EVALUATING THE EFFICACY OF SYSTEMATIC PATIENT FEEDBACK IN AN INTEGRATED MENTAL HEALTH AND PRIMARY CARE SETTING

The implementation of the Affordable Care Act (ACA, 2010) has resulted in efforts to make healthcare more affordable and effective. One strategy for making healthcare more affordable and effective is the integration of behavioral health and primary care. In today’s healthcare system, it is estimated that approximately one in three patients seen in a primary care setting meet the criteria for a mental health disorder and another third – while not meeting those criteria – are experiencing psychological symptoms that impair their functioning (Kessler, 2005). Despite the evidence supporting behavioral health services in a primary care setting, treatments tend to be diagnosis specific (Archer et al., 2012; Lemmens, Molema, Versnel, Baan, & deBruin, 2015) and as such do not capture patients’ varied presentations. Patient feedback offers a potential strategy to improve the quality of services provided. Patient feedback is the use of measures administered at each session to assess distress and track progress. There is a robust psychotherapy literature demonstrating the effectiveness of using routine progress monitoring in clinical practice but it has not been evaluated in an integrated care setting. Therefore, the purpose of this study was to evaluate the efficacy of patient feedback in this setting. Preliminary results of this ongoing study revealed there was a moderate feedback effect using both the ORS (d = 0.38) and PHQ-9 (d = 0.12) as the outcome measures. Using the ORS as the outcome measure, patients in the feedback condition demonstrated faster treatment gains, which suggests that they improved faster compared to those patients in the TAU condition. Additionally, patients in the feedback condition incurred significantly more reliable change compared to TAU. However, this result was not replicated when the PHQ-9 was used to measure outcome. Overall, the results suggest that PCOMS may be a potentially useful quality improvement strategy

Stability, Dynamics And Change-Of-State In Liquid Drop-Bridge Systems

A capillary based adhesion device motivates the study of coupled free-interface shapes and the transition from the drop to bridge shape. When a large number of drops, pinned at circular contact lines, are touched to a surface they form liquid bridges, and these bridges create an adhesive force. Alternatively, if the drops are not brought to the surface quickly enough the drops will coarsen, forming instead one large drop. Consider first the coarsening process. The dissipation occurs primarily in the conduits, the drop retain their equilibrium shape - the spherical cap. Drops scavenge volume from one another based on pressure differences, proportional to the surface tension, and arising from curvature differences. This process minimizes the total surface energy. All fixed points and their linear stabilities, obtained analytically, are found to be independent of connectivity. The system coarsens in the sense that, with time, volume is increasingly localized and ends up in a single 'winner' drop. To determine which of the stable fixed points will be the winner, manifolds separating the attracting regions are found using a method which combines local information (eigenvectors at fixed points) with global information (invariant manifolds due to symmetry). The coarsening rate is predicted heuristically, with the Lifshitz-Slyozov-Wagner (LSW) model and compared against numerical simulations for a variety of networks. Distributions of large drop volumes from LSW are independent of network topology; in contrast, simulation results depend weakly on the network dimension. When a pinned drop touches a solid surface it forms a liquid bridge; here the energy is dissipated within the bridge. The dissipated energy is equal to the loss of surface energy, which can also be expressed in terms of forces along the interface using a geometric relation. This energy balance provides an extra relation which determines the microscopic nature of the contact line. Boundary integral method simulations are used to compute the flow field and viscous bending of the free interface. The energy balance is applied to simulations to find slip lengths. The energy balance is used to bound the microscopic contact angle analytically