-reports of satisfaction, burnout and barriers associated with treating complex patients.


Check out our online repository for MHRN diagnoses codes!

Check out our online repository for MHRN diagnoses codes!

Check out our online repository for MHRN diagnoses codes!

The Mental Health Research Network (MHRN) created an online repository for MHRN diagnoses codes on GitHub and posted various specifications and codes. Everything is downloadable and free to the public.


MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

In September 2014, an MHRN-affiliated study began ground-breaking work on suicide prevention , with a goal to enroll 15,000 patients. We have now enrolled 6,500 participants and added a fourth data collection site: Kaiser Permanente Northwest.

This pragmatic trial of selective prevention should fill a major gap in current suicide prevention efforts, and the methods developed should dramatically accelerate future suicide prevention research. 


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New HEDIS measures: MHRN partners with health systems to prepare for next generation of NCQA/HEDIS measures

New HEDIS measures: MHRN partners with health systems to prepare for next generation of NCQA/HEDIS measures

NCQA has released preliminary specifications for a next generation of depression measures – focused on use of outcome measures (like the PHQ9) to assess quality and effectiveness of care.  MHRN investigators are partnering with our health systems to give feedback on measurement specifics, evaluate gaps in our current performance, and design appropriate quality improvement strategies.  Contact Leif Solberg (Leif.I.Solberg@HealthPartners.Com), Robert Penfold (penfold.r@ghc.org) or Greg Simon (simon.g@ghc.org) for more information.


Now available via webcast: How to work with MHRN

Now available via webcast: How to work with MHRN

Now available via webcast: How to work with MHRN

A webcast on how to work with MHRN is available for anyone interested in partnering with us. The webcast is from a session at the 23rd NIMH Conference on Mental Health Services Research (MHSR), which brought together leading mental health services researchers, clinicians, mental health advocates, and federal and nonfederal partners. The conference highlighted opportunities for the next generation of high-impact research to drive mental health care improvement.


MHRN-affiliated health systems receive funding to lead a research consortium as part of NIH's All of Us Precision Medicine Initiative Cohort Program

MHRN-affiliated health systems receive funding to lead a research consortium as part of NIH's All of Us Precision Medicine Initiative Cohort Program

MHRN-affiliated health systems receive funding to lead a research consortium as part of NIH's All of Us Precision Medicine Initiative Cohort Program

A team of MHRN-affiliated health systems and investigators recently received NIH funding to lead a five-member Healthcare Provider Organization research consortium to expand the geographic reach and diversity of enrollment and engagement in the NIH's All of Us Precision Medicine Initiative (PMI) Cohort Program.

The consortium, led by co-PIs Brian K. Ahmedani, PhD and Christine Johnson, PhD, is a landmark research effort with a goal to advance personalized health care by studying how individual differences in lifestyle, clinical history, environment and genetics influence a person's health, disease risk, and optimal prevention and treatment approaches.

More information on this program can be found on the following websites: the NIH reporter website and the program’s lead site, Henry Ford Health System


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HealthPartners and Park Nicollet EHR integration expands research capability

HealthPartners and Park Nicollet EHR integration expands research capability

HealthPartners and Park Nicollet fully integrated their electronic health records systems on September 1st.  HealthPartners Institute researchers will be able to include patients seen at Park Nicollet clinics in the MHRN Suicide Prevention Outreach Trial this month. Early next year they will be able to include patients in an MHRN pragmatic trial of decision support designed to address excess cardiovascular risk in people with severe mental illness


MHRN welcomes new NIMH Program Official, Michael Freed, PhD

MHRN welcomes new NIMH Program Official, Michael Freed, PhD

MHRN welcomes a new Program Official at NIMH, Michael Freed, PhD.  Dr. Freed recently joined NIMH from the U.S. Department of Defense, where, as research director, he worked to transform behavioral health care across the military health system, assisted with research priority setting, and helped design a system to expedite the translation of research findings into practice. Dr. Freed is a licensed and practicing psychologist and holds academic appointments in the Department of Psychiatry and the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences. As part of a cooperative agreement with NIMH, MHRN will be partnering with Dr. Freed on future work.

 


Two new Mental Health Scientific Investigators, Joe Glass, PhD and Cara Lewis, PhD, join the Group Health Research Institute

Two new Mental Health Scientific Investigators, Joe Glass, PhD and Cara Lewis, PhD, join the Group Health Research Institute

Two new Mental Health Scientific Investigators, Joe Glass, PhD and Cara Lewis, PhD, join the Group Health Research Institute

The Group Health Research Institute (GHRI) welcomes two new mental health scientific investigators: Joe Glass, PhD and Cara Lewis, PhD.

Joe Glass, PhD is a health services researcher with an interest in mental health and a particular focus on alcohol and drug addiction research. His primary research interests are: understanding why people don’t seek treatment, how to link more people with services, and how to reduce disparities in who receives services. Dr. Glass is currently a principal investigator on a grant from the National Institute on Alcohol Abuse and Alcoholism, “Racial and ethnic disparities in alcohol outcomes and health services.”

 


Cara Lewis, PhD studies dissemination and implementation science in GHRI’s MacColl Center for Health Care Innovation. Her research interests include integrating evidence-based interventions into care for mental illness. Dr. Lewis is currently a principal investigator on two grants from the National Institute of Mental Health. One is a randomized trial comparing standardized and tailored approaches to implementing measurement-based care for depression. The other is a study to develop measures of acceptability, feasibility, and appropriateness of behavioral health services and to advance pragmatic measures for informing practical implementations.


Description of an effort to prevent suicide among patients served by MHRN care systems

Description of an effort to prevent suicide among patients served by MHRN care systems

Description of an effort to prevent suicide among patients served by MHRN care systems

 Rebecca Rossom, MD and other MHRN partners recently published a column in Psychiatric Services in collaboration with health system partnersdescribing their efforts to prevent suicide among patients served by MHRN care systems.

The column describes the practice changes, the effectiveness, and the exploratory research undertaken by MHRN partners when they found a sustained elevated risk of suicide attempts among patients who reported suicidal ideation on the nine-item Patient Health Questionnaire.

The authors report the following challenges:

  • Differences between health care system  and  funding agency  priorities
  • Balancing research needs with clinical needs
  • Perceived potential disruption to health systems due to study implementation or research findings.

The authors describe potential solutions to challenges confronted by embedded researchers, including finding common ground between what healthcare systems and funding agencies find compelling, choosing study designs that balance research and clinical tensions, and implementing studies in ways that minimize disruption to the health system.  When engaged scholarship is done well, the ultimate reward is the opportunity to both participate in transforming care and measure the impact. 


MHRN Investigators presenting at NIMH Mental Health Services Research Conference

MHRN Investigators presenting at NIMH Mental Health Services Research Conference

NIMH’s 23rd Mental Health Services Research conference is scheduled for August 1-3, 2016 in Bethesda, MD.  MHRN investigators will be presenting results of our current research and identifying partners for future projects.  We are planning a concurrent session for potential research partners – describing our health systems, data resources, and research capabilities.


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MHRN Welcomes New Staff

MHRN Welcomes New Staff

MHRN welcomes new site investigator, Samuel Hubley, PhD from Kaiser Permanente Institute for Health Research in Colorado.

MRHN is pleased to welcome two new investigators, Deborah Rohm Young, PhD and Jean Lawrence, ScD from Kaiser Permanente Southern Californai Department of Research and Evaluation.

 

 


The Adolescent Behavior Health Program wins first place in the

The Adolescent Behavior Health Program wins first place in the "We Plus You Award" from Sutter Health.

The Adolescent Behavior Health Program was created to address the alarming number of teen suicides happening in the Palo Alto area.  Recently this program won first place in the "We Plus You Award" from Sutter Health.

The Adolescent Behavior Health (ABH) Project is a 5-year program at Sutter Health Palo Alto Medical Foundation, beginning in 2013, to implement and evaluate intergration of behavioral health into primary care settings, focusing on adolescents, through enhanced usual care, behavioral health navigation services, and care management.


New MHRN-affiliated study funded on targeted approach to safer use of antipsychotics in youth.

New MHRN-affiliated study funded on targeted approach to safer use of antipsychotics in youth.

A multi-site research team led by Robert Penfold, PhD was recently awarded a nearly $10 million contract to develop and test ways to support clinicians and families in choosing safer treatments for behavioral disorders in youth ages 5 to 17.  This grant resulted from a NIMH special call for research proposals to fund a new research initiative called "A Targeted Approach to a Safer Use of Antipsychotics in Youth" (SUAY).

For more information, see a Group Health Research Institute blogpost on this important topic.


Kaiser Permanente Northern California is recruiting new mental health researcher.

Kaiser Permanente Northern California is recruiting new mental health researcher.

The Division of Research of The Permanente Medical Group (Kaiser Permanente, Northern California) seeks an investigator to establish a successful mental health research program within Kaiser Permanente, including treatment developments and implementation research.  The focus of this position is on delivery science in specialty mental health clinics, primary care and other health care departments.  More information is available on the Kaiser Permanente Careers page.  Applications are welcome from early career, mid-career, and senior investigators.


NIMH funds new MHRN-affiliated study on pediatric suicide prevention & firearms means restriction.

NIMH funds new MHRN-affiliated study on pediatric suicide prevention & firearms means restriction.

The National Institute of Mental Health recently funded a new study on pediatric suicide prevention and firearms means restriction.  Led by Rinad Beidas, PhD from the University of Pennsylvania, the study is an MHRN collaboration between the University of Pennsylvania and MHRN sites Henry Ford Health System Research Centers and Baylor Scott & White Center for Applied Health Research.


MHRN Investigators presenting at NIMH Mental Health Services Research Conference

NIMH’s 23rd Mental Health Services Research conference is scheduled for August 1-3, 2016 in Bethesda, MD.  MHRN investigators will be presenting results of our current research and identifying partners for future projects.  We are planning a concurrent session for potential research partners – describing our health systems, data resources, and research capabilities.


Take our stuff!  Please!

Take our stuff! Please!

We have activated the MHRN repository on GitHub and posted various specifications and code for public use, including diagnoses, drugs, and procedures.  All of these tools are downloadable and free to the public.  Please make use of it!

https://github.com/MHResearchNetwork/MHRN-Central


Call for Abstracts now open for the 23rd NIMH Conference on Mental Health Services Research

Call for Abstracts now open for the 23rd NIMH Conference on Mental Health Services Research

MHSR 2016: Harnessing Science to Strengthen the Public Health Impact will be held August 1-3, 2016, in Bethesda Maryland.

MHSR 2016 seeks to highlight scientific investigative efforts to improve population mental health through high-impact mental health services research. They are soliciting abstracts for individual papers, symposia, posters, and technology demonstrations. Download the Call for Abstracts for details and submission instructions.


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MHRN research cited in Joint Commission Publication

MHRN research regarding identifying suicide risk was cited in the recent Joint Commission Sentinel Event Alert regarding detection and treatment of suicidal ideation.  MHRN researchers are also collaborating with Kaiser Permanente’s national Care Management Institute to understand and reduce suicide mortality rates across all KP regions.  The data resources and methods developed in our research on suicide risk will inform prevention and quality improvement efforts.


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D&I Interest Groups Seeks Care System Leaders and Research Partners

The MHRN interest group on dissemination and implementation (D&I) is starting a new subgroup of care system leaders and researchers who are interested in collaborating to improve the new HEDIS measures of depression care and outcomes. 

These measures are currently in pilot mode, but are likely to appear to represent rather low levels of performance. Depending on the decision of group members, this subgroup could:

  • Analyze existing data relevant to these measures, 
  • Write a paper for publication describing potential ways to improve care and these measures, 
  • Undertake a quality improvement project in this area, develop a proposal for a research study of the topic, or
  • Some combination of these activities

If there is sufficient interest on the part of both care system leaders and researchers, the group shall start with monthly conference calls to develop a specific direction and an appropriate group process. 

For more information or to indicate an interest in participating, contact Leif Solberg, MD of HealthPartners at (952) 967-5017 or leif.i.solberg@healthpartners.com). 


MHRN Welcomes New Staff

MHRN Welcomes New Staff

MHRN welcomes new site investigator, Samuel Hubley, PhD from Kaiser Permanente Institute for Health Research in Colorado.

MRHN is pleased to welcome two new investigators, Deborah Rohm Young, PhD and Jean Lawrence, ScD from Kaiser Permanente Southern Californai Department of Research and Evaluation.


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Dissemination & Implementation Interest Group Launched

MHRN dissemination and implementation interest group launched creating new care system/research partnership opportunities.  First opportunity will take advantage of planned rollout of new HEDIS depression measures to examine improving depression care to meet new guidelines.  

MHRN recently launched a new interest group on dissemination and implementation (D&I) with an innovative approach for encouraging collaboration with health system partners.  A small steering committee comprised of MHRN researchers and several representatives of our health care systems will convene interest groups around particular high priority topics of interest to both constituencies. The groups will include roughly equal numbers of researchers and care system representatives.  Together they will decide whether to collaborate on specific improvements, develop a proposal for external funding, or create a publication or white paper. Leaders from care systems are particularly encouraged to participate so our efforts can address care system needs and priorities.

The first such group will start soon aimed at improving depression care.   The new HEDIS measures for depression that will soon become part of the standard measurement set create an ideal opportunity for care system leaders and researchers to join together as partners in response to the new measures to improve depression care. A second group is being planned aimed at facilitating training in dissemination and implementation methods.  The steering committee welcomes other ideas for groups.  Are there other high priority areas of interest to you?  Contact us!


MHRN investigator to serve on NIH Precision Medicine Advisory Panel

MHRN investigator to serve on NIH Precision Medicine Advisory Panel

MHRN investigator Gregory Simon MD MPH was recently appointed to serve on the Advisory Panel for the NIH Precision Medicine Cohort program.   

The Precision Medicine Initiative aims to produce the scientific evidence needed to approach disease prevention and treatment in ways that take into account individual differences in people's genes, environments, and lifestyles.   A key part of the initiative is the creation of a Cohort program.  This program aims to enroll over 1 million volunteers in a longitudinal study to inform personalized selection of treatments for a wide range of diagnoses, including mental helath conditions.  Dr. Simon commented:  "I plan to emphasize the importance of engaging with health systems regarding key questions adn relevant data.  We want these research findings to be useful for real-world clinicians and health system leaders."


MHRN Steering Committee meets with NIMH leaders to discuss NIMH priorities for MHRN.

Focus is on high impact research that moves the needle, sense of productive urgency.  MHRN well positioned with established infrastructure resources, access to patient populations with electronic health records, and scientific expertise.

Numerous ongoing activities in the network have the potential to impact high priority areas for NIMH in mental health research:

  • Suicide Research
    • Suicide Prevention Outreach Trial (SPOT)
    • Treatment Utilization Before Suicide (TUBS)
  • First Episode Psychosis
    • Precursors of First Episode Psychosis
  • Improve Health & Reduce Mortality in SMI
    • Reducing CV Risk in Adults with SMI using EMR-based Clinical Decision Support.
  • Personalized Depression Treatment
    • Ongoing studies on Practice Variation & Suicide created longitudinal dataset (with 400,000-500,000 episodes linked with outcomes) with potential as a valuable resource for personalized treatment research
  • Autism Spectrum Disorders
    • Maximizing Biospecimen Collection from Children with Mental Health Conditions
  • Harnassing advanced health technologies to improve mental health
    • Next-generation clinical assessment using mobile devices

Data sharing also discussed.  MHRN  to explore making analytic datasets available to others, with appropriate privacy protections.

MHRN priorities, in line with NIMH priorities, will continue to emphasize engagement with external researchers and health system leaders.


Addressing Teen Suicides

Addressing Teen Suicides

An alarming number of teen suicides leads to a project aimed at designing enhancements to improve integration of behavioral health and primary care.

Adolescent Behavioral Health (ABH) Study at Sutter Health Palo Alto Medical Foundation. Ming Tai-Seale, PhD, Lead researcher

In 2009-2010 the city of Palo Alto was struck by five teen suicides.  With funding from Palo Alto Medical Foundation (PAMF), Sutter Health, Palo Alto Foundation Medical Group, and private individuals and foundations, a team of psychiatrists, primary care physicians, and health services researchers began designing enhancements to improve the integration of behavioral health and primary care.

The Adolescent Behavioral Health (ABH) Project is a 5-year program at Sutter Health Palo Alto Medical Foundation, beginning in 2013, to implement and evaluate integration of behavioral health into primary care settings, focusing on adolescents, through enhanced usual care, behavioral health navigation services, and care management.

There are 3 phases.  In Phase 1, nearly 100 Pediatrics and Family Medicine physicians have completed a survey on their attitudes, beliefs, and practice of BH care for teens. The research team also performed more in-depth interviews with a smaller group of physicians to obtain more detailed information around ways to improve the care of teens with BH needs.  Analyses of the EHR revealed 16,001 adolescents with some history of BH needs, including 4307 adolescents with depression, 4151 with anxiety, 4257 with Attention Deficit Disorder, 495 with Bipolar Disorder, and 47 with Schizophrenia.

In Phase 2, the team will measure the impact of Resource Navigation, which includes support for physicians in linking their teen patients with BH services in the community. In June 2015, Navigation has been successfully rolled out in 4 divisions of PAMF, serving more than 300 patients.

In Phase 3, the team will implement & evaluate a care management service delivered by a pediatric psychiatric nurse practitioner who will be co-located in pediatric clinics and who will co-manage patients alongside the primary care physicians.

The project's Executive Team consists of two psychiatrists (Daniel Becker, MD, Lukuang Lynette Hsu, MD), two primary care physicians (Meg Durbin, MD, Amy Heneghan, MD), a health services researcher (Ming Tai-Seale, PhD), and a Project Coordinator (Kimberly Erlich, MSN, RN, MPH, CPNP, PMHS).  For more information, contact Ming Tai-Seale, PhD.


Quality Measures

Quality Measures

Recent JAMA articles raise questions about HEDIS quality measures - should they be adjusted for race and ethnicity?  MHRN data from 5 health systems serving 6 million patients examined this question looking specifically at the quality of antidepressant treatment.

HEDIS Quality Measures - should they be adjusted for race and ethnicity? Greg Simon, MD, MPH, Lead author

As awareness of healthcare disparities has increased, so has the call for a re-examination of the 2006 National Quality Forum recommendation that measures of healthcare quality not be adjusted for patients’ sociodemographic characteristics. Recent articles by Fiscella et al and Jha & Zaslavsky argue that these quality measures should be adjusted so as to not unfairly penalize health systems serving larger proportions of disadvantaged groups. Data from 5 large health systems serving 6 million patients were used to examine the quality measure for antidepressant treatment.  The results of this study have been submitted for publication.  Check back here for an update when detailed results are published.  For more information, contact Greg Simon.


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Treatment Utilization Before Suicide (TUBS)

A new study funded by NIMH will use electronic medical record data from 8 MHRN sites to optimize suicide risk identification in primary care and general medical settings.  The new study is led by Dr. Brian Ahmedani at Henry Ford.

New study - Treatment Utilization Before Suicide (TUBS), Brian Ahmedani, PhD, lead investigator

Over 80% of individuals make a health care visit in the year before suicide, yet over 50% of individuals do not have a mental health diagnosis.  Since most suicidal patients do not have mental health conditions, finding other clinical factors that are associated with suicide risk is imperative.  A newly study funded by NIMH will use electronic medical record data from eight MHRN sites will be used to optimize suicide risk identification in primary care and general medical settings.  Electronic medical records already have extensive healthcare data for patients, can be tapped to detect risk factors, and can be used to implement automated algorithms to detect risk and trigger intervention.  Suicide prevention directed only towards individuals with a mental health diagnosis, on whom most interventions are currently focused, can necessarily reach less than half of all healthcare patients before their death.

This project will be a comprehensive multisite investigation to fill this major gap. The sample will be drawn from over 5 million individuals who annually receive services from one of eight geographically diverse MHRN sites across the US. The results from this study can inform important suicide prevention efforts in healthcare and future research.  For more information, contact Brian Ahmedani.


MHRN Infrastructure Leveraged to Support New Research Projects

MHRN Infrastructure Leveraged to Support New Research Projects

Several new projects leveraged MHRN infrastructure to support proposed work.  Topics include first-episode psychosis, suicide prevention, and collaborative care for patients with depresisons and diabetes or heart disease.

First-Episode Psychosis In a Population-Based Sample

Five MHRN sites (Group Health and Kaiser Permanente Colorado, Northern California, Northwest and Southern California) are participating in this observational study of precursors to and management of first-episode psychosis.

The combined population of these health systems includes a sample at least 10 times as large as those in previous observational studies. Methods will draw heavily from those developed in the first cycle of MHRN funding:

  • Using EMR and insurance claims data to identify all new diagnoses of psychosis in a defined population
  • Use of prescription refill data to examine continuity of medication treatment over time
  • Use of health plan race and ethnicity data to examine disparities in treatment initiation and adherence
  • Efficient outreach for research recruitment using email and online messaging

Pragmatic trial of population-based suicide attempt prevention programs

Four MHRN sites (Group Health, Kaiser Permanente Colorado, HealthPartners, and Henry Ford) are participating in this trial, funded as one of the initial 7 NIH Collaboratory Projects. 

15,000 outpatients at elevated risk for subsequent suicide attempt (based on PHQ9 depression questionnaires) will be randomly assigned to continued usual care or to one of two population-based prevention programs: an outreach and care management program based on interventions previously tested at Henry Ford and Group Health OR an emotion regulation skills training program based on Marsha Linehan’s Dialectical Behavior Therapy.  Both programs will be delivered by a combination of telephone and online messaging.  The study recruitment, intervention, and outcome assessment depend on methods developed in the first cycle of MHRN funding:

  • Rapid extraction of PHQ9 questionnaire from EMR databases across sites
  • Use of PHQ9 data to identify outpatients at risk for suicide attempt
  • Use of the DatStat software platform for secure delivery of online surveys and interventions
  • Use of records data to accurately identify suicide attempts and suicide deaths

Collaborative care of mental, physical, and substance use syndromes

Three MHRN sites (HealthPartners, Kaiser Permanente Colorado, and Kaiser Permanente Southern California) along with 15 other medical groups in Washington, Minnesota, Michigan, Pennsylvania, and Massachusetts are participating in this demonstration/evaluation project (funded by the Center for Medicare and Medicaid Innovation) to spread a collaborative care program for patients with both depression and either diabetes or heart disease.

Comparative risks and benefits of gender reassignment therapies

Three MHRN sites (Kaiser Permanente Georgia, Northern California and Southern California) are participating in this PCORI-funded study that aims to understand the short- and long-term health issues among transgender persons who had or are planning to have a sex change treatment. 

This project will take advantage of the data harmonization and quality control work conducted by the MHRN during the first cycle of funding specifically related to mental health diagnoses, medication use, and use of other mental health treatments


ICOT: Improving Care Outcomes Tool

ICOT: Improving Care Outcomes Tool

The Behavioral Health Department at Kaiser Permanente Colorado (KPCO)  and researchers at the KPCO Institute for Health Research, led by MHRN researcher Dr. Arne Beck, have worked in partnership developing an automated tool called the Improving Care Outcomes Tool (ICOT) that clinicians can use to access reports generated prior to their patients’ appointments in order to guide treatment planning and monitor progress. Read more.


MHRN II Funded

MHRN II Funded

The Mental Health Research Network (MHRN) received Notice of Award from NIMH for 5 years of funding - Beginning August 1st, 2014, MHRN received another 5 years of funding to continue and expand work begun under the initial 3-year award.  With renewed funding, MHRN hopes to become a national resource for researchers and policy makers.

Background: Infrastructure development during the 1st cycle was designed to support an initial group of research projects and to create the capacity to respond rapidly to future challenges and opportunities. This work included:

  • Infrastructure Development focused on developing data infrastructure, facilitating research assessment, and improving human subjects protection. Primary goals of a data infrastructure workgroup included evaluating the availability and quality of electronic records data regarding mental health diagnoses and treatments; establishing standard definitions and specifications for key mental health variables; and establishing an ongoing quality assessment process. Ongoing descriptive analyses of patterns of mental health diagnoses, treatments, sentinel events, and outcomes should serve two purposes: assessment of data quality AND detection of true changes in prevalence, patterns of care, or outcomes.

    In addition, infrastructure work included development of a mental health assessment library and online assessment platform. Work to improve assessment should now focus on harmonizing and spreading the use of standardized assessments in clinical practice throughout partner health systems.

    Four specific research projects both contributed to and benefited from this infrastructure development. See updates on findings and links to published results.
    • An observational study of patient, provider, and health system influences on the process and outcomes of acute-phase depression treatment
    • A pilot randomized trial of behavioral activation psychotherapy for depression in pregnancy
    • A population based registry (including electronic medical records, survey data, and biospecimens) of families affected by Autism Spectrum Disorder
    • An observational study of the effect of FDA safety advisories regarding suicide risk on the prescribing of antidepressants and the risk of suicidal behavior
  • Evaluation and Development Core which focused on engagement with health system partners and external stakeholders and on evaluating relevance of MHRN research to those stakeholders. Strategic planning, research planning, and dissemination must be informed by engagement with three groups of stakeholders: leaders of partner health systems, external researchers, and representatives of the broader mental healthcare system (patients/consumers, providers, care systems, and insurers or public payors). Under the initial round of funding, work was begun engaging these 3 groups.
  • Emerging Issues and Surveillance Core focused on the use of electronic records data to identify emerging issues and treatment patterns in mental health care.

New Priorities for MHRN

Specific priorities for MHRN infrastructure development during the proposed next cycle of funding, include:

  • Dissemination of MHRN tools and resources to the broader mental health research community
  • Facilitating new research collaborations with investigators outside of MHRN member institutions
  • Improving capacity for ongoing surveillance of mential health treatment patterns and outcomes

Plans for infrastructure maintenance and new infrastructure development must account for anticipated opportunities and challenges arising from changes in the mental health and general health care systems. Those challenges and opportunities include:

  • Effects of health insurance and healthcare reform
  • Increasing use of standardized patient-reported outcome measures
  • Increasing diversity and complexity of large health systems
  • Expanded use of new communication technologies Precision or personalized medicine
  • Evolving regulations for human subjects protection
  • Transition to ICD-10

If you have an interest in any of these areas, particularly given MHRN's resources available to explore these areas, please do contact either Greg Simon, MHRN lead PI or submit a collaborative inquiry form.


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The Mental Health Research Network welcomes two new members

With the renewed funding for MHRN, two new members join our network, Palo Alto Medical Foundation (PAMF), led by Dr. Ming Tai-Seale in Northern California, and Essentia Institute for Rural Health (EIRH), led by Dr. Stephen Waring in Minnesota

 

Health care systems participating in MHRN with the addition of PAMF and EIRH
Thirteen health care systems are now participating in the Mental Health Research Network. Two additional members (Palo Alto Medical Foundation, and Essentia Health) have been added to the 11 members already participating. These 13 systems serve a combined member/patient population of approximately 12.5 million across 15 states. Member systems include traditional HMOs (with complete integration of insurance coverage and care system), mixed-model systems (insurance systems served by a both an internal group practice and contracted network providers) and medical groups serving patients with diverse types of insurance coverage.

The combined population is generally representative of the US population in terms of age, race, and ethnicity, including approximately 2.9 million under age 18, 1.7 million over age 65, 1.25 million Asian Americans, 900,000 African Americans, and 2.25 million of Hispanic ethnicity. The patient/member population is NOT limited to those who are currently employed or covered by employer-sponsored insurance. Patients/members are covered by a mixture of employer-sponsored insurance, individual insurance, Medicaid, and Medicare. The Medicaid and Medicare populations include those covered by capitation and fee-for-service payment arrangements. Those covered via employer-sponsored insurance include family members and dependents (including children up to age 26). Palo Alto Medical Foundation Research Institute and Essentia Institute for Rural Health add significant diversity of health system organization, geographic reach, and rural/urban residence.