We hypothesized that the electronic patient portal could be used as a population health tool to screen and detect patients living with major depressive disorder. This project integrated a computerized adaptive test for depression symptoms into the electronic health record. Then, in two randomized controlled trials, it tested if using patient portals to conduct population-level depression screening and symptom monitoring improved assessment rates and outcomes compared to usual care. We found that patients randomized to receive depression assessments via the portal in addition to usual clinic-based care had much higher screening and monitoring rates. Depression symptoms were more common and more severe among people who completed assessments via portal versus in clinic. 

Funding: AHRQ Grant U18 HS26151-01, Agency for Healthcare Research and Quality

Persons living with HIV (PLWH) who suffer from anxiety have significantly lower adherence to antiretroviral therapy, less engagement with HIV care, and higher rates of unprotected sex.  PLWH with comorbid anxiety have high levels of unmet need for mental health services and more emergency room visits and hospitalizations. However, few studies have examined strategies to increase anxiety screening and management in PLWH. This pilot study implemented a system for in-clinic anxiety screening and management and designed a patient portal strategy for assessing anxiety in PLWH receiving care at the University of Chicago HIV Care clinic. Provider surveys also showed an interest in increased anxiety and depression screening and identified barriers to depression and anxiety treatment in the clinic. Patient interviews identified barriers of anxiety and depression screening in the clinic including access to treatment, inconsistent screening, and limited access to treatment resources.

Funding: Third Coast CFAR Pilot Award NIH P30 AI117943, Third Coast Center for AIDS Research

People living with HIV (PLWH) who have comorbid SUD have a higher likelihood of condomless sex, lower retention in care, lower antiretroviral therapy adherence, less viral suppression, and increased mortality. Without systematic screening for SUD, many cases will likely be missed. This project interviewed PLWH with substance use disorder (SUD) about their thoughts on population-level SUD screening via MyChart in the Ryan White HIV/AIDs clinic. SUD is highly prevalent and often unrecognized and underdiagnosed in PLWH. Interviews showed PLWH were interested in completing SUD screening over MyChart. Participants cited the privacy of health information as a main driver of using MyChart.

Funding: Third Coast CFAR Administrative Supplement Pilot Award NIH P30 AI117943, Third Coast Center for AIDS Research

This study aims to improve digital health equity among Black PWLH. ePORTAL evaluates the implementation of a patient portal training program, uses a randomized controlled trial to assess the effectiveness of population-health substance use screening, and evaluates the implementation of decrease barriers to SUD screening (clinic-based, in-person). The Collaborative Care Model for SUD treatment to decreases structural barriers to SUD care. ePORTAL works with a community health worker and community advisory board to guide the intervention. The ultimate goal is to achieve health equity in SUD screening and treatment among Black PLWH.

Funding: NIDA Grant R01DA058965, National Institute for Drug Abuse

Chronic pain is highly prevalent in older adults, but management is complicated by high rates of multi-morbidity, polypharmacy, geriatric syndromes, and challenges managing opioid use and opioid use disorder (OUD). I-COPE was an outpatient intervention intended to improve chronic pain, opioid use, and OUD management in older adults. I-COPE combined a pre-visit patient questionnaire, a tailored electronic clinical decision support order set, a shared decision-making conversation tool, and patient education materials, coupled with trainings for primary care providers, including an optional Project ECHO® series. I-COPE was piloted in two clinics and was assessed via a pragmatic, stepped-wedge trial at 35 clinical sites.

Funding: AHRQ Grant No 1R18HS027910-01, Agency for Healthcare Research and Quality

Currently in primary care, there are no formal recommendations to screen for post-traumatic stress disorder outside of the VA setting; however, clinics located in geographic areas with high community violence may also benefit from a policy of universal PTSD screening. This study is testing this hypothesis in partnership with a federally qualified health center (FQHC) on the South Side of Chicago. It is evaluating the implementation and effectiveness of PTSD screening and management using a pragmatic open cohort stepped wedge clinic-randomized trial across 5 clinics of the Chicago Family Health Center (CFHC). The aims are to implement visit-based screening for PTSD, population health screening for PTSD via a patient portal, and treatment when patients screen positive via their integrated primary care behavioral health services. This 3-year project commenced in September 2023.

Funding: NIMHD Grant 3P50MD017349-03S3, National Institute of Minority Health and Health Disparities

Eliminating diabetes health disparities has been a national goal since 2000, but disparities in diabetes quality of care and outcomes still persist. In order to reduce diabetes health disparities, one essential tool that is not available is an accurate model for predicting future health disparities. We developed a multi-ethnic simulation model of diabetes outcomes, and systematically reviewed the literature to understand the impact of interventions to reduce diabetes health disparities.

Funding: NIMHD R01 MD013420