Standardized psychosocial evaluation process benefits patients awaiting a transplant

Psychosocial evaluation is often used to identify candidates most likely to benefit from transplantation. At Mayo Clinic, however, a multisite, multidisciplinary team ensures that patients awaiting a transplant receive consistent evaluation, collaborative consultation and treatment recommendations with trackable outcomes.

"Standardization of evaluation provides huge benefits," says Sheila G. Jowsey, M.D., of the Department of Psychiatry and Psychology at Mayo Clinic in Rochester, Minn. "It employs the collective wisdom of many providers to offer the best care for our patients, improves our ability to have patients move between Mayo sites and helps us track outcomes using research-based approaches. It also allows us to repeat evaluative tests consistently to monitor change over time."

The process

The multisite, multidisciplinary team includes social workers who assist patients in completing the evaluation forms that apply. "We choose the best combination of tools to ensure that the process won't be burdensome for the patient," says Dr. Jowsey. "Team members can quickly single out the patients who need help." A triaging mechanism streamlines the process of referring those patients to mental health professionals.

Mayo team members in Arizona, Florida and Minnesota use the same screening instruments, including:

• Patient Health Questionnaire (PHQ-9) depression rating scale
• Generalized Anxiety Disorder (GAD-7) anxiety rating scale
• Alcohol Use Disorders Identification Test (AUDIT)
• Drug Abuse Screening Test (DAST-10)
• Fagerstrom Test for Nicotine Dependence
• Spitzer Uniscale
• Memory testing measures
• Transplant psychosocial suitability overall rating scale

Future applications

Teams at all three sites will collaborate to transition from a paper-based system to a patient self-entry system that uses a computer interface, with data stored in a data system that is compliant with the Health Insurance Portability and Accountability Act.

"We have a battery of screening tools to use at the time of transplantation," says Dr. Jowsey. "Several of them can be used repeatedly to track changes in important psychosocial factors. Ultimately, we intend to be able to compare patients using the same tools over time."

Points to remember

Mayo Clinic standardizes the evaluation of patients awaiting a transplant in Arizona, Florida and Minnesota, allowing health care providers to offer the best care for patients by:

• Moving patients among Mayo sites seamlessly
• Tracking outcomes using research-based approaches
• Repeating evaluative tests consistently to monitor change over time
• Employing the collective wisdom of many specialists