SBIR-STTR Award

The US healthcare delivery system suffers from intractable problems that increasingly prevent it fromidentifying and treating people suffering from SUDs. Primary care clinicians, the front line of our health caredelivery system, have neither adequate tools nor incentives to evaluate SUDs and co-occurring mental healthdisorders. The result is chronic under-diagnosis and under-treatment, in addition to the associated adversepersonal and societal impacts. These shortcomings disproportionately affect individuals from underservedpopulations who already have poor access to health care resources. We propose to develop and test a new Primary Care-SUD-Intake System (P-SUD-IS) that is intendedto address the problem of under-diagnosis by changing primary care clinician behavior and motivating clientswith previously undiagnosed SUDs to seek help. The P-SUD-IS will be a HIPAA-compliant, user-friendly,automated, and cloud-based system, and, if successful, will reduce the time needed for primary care cliniciansto complete and bill for a biopsychosocial assessment. The P-SUD-IS will assess and record family SUDhistory, personal SUD history, educational history, occupational history, social history, current social supports,and willingness to participate in treatment. Diagnosis and a mental status exam will be conducted usingTeleSage's existing validated DSM-5 self-report diagnostic system (SAGE), which will be integrated into thenew P-SUD-IS. Responses to all questions will be used to provide clinicians with detailed electronic reportsthat can be entered into the client's EHR. This system is in no way intended to replace the clinician. As adecision-support tool, the P-SUD-IS is intended to help clinicians without specialized training in behavioralhealth and SUDs use all available resources to complete a biopsychosocial assessment. This study will assess whether underserved primary care clients might be willing and able to completethe P-SUD-IS. Questions will be written at a 5th grade reading level and read aloud using a native text-to-speech application. The client will receive a highly customized electronic report with educational & self-helpinformation as well as links to relevant on-line referral systems.The P-SUD Intake System will generate a report containing actionable information that will make it easier forprimary care clinicians to determine if a referral is warranted, and for them to provide the referraldocumentation that will be most helpful. The new strategy needs to fit within the normal workflow of primarycare clinics so as not to cause disruptions. Our goal is for the clinician to be able to look at the report for 2-3minutes, ask the client specific questions informed by the report, discuss options with the client, finalize thetreatment plan, write orders, and bill a sufficient amount for a biopsychosocial assessment to make the wholeprocess economically feasible. By making primary care SUD assessments cost effective and feasible, the P-SUD-IS will have a large impact on the underserved and undiagnosed.

Public Health Relevance Statement:
Project Narrative We intend to develop a low-cost, fully scalable, cloud-based mobile health solution designed to enable underserved populations with low digital literacy to complete a self-report Primary Care-SUD-Intake System. When combined with our existing validated SUD diagnostic system, it will meet all the requirements of a biopsychosocial assessment as defined by existing CPT billing codes. The results of the customizable biopsychosocial intake will be provided to primary care clinicians in the form of an intuitive electronic report that can be uploaded to the EHR, modified, and forwarded to specialty providers as detailed referral information; this will appreciably reduce the amount of clinician time required for completion of a biopsychosocial evaluation and enable biopsychosocial assessment and associated billing to become a routine part of the primary care workflow.

Project Terms: