Grant: Team Grant: GACD Mental Health - Canada-China

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, lowcost, 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 physicianand 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 costeffectiveness 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.