We have completed the first implementation of the GAD-7 and PHQ-9 assessments in iDialogs. This release includes:
- A way for the staff member at the front desk to select which assessments the patients will complete in iDialogs
- The GAD-7 and PHQ-9 questions presented to the patient in iDialogs
- A complete set of reports for the clinician for the GAD-7 and PHQ-9
This release does not include:
- The innovations suggested for the PHQ-9 where some questions are split into individual parts. This feature will be added in a later release. Our strategy for implementing this feature is described later in this document.
We have put this version in front of patients to begin getting feedback, which has so far been positive. The ICS team decided that it would be procedurally difficult to enter in historical GAD-7 and PHQ-9 data from most patient. They may select a few patients that are interesting case studies for whom to import the past data.
Here's how the in-office GAD-7 and PHQ-9 assessments work:
Selecting Assessments for the patient
When the front desk staff member selects a patient name in iDialogs, a window appears asking whether the patient will be filling out the Emotions Assessments (GAD-7 and PHQ-9), the Symptom Assessments (ESAS), or all three. The PHQ-9 and GAD-7 are included as one choice because the patient completes both forms at the same time.
For each patient, iDialogs will remember which assessments were filled out at the last appointment so that the choice doesn't have to be re-selected if the patient completes the same assessments at a subsequent appointment. The selections can be changed if the patient is to complete a different set of assessments than were assigned at the previous appointment.
Completing the GAD-7 and Phq-9
Once the patient confirms their identity, the first question of the GAD-7 is presented. In this release, we use radio buttons and present the choices as a list.
In a future release, we may make available other input mechanisms such as the use of faces or thermometers. The goal is to explore which input styles are easiest to use.
When the patient selects an answer for the question, iDialogs automatically advances the screen to the next question to make the experience easier for the patient and more efficient for the office process.
The patient proceeds through the questions and arrives at a review screen. This screen shows the patient's total score for the GAD-7 without providing an interpretation of the score. The patient can change an answer if necessary. However, with the ESAS, we found that it was rare for a patient to return to a previous screen to change their answer.
When the patient has completed the GAD-7 and is satisfied with the answers, the patient presses Submit. iDialogs directs the patient to the PHQ-9.
Note: we have found that some patients think they are done with assessments when they reach Submit. We will explore additional changes in the future to make this clearer so that the front desk staff member doesn't waste time instructing the patient to continue.
In order to streamline the experience, the presentation of the PHQ-9 questions follows the format of the GAD-7 questions.
When the patient selects an answer, iDialogs advances to the next question. iDialogs also does not allow the patient to skip any questions on the PHQ-9 and GAD-7 to ensure the assessments are complete.
The patient proceeds through the rest of the questions and arrives at a review screen. This screen shows the patient's total score for the PHQ-9 without an interpretation of the score. The patient can change an answer if necessary.
When the patient has completed the PHQ-9 and is satisfied with the answers, the patient presses Submit. If the patient is scheduled to complete the ESAS, iDialogs automatically begins the ESAS at this time. If not, the patient is instructed to return the tablet to the front desk.
For this release, our implementation of the PHQ-9 does not ask the patient to clarify which symptom is of concern when the question asks about more than one potential problem. An example of one of those questions is shown below.
We believe it would be valuable to introduce the iDialogs version of the PHQ-9 and the GAD-7 to patients before introducing a change with some of the individual questions. This way, we keep the experience simpler for patients by not introducing new technology and new questions at the same time. Also, we can get feedback about the implementation earlier if we put the technology in front of patients sooner.
Reports for the clinician
iDialogs offers an assortment of reports with summary data for the GAD-7 and PHQ-9 as well as detailed information about the patient's response to each question. All reports are documented here.