Web-based technological innovations are increasingly being utilized to enhance the quality of healthcare. The UCLA Behavioral Health Checkup™ (BHC) is an innovative real-time, cloudbased behavioral health assessment and clinician decision making tool. This paper examines the implementation and acceptability of the BHC within the UCLA Health System. The BHC was successfully integrated into seven UCLA Behavioral Health Associates (BHA) behavioral health collaborative care settings. Components of successful integration included training of administrative and clinical staff in use of the BHC platform, including how best to introduce behavioral health screening and measurement to patients and caregivers. BHA adult patients and caregivers of BHA youth patients reported positive experiences with the BHC. As the BHC delivers results to providers in real-time, it provides a unique occasion to engage patients through immediate discussion of patient responses and to use results for guiding and customizing clinical care. In addition, the integration of BHC results into a primary care system's health record framework facilitates the coordination of care over time, providing an opportunity for measurement based treatment to target and treatment quality improvement.

BackgroundGiven the high rates at which patients present with behavioural health (BH) concerns in primary care (PC), this setting has become the de facto mental health system. As a result, screening for depression and other BH conditions in PC has become a critical target for improving patient outcomes. However, integration of screening into busy PC workflows can be challenging due to barriers such as limited time and resources.MethodologyA digital, cloud-based BH assessment tool, which included electronic health record enhancements, was developed and implemented in two urban PC practices as a prelude to a planned larger-scale implementation. The implementation strategies included a reorganisation of workflows within the PC setting, comprehensive training for staff and PC physicians, and institution of an incentive programme for PC clinic managers. To examine whether the introduction of the cloud-based BH assessment tool and associated implementation strategies was associated with increased screening rates, we compared rates of screening from January through June 2017 to rates of screening from January through June 2018 (subsequent to implementation). We also examined BH symptomatology reported by patients in PC.ResultsFollowing the implementation process, rate of BH screening with Patient Health Questionnaire-2 (PHQ-2) increased from 50.5% to 57% (p<0.00000000000000022) and rates of subsequent screening with PHQ-9, for those scoring at risk, defined as a score of ≥1, on PHQ-2, increased from 34.5% to 91.4% (p<0.00000000000000022). Additionally, high rates of ‘moderate’ and ‘severe’ symptoms of depression (40.3%), anxiety (42.6%) and substance use (26.7% alcohol; 31.2% other substance use) were observed among PC patients.ConclusionsResults suggest that a comprehensive implementation plan, including digitisation of BH assessment, reduced the burden of systematic screening. High rates of BH symptomatology underscore the need for comprehensive BH assessment and systems planning to address the high need for BH services among PC patients.

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