NAVIGATE Training

COMPASS Visit Sequence and Overview Benji Kurian, MD, MPH Ronny Pipes, MA, LPC UT Southwestern Medical Center at Dallas

COMPASS OVERVIEW  COMPASS is a web-based decision support system that promotes:  MBC,  Evidence-based practice, and  Shared decision-making

COMPASS OVERVIEW  COMPASS provides feedback to providers at the point of care.  The concept of MBC for COMPASS is to use validated ratings at defined intervals to systematically assess:  symptoms,  side effects, and  treatment adherence.

Patient Visit Flow Diagram RA Visit Flow Prescriber Visit Flow

 The First Section of the Patient Visit is Led by the Site Research Assistant  Login Using Your Unique User Profile  User ID  Password RA Visit Flow

Logging In User ID = 1 st initial of your first name + your last name No spaces Example: John Doe = jdoe Password = Trainingpassword1

Compass Welcome Screen Click on your clinic name: AMHC Is the center we’ll use for training Click on your clinic name: AMHC Is the center we’ll use for training

Patients Screen Click on: Add new patient Click on: Add new patient

New Patient Entry Screen Enter patient information, then click “Initial History” to open the next form. Remember to assign the prescriber & the RA

Initial History Form Complete the form by clicking through each item

Initial History Form (Continued) + and – signs add & remove lines for medications

When Form is Complete Click Submit

Click on “Add New Labs”

Labs Screen: Enter Lab Values and Click “Submit”

Return to the Report Center Page & Click on “New Visit”

Enter Vital Signs & Click to Patient Self Evaluation

Little red boxes indicate items not yet addressed

When Form is Complete, Click “Save” - End of RA/Patient Encounter - Patient Ready to See Prescriber

Prescriber Visit Flow Login with Your Unique User Profile  User Name  Password

Logging In User ID = 1 st initial of your first name + your last name No spaces Example: John Doe = jdoe Password = Trainingpassword1

Compass Welcome Screen Click on your clinic name: AMHC Is the center we’ll use for training Click on your clinic name: AMHC Is the center we’ll use for training

Now Patient is Ready to be Seen by the Prescriber

Click on “Status”

Patient Status Screen Mood & anxiety symptoms graphs Pull-down menu allows you to select which symptoms to graph

Patient Status Screen Medication dose, Side effects, weight, etc also w/ pull-down

Click “Patient Assessment” to go to Clinician Rated Questions

Doctor Assesses Patient & Completes the Clinician Rated Questions Form This section reports information from Patient Self-Report that does not have a corresponding question on the Clinician Rated Form

Clinician Rated form includes information from Patient Self-Rated Form on corresponding items and adjusts the prompt questions accordingly. This item includes prompt question for a patient who did not endorse depressed mood on the Self-Report Form Prompt question for patient who did endorse anxious mood

After completing the Clinician Rating Form, Click “Next: Prioritize Treatment”

Shared Decision Making: Discuss with patient which treatment issues are most important to address at this visit. Highlight the symptom or side effect in the list on the left then click the arrow next to the priority number on the right

Shared Decision Making: Prioritizing Treatment issues Here you can type as much free text into the progress note as you like It’s easy to re-prioritize Any number up to 5 is acceptable It’s easy to re-prioritize Any number up to 5 is acceptable When you’re finished prioritizing, click here to go to the decision support/treatment selection screen

Decision Support & Treatment Selection Screen Here you will get your list of issues to address in order of priority. Under each issue there will be a recommendation for treatment from the decision support messenger More room for free text for the progress note here Step 1: From this drop-down you select from a list of clinical issues to treat Step 2: From this drop down you will choose from a list of recommended treatments for the selected clinical issue

Treatment Selection − Principles  Measurement Based Care  Evidence based principles to guide treatment selection based on regular assessments of symptoms, SE and adherence  Shared Decision Making  Suggested treatment guidelines are based on 5 priorities that prescriber and patient decided on prior page  Suggested Sequence/Dose of Medications  Generally, emphasizes medications having recent studies with efficacy data in FEP and/or adolescents with schizophrenia spectrum disorders

Treatment Selection − Medications (cont’d)  Suggested Sequence/Dose of Medications (cont’d)  Efficacy studies provide the base for efficacy, dosing and SE  Antipsychotic and SE medications without studies in FEP patient groups are not supported by COMPASS.  While unsupported meds may be effective, dosing and SE profiles for these meds in FEP patients are unknown  COMPASS does provide support for antidepressants and mood stabilizers  These recommendations are based on studies in patients with primary mood disorders, as data from FEP patient studies is unavailable

List of COMPASS Supported Medications (alphabetical order) Antipsychotics:  Aripiprazole  Chlorpromazine  Clozapine  Haloperidol  Olanzapine  Paliperidone  Quetiapine  Risperidone  Ziprasidone Antidepressants:  Bupropion  Citalopram  Duloxetine  Escitalopram  Fluoxetine  Mirtazapine  Paroxetine  Sertraline  Venlafaxine Mood Stabilizers:  Divalproex  Lithium Side Effect Medications:  Benztropine  Lorazepam  Propranolol

Positive Symptoms Treatment Aripiprazole is started at 5mg for 7 days, then titrated up to 10mg until next visit

Positive Symptoms Treatment Click on the blue text with the drug information to navigate to pricing screen

Drug Information Link Click on the name of the drug to get information

Pricing Information Drug pricing is listed here When you’re finished, close the window

When You’ve Finished with Treatment Selection, Proceed to the Finishing Up Screen Click Next: Status  to advance to the final screen Click Next: Status  to advance to the final screen

Finishing Up Screen Address Suicidality Address Homicidality Explain Risks & Benefits of Medications Check Finalize When finished

Complete the Visit Free Text Notes have Full Function Text Editing Toolbar Click Submit to Finish Visit and Return to Home Screen

LOGGING OUT

Other Aspects of COMPASS  Other Providers with Access  Designated Psychosocial Treatment Team Members  Access and Security  Site Secure website  User specific login/passwords (DO NOT SHARE)  User requirements  Stable Internet Connection  Works best on Internet Explorer 6 or later

Contacting You  Brief Primer in the next few weeks  If you have questions please contact us: