2 - (OP23) Designing, Implementing, and Using a CBT Outcome Tracking Database in a Multi-site Integrated Primary Care Program

Introduction: Mental health conditions frequently present in primary care settings, thus affording the opportunity to embed mental health assessment and treatment resources within this context. Integrated Behavioural Health (IBH) programs are specifically designed to improve access to mental health services, including evidence-based cognitive behavioural therapy (CBT), right at the point of care. An important element in ensuring quality, sustainable IBH programs is the implementation of a mechanism to track treatment outcomes. The aim of the proposed presentation is to describe how we designed, implemented, and use a digital solution for a CBT treatment outcomes database for our IBH programs spread across 22 primary care clinics located in Minnesota, Wisconsin, Iowa, Arizona, and Florida.

Method: In 2014, key stakeholder interviews were conducted to assess relevant variables to consider in tracking outcomes for our adult and pediatric IBH programs. Emphasis was placed on identifying and operationalizing evidence-based CBT interventions, utilization of mental health services, and patient self-report measures (e.g., PHQ-9, GAD-7). Furthermore, maximizing user efficiency when interfacing with the online tracking platform was prioritized. In 2017, our medical centre transitioned to a unified electronic health record which required our team to make further adaptations to the tracking database and clinical documentation templates to enhance efficiency and consistency with data capture.

Results: To date, a total of 23,135 adults and 10,270 children/adolescents who have provided research consent have been enrolled in this tracking database across our IBH programs (updated data will be included; Roche et al., 2023), including over 30,000 and 17,000 individual CBT sessions for adult and pediatric patients, respectively. In addition to patient demographics and clinical characteristics (e.g., age, mental health diagnoses), we will also present updated data on psychotherapy outcomes (e.g., average number of sessions, length of treatment), CBT principles used in session (e.g., exposure, behavioural activation, cognitive challenging, motivational engagement), mental health service utilization (e.g., 6-months prior to IBH engagement, services recommended and accepted during their course of IBH care), and measurement-based outcomes on self-report questionnaires (e.g., % reaching reliable change, response, remission on the PHQ-9 and GAD-7).

Discussion: A technological solution was necessary to design and implement a large-scale CBT tracking database across our primary care IBH programs (Sawchuk et al., 2020). Data from this registry has allowed us to report on our outcomes to support service growth efforts, quality improvement projects, educational initiatives, and research endeavours. Future efforts to link this large-scale database with other clinical and epidemiological databases within our health system will be discussed.