Improving Assessment of and Response to Depression in Chronic Obstructive Pulmonary Disease Care

Principal Investigators: Joanna Hart, MD, MS and Robert Schnoll, PhD

Our objective in this pilot proposal is to fill the existing research-to-practice gap by pilot testing behavioral economic-based approaches to protocolizing depression screening and mental health service referrals of patients with COPD at high risk for depression. To do so, we will complete two specific aims:

1. Conduct a formative evaluation, using semi-structured interviews with key stakeholders, to assess the barriers to assessing patients with COPD for depression and referring appropriate patients for treatment.

2. Refine and test the implementation of protocolized depression screening combined with clinician-directed nudges to increase the assessment of depression and referral for mental health services to appropriate patients.

The proposed work will develop a novel approach of implementing behavioral economic approaches to improve the assessment and referral of mental health services to high-risk patients with COPD. We will design and test innovative, scalable interventions based on principles of behavioral economics using implementation science methods. Interventions chosen will be easily integrated into the electronic health record (EHR) in order to change clinical practice by reducing the cognitive load on decision-makers while preserving clinical judgement and opportunities for shared decision-making. Such interventions are well-suited to address the underuse of appropriate assessments and evidence-based therapies, such as treatment of depression in patients with COPD. In doing so, they may also reduce sociodemographic disparities in health care and subsequent health outcomes by uniformly nudging clinicians to respond to depressive symptoms. Use of implementation science methods to develop and test EHR-based interventions is necessary to confirm that the interventions improve outcomes while avoiding the burden of “alert fatigue” or other undesired consequences.