EMBED

Enhanced Measurement-Based care Effectiveness for Depression (EMBED): A Canada-China implementation project

People gaze across the water at the Shanghai skyline.

Mood Disorder Centre researchers have been awarded a 5-year CIHR grant to improve depression treatment outcomes in Shanghai using novel tech tools.

 

We are excited to announce the Canadian Institutes of Health Research (CIHR) and National Natural Science Foundation of China (NSFC) through the Global Alliance for Chronic Diseases (GACD) have awarded a team of Mood Disorder Centre and other researchers approximately 2.15 million over 5 years to conduct a research and implementation program to improve depression treatment and outcomes in China.

The project, called “Enhanced Measurement-Based care Effectiveness for Depression” (EMBED), will adapt and develop technologies such as mobile apps, online training programs, electronic medical records, and telephone and text interventions to promote measurement-based care (MBC) for depression in community mental health centres across Shanghai. MBC is an evidence-based practice that can improve depression diagnosis and treatment, and technology-enabled MBC (called “enhanced” or eMBC) tools developed through the program may serve as models for future development and scale up in the region.

Principal Investigators are Dr. Raymond Lam, Professor of Psychiatry at the University of British Columbia (UBC) and Director of the Mood Disorders Centre (Canada) and Dr. Chen Jun, Professor of Psychiatry at the Shanghai Jiao Tong University (China).

Dr. Erin Michalak, Professor in the Department of Psychiatry at UBC and a psychologist of the Mood Disorders Centre is also a Co-Investigator on the project.

The program is also one of the first initiatives affiliated with the Asia-Pacific Economic Cooperation’s (APEC) Digital Hub for Mental Health, which supports APEC’s vision to strengthen mental health and reduce the economic impact of mental illness in the Asia-Pacific region.

Read the press release.

Read the news article.

 

 

Grant details:

Grant Title: Enhanced Measurement-Based Care Effectiveness for Depression (EMBED): A Canada-China Implementation Project

Funding Amount: 2.15 million over 5 years
215,000 CAD per year for Canada-based researchers (1,075,000 CAD total / ~5,600,000 RMB);
1 million RBM per year for China-based researchers (5 million RBM total / ~959,500 CAD)

Funding Agencies: Canadian Institutes of Health Research (CIHR) Roadmap Accelerator Fund (RAF) in partnership with the National Natural Science Foundation of China (NSFC)

Investigators:

Principle Investigator, Canada:

Dr. Raymond W. Lam, MD, FRCPC
Professor and BC Leadership Chair in Depression Research;
Associate Head for Research, Department of Psychiatry, University of British Columbia;
Director, Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health;
Executive Chair, Canadian Network for Mood and Anxiety Treatments (CANMAT)

Principle Investigator, China:

Dr. Jun Chen, MD, PhD
Director & Chief Physician, Depressive Disorders Program, Division of Mood Disorders
Director, Office of Clinical Research Center
Director, Office of Shanghai Clinical Center for Mental Disorders
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine (SMHC)
Secretary, Chinese Society of Psychiatry (CSP)
Vice Chairman, Youth Council, Chinese Society of Psychiatry
Committee Member, Chinese Psychiatrist Association (CPA)
Secretary, International Society for Bipolar Disorders Chinese Chapter (ISBD-CHN)

Co-Investigators:

Dr. Heather Colquhoun
Dr. Larry Culpepper
Dr. Carolyn Dewa
Dr. Andrew Greenshaw
Dr. Yanling He
Dr. Sidney Kennedy
Dr. Xin-Min Li
Dr. TianLi Liu
Dr. Erin Michalak
Mr. Jonny Morris
Dr. Chee Ng
Dr. Sagar Parikh
Dr. Claudio Soares
Mr. Phil Upshall
Dr. Zuowei Wang
Dr. Yifeng Xu

 

Abstract:

Depression affects 300+ million people globally and is now the leading cause of disability and burden of disease worldwide. In China, the National Mental Health Work Plan 2015-20 specifies improving the ability of healthcare facilities to identify depression and increase the treatment rate by 50%. Measurement-based care (MBC) – the routine use of validated outcomes such as the PHQ-9 depression questionnaire to guide clinical decision-making – is a simple evidence-based practice (EBP) that may help meet these objectives. However, there is still a significant care gap in the implementation of MBC in China and elsewhere. In Canada, we have adopted the concept of enhanced MBC (eMBC), in which technology can engage both patients & physicians in using MBC; eMBC enhancements include web and mobile app tools for patients to track their own progress with the PHQ-9, and an evidence-based, low-cost, low-intensity psychological treatment (guided self-management with telephone coaches) that has embedded patient measurement and feedback to physicians.

EMBED: a Canada-China implementation project, proposes to develop a novel EBP implementation strategy by adapting, implementing and evaluating eMBC in diverse community mental health clinics in Shanghai, modeled on programs implemented in Canada. EMBED addresses 4 broad aims: 1) identify contextual enablers & barriers to MBC implementation; 2) explore physician- and patient-level factors as mediators for an EBP implementation; 3) provide clinical & health economic outcomes to establish effectiveness of eMBC; and 4) build knowledge & capacity for scale up of eMBC in China and beyond. Our hypothesis is that physician & patient factors that are barriers for implementation of standard MBC will be enablers for implementation of eMBC.

To achieve these aims, we will first conduct a Situation Analysis to determine the key barriers & enablers for MBC implementation in Shanghai. We will adapt a Canadian eMBC program for the Chinese context, then will use a hybrid implementation-effectiveness design (an adaptive cluster randomized evaluation) to compare eMBC with standard MBC implementation in 12 community clinics, 240 physicians, and 1200 patients. We hypothesize that eMBC implementation will lead to superior implementation, patient and cost-effectiveness outcomes, compared to standard MBC.

EMBED will advance the international literature on MBC broadly by focusing on the understudied role of patients in implementation of MBC. EMBED will also further implementation science by creating new knowledge on contextual factors, including mediating effects of physician- and patient-level factors, together, on EBP implementation outcomes. Moreover, the unique partnership of the EMBED team with the APEC Digital Hub for Mental Health will ensure a pathway for integrated knowledge & policy translation so that findings will have significant scale-up and spread potential in other regions in China, the Asia-Pacific and worldwide.