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Last month, Centerstone announced a partnership between the company’s research arm and Dr. Madhukar Trivedi, a professor of psychiatry at the University of Texas Southwestern Medical Center who is nationally recognized for his leadership in evidence-based treatment of depression.

Fueled with a $1.2 million grant from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, the renowned researcher and the nation’s largest provider of community mental health services are combining technologies to bring the latest scientific evidence regarding the treatment of major depressive disorder (MDD) to clinicians through a three-year pilot program.

Trivedi has developed an algorithm-based clinical decision support system (CDSS) that incorporates the latest best practice guidelines and research discoveries impacting the treatment and management of MDD. The CDSS is being merged with Centerstone’s sophisticated electronic health record system to help clinicians standardize care, improve medication management and track outcomes.

David Ayer, PhD, director of clinical research for Centerstone, said measurement-based care is an effective tool to guide clinicians in creating a treatment plan. The three domains measured in the pilot program are: 1) symptom severity, 2) side effects from current or past medications and 3) adherence to treatment.

“These are questions a provider asks anyway but not necessarily in a standardized form,” Ayer said.

The system will also include prompts to remind practitioners to ask specific questions, graphically illustrate inputted data from a baseline starting point and provide information on updated practice guidelines and research.

“There are about 900,000 new biomedical studies coming out every year,” pointed out Ayer. “There’s no way a busy clinician can keep up with that.”

However, he added, researchers and specialists focused on a single area do keep up with information impacting their field of study. By using technology, these experts can broadly disseminate the most up-to-date information to clinicians, thereby cutting the typical lag time — which is often measured in years — between discovery and practical application.

“It’s really bringing the expertise of specialists and all the major research advances in major depressive disorder to the clinician’s fingertips at the point of care,” Ayer said of the pilot program.

Of course, the bottom line is outcomes.

“We know from past research we can achieve about an 80 percent remission rate with major depressive disorder,” Ayer said of applying best practices to manage the chronic illness.

Based on smaller studies, the team is very hopeful that this measurement-based approach will help clinicians standardize care to reach maximum outcomes for patients. If results match expectations, Ayer said the hope would be to make this type of system the national standard of care for treating MDD and a springboard for piloting similar programs in other diagnostic categories.

He added that the information presented to clinicians is a suggested course of action, but medical professionals still have the leeway to alter the treatment plan to best suit an individual patient.

“We’re very sensitive that we don’t want to dictate to the medical professional, but this is a very important tool to have in their doctor’s bag … and one they haven’t had in the past,” concluded Ayer. “It’s very exciting to think we could positively impact 80 percent of the people with such a debilitating diagnosis, and we really think following this approach is going to get us to the 80 percent remission rate.”

The three-year pilot program is being conducted with 8,000 patients across 24 Centerstone clinics in Tennessee. The first year is dedicated to merging the CDSS and electronic health record (EHR) technologies and integrating the new system into the workflow. Ayer said that a prototype should be ready this summer. After review by providers, the technology team is expected to make necessary modifications and roll out the system for clinical use in January 2009.



May 2008

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