Key ingredient for improving behavioral health outcomes: measurement-based care


Jason Washburn, professor at Northwestern University Feinberg School of Medicine

The burden of mental disorders is well known. Mental disorders are common, and lead to significant disability, in addition to contributing to and complicating chronic health conditions. Most mental disorders are not treated and the COVID-19 pandemic has only highlighted significant disparities in access to treatment. Effective pharmacological and psychological treatments are available, but results in routine practice are often weaker than those found in randomized controlled trials.

Measurement-based care (MBC) can improve the outcomes of routine mental health practice. MBC involves routinely and systematically assessing mental health symptoms, ideally before or during a clinical encounter, to inform and direct mental health treatment. For example, in 2015, a randomized controlled study of MBC in the treatment of depression found a much higher remission rate among the MBC group compared to usual treatment (73.8% vs. 28.8%).

What explains the impact of MBC on results? MBC can help providers track their patients ’response to treatments, alert providers when patients need to adjust treatment, and help with clinical decision making. For example, MBC may facilitate dose and medication changes, improve case conceptualization, identify the need to change treatment modality and goals, or report when patients need an increase or decrease in the frequency and intensity of treatment. service. MBC can also facilitate communication between patients and providers, improving the therapeutic relationship as well as shared decision making.

Patients like MBC. They accept MBC as part of the treatment process and report that it improves their care. When implemented correctly, providers also like MBC, recognizing its numerous benefits and its usefulness in treating its patients. Although vendors often express fears about the MCC’s burden, successful implementation of the MBC usually carries little or no burden for vendors; in fact, MBC is associated with positive experiences for both patients and physicians.

I have first hand knowledge of the usefulness of MBC. In 2006, I was hired by a large behavioral health organization to answer a seemingly simple question: Do our patients get better? Like many organizations, this organization relied on standard customer satisfaction surveys and other regulatory or quality metrics to assess performance; however, these approaches almost invariably focused on the care process (e.g., the number of patients with multiple antipsychotics), but not on the outcome of care. To meet their needs, I created a system that measured how patients changed in their symptoms, functional impairment, and quality of life throughout treatment.

For the first time, this organization got what it needed: data which certainly showed the patient’s progress. Once they got this data, both doctors and administrators wanted more. However, my custom results systems, which were initially based on costly and inflexible paper-based approaches, could not keep up. They wanted a quick and easy way not only to collect data without interrupting clinical flow, but also accessible and useful presentations of patient progress so they could evaluate how their current treatment methods worked both for individual patients and between programs.

They finally found their answer with Owl, a measurement-based care platform that collects and measures patient outcomes in a much faster and more efficient way than my own initial production system. Finally, doctors in this organization had tangible evidence that their patients were improving, or more importantly, alerts when they were not improving and a different course of action was needed. Doctors and administrators had seven of these data. After all, MBC helps physicians do a better job of understanding and treating their patients, ultimately improving patient outcomes, and opening up access to care. And isn’t that the ultimate goal in behavioral health?

Despite the clear benefits of MBC, routine use of MBC remains rare. The available evidence suggests that less than 20% of psychiatrists, psychologists, and master’s level providers use any significant level of MBC. Why do so few vendors use MBC?

Concerns about the practice of implementing MBC is one of the main barriers to using MBC. Practical concerns may include the time required to complete the measures, the administrative burden of administering the measures, and interruptions in the flow and processes of patients. Another hurdle is the trust of providers in clinical judgment. Even when providers recognize that MBC is likely to improve their treatments, providers may turn to their clinical judgment when the infrastructure for MBC is not available. Unfortunately, clinical judgment is not always accurate: one study found that nearly 80% of providers did not accurately notice the deterioration of their patients.

While the adoption of MCC has been slow, technological solutions are promising to accelerate the integration of MCC into routine mental health care. Many, if not all, of the perceived and actual barriers associated with MBC can be addressed through a technology infrastructure that supports fully automated MBC systems. MBC automated systems can be integrated into existing clinical workflows, including electronic health record, providing a seamless experience for both the patient and the provider.

As stated above, accelerating MBC adoption will not only improve care but will increase access to care. Because MBC is associated with a faster response to treatment (e.g., 4.5 weeks in the MBC group versus 8.1 weeks in regular care), the increase in efficiency obtained in the use of MBC allows for greater patient performance and greater access. By tracking referral rates, MBC can also help identify when patients no longer need a specific level of care, facilitating faster transitions to faster levels of care and completion, thus increasing access for new patients. to enter the system.

The available evidence is clear: MBC promises to improve mental health. However, to update the potential of MBC, providers and organizations that support them must make MBC a common expectation in the delivery of mental health treatment.

About Jason J. Washburn, Ph.D., ABPP

Jason J. Washburn, Ph.D., ABPP is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine, where he is also the Director of Master’s Postgraduate Studies and Ph.D. Clinical Psychology programs. For more than a decade, he served as director of the Center for Evidence-Based Practice at AMITA Health Alexian Brothers Behavioral Health Hospital, where he oversaw the clinical outcomes and research associated with the Center for Recovery. of Self-Injuries.

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