Michigan Screening for Treatment
and Research Triage (M-START)
A core component of The University of Michigan Depression Center
The Michigan Screening for Treatment and Research Triage (M-START) is a newly developed component of the Depression Center’s information technology infrastructure incorporating a brief telephone-screening interview and patient database. The purpose of M-START is to enhance clinical care, administrative functioning, research recruitment, and the coordination of patient-related activities.
M-START is the first link in a network of treatment options and research projects available within the University of Michigan Depression Center. It begins with a phone interview during the patient’s first contact and the result is a brief but comprehensive overview of patients’ current symptoms, environment, and treatment history. More than 50 members from a variety of disciplines including Psychiatry, Internal Medicine, Family Medicine, Pediatrics, and the School of Public Health, helped develop M-START. This ensured that the most important clinical areas were covered. The M-START database is Oracle-based, housed in an environment supported by the Health Systems information technology division, and meets all UMHS standards for data security.
M-START is web-based and utilizes branched logic to tailor the interview to the patient’s specific needs. Each question is determined by the patient’s answer to the previous question. For example, separate question streams are available for adults and children, to allow for age-appropriate assessment. Standardized text is provided for most items, and mandatory assessment areas are identified, ensuring that basic clinical information is obtained for all patients entering the Depression Center and the Psychiatry Department. This structured interview permits efficient triage of patients to appropriate clinical services and specialty clinics. A current department study is attempting to establish a patient profile that predicts poor outcomes and high utilization, so that at-risk patients can be offered specialized treatment at an early stage in their care when it is most important.
During the phone interview, patients are also asked about their willingness to participate in current research on depression and related disorders. This provides an opportunity for interested patients to learn more about projects designed to advance knowledge about depressive disorders, and the opportunity for investigators to identify patients who wish to contribute to research. Routinely asking callers if they are willing to be contacted about research participation provides a renewable, formerly untapped, pool of potential subjects who can be pre-screened for eligibility based on their interview responses. This is particularly valuable for research studies that target difficult-to-reach populations.
Currently, the M-START interview is being conducted by staff at the Michigan Center for Diagnosis and Referral (M-CDR) appointment line. An average of 250 adult patients who are new to the system are screened each month. Pilot data on 291 patients indicate that 52% are interested in research opportunities, and that 72% of individuals with a family history of a psychiatric disorder wish to learn more about research participation.
Future development plans for M-START include the capacity to modify the interview and dataset to ensure longevity within the dynamic environment of research and clinical care. These include incorporating M-START as part of the University of Michigan Health System’s centralized patient database, and having patient profiles accessible through the University of Michigan electronic medical record, CareWeb. A final development stage will allow customization modules so that specialized clinics and research studies can create unique assessment pages that also become part of the patient’s common record.
