Measurement-based care (MBC) is a dynamic clinical practice in which care decisions are based on patient data collected routinely throughout treatment. While MBC can be a component of almost any treatment process, it’s become especially useful in behavioral health, providing a continuous feedback loop on patient progress.
The MBC practice usually begins by collecting patient-reported symptoms using validated measurement tools such as:
- Personal Health Questionnaire 9 (PHQ-9)
- General Anxiety Disorders 7 (GAD-7)
- Columbia Suicide Severity Rating Scale (C-SSRS)
- Primary Care Screen For Post-Traumatic Stress Disorder (PTSD-5)
The measures are collected with relatively short questionnaires that are easy for patients to answer. In terms of timing, patients ideally would complete the assessment at intake, before a scheduled appointment, or as needed between appointments.
Next, the clinician reviews the most recent scores as well as the longitudinal view of the patient’s progress overall. With that information in hand, the clinician can open up a discussion with the patient about treatment progress.
Ongoing monitoring of the numeric scores helps directly inform care decisions, essentially answering the question, “What shall we work on now?” Here, MBC becomes part of shared decision-making, enhancing not only communication between patient and provider but also patient outcomes.
As a framework to guide treatment, MBC lends itself to a collaborative care experience. For the patient, that might mean enjoying a therapeutic alliance with a therapist or counselor. For a provider, that might mean sharing the patient profile data and collaborating with other providers, such as primary care physicians or pediatricians, to improve comprehensive care.
Measurement-based care adds insight
MBC can objectively and methodically track patient-reported symptoms across the continuum and provide insight to the full complement of care teams. Without this ongoing monitoring of symptoms, providers might otherwise miss opportunities to improve treatment for individual patients and at the population level.
Utilizing the aggregated MBC data as a predictive tool, providers can improve treatment interventions, inform service refinements, and address clinician training needs. The combined data might reveal patterns that suggest, just for a few examples:
- Adjustments in length of stay for inpatient or residential treatment
- Which patients are most likely to discontinue treatment too soon
- Who might need medication management
- The effectiveness of patient matching
Measurement-based care overcomes subjectivity
Certainly one of the best advantages of MBC is the fact that it helps turn subjective patient experiences and clinician observations into more objective data. And objective assessments are important to validate — or dispute — clinical decision making.
Not all health indicators can be captured with quantified data of course. But in behavioral health treatment where so much of the patient’s input comes from experiences — rather than lab tests, as is the case with medical treatment — MBC creates a standard frame of reference.
In other words, MBC individualizes each patient’s subjective experience in terms of how they’re doing and conveys that through a number or a set of numbers. Those numbers can then be compared to chart progress visit-to-visit and between visits, enhancing clinical management.
For example, research shows that when male and female patients have the same amount of physical pain, women’s pain is often viewed by observers as less intense compared to men’s. To overcome the observer’s bias and the subjectivity of the patient’s experience of pain, a standard measure, such as the 10-point pain scale, can serve as the reference point that can be tracked over time for each patient individually.
Measurement-based care is especially important in behavioral health
There are no lab tests that will capture a person’s mental health status, but providers do have sound measurement tools (GAD, PHQ, CSSRS, etc.) that can record symptoms and alert them to red flags, such as potential for patient self-harm or harm to others. With regular use of these tools, care can be adjusted to meet the individual’s varying needs throughout their treatment journey.
And treatment must be personalized and frequently reassessed — especially in behavioral health. Why? Because treatment for mental health or substance use disorders typically doesn’t progress in a linear fashion. Frequent, methodical check-ins are needed.
MBC has been gaining traction in mental health treatment, and a growing collection of studies note how MBC creates a positive effect on care. Research shows that MBC in behavioral health results in better patient outcomes when compared to usual care. The feedback process can also trigger treatment change in 40 percent of patient encounters. One study also demonstrated that MBC can work well for patients who experience obstacles in their treatment progress.
Even though MBC works well, behavioral health treatment providers don’t use it often enough. According to the Kennedy Forum, only 18 percent of psychiatrists and 11 percent of psychologists routinely administer symptom rating scales to patients to monitor improvement.
Technologies that allow providers to collect, analyze, and then act on patient data throughout treatment have enhanced care delivery for decades. MBC systems that rely on both provider- and patient-facing technologies can make the practice more efficient and effective, in terms of both time and cost.
New efforts are underway to advance MBC in behavioral health. In fact, Tridiuum has partnered with Vertava Health, a leading national treatment provider for mental health and substance use disorders, to refine the use of MBC for addiction treatment. Tridiuum’s technology enables Vertava Health to track and measure the patient recovery process, ensuring patients get the right treatment at the right time, with the appropriate level of care. Through this partnership, Vertava Health patients saw 60 percent improvement in their symptoms by their third assessment.
Together, Vertava and Tridiuum will help improve outcomes and lead patients toward a life in recovery. Read the latest whitepaper to learn more about MBC in addiction treatment.