Creating Mental Health Data: A Tipping Point for Measurement-Based Care
In the research study “A Tipping Point for Measurement-Based Care” published in the National Library of Medicine, researchers reviewed 51 relevant articles. The goal of this study was to understand the benefits of measurement-based care (MBC). Measurement-based care means using standardized symptom rating scales and their results to help make patient treatment decisions. This review looks at the theories and evidence supporting this approach.
The researchers found the 51 relevant articles by searching PubMed and Google Scholar. They checked the references of the articles they found. They also talked to experts in a focus group organized by the Kennedy Forum.
There are many short, structured scales for rating symptoms that work well. In most studies, patients' symptoms were regularly shared with their healthcare providers during treatment. In such studies, the outcomes improved significantly. Comparatively, ineffective treatments included...
one-time assessments,
infrequent symptom checks
sharing outcomes with providers outside of treatment sessions
Large-scale studies and clinical projects prove to be effective. They also show that MBC is relevant in broad terms. It is well-liked by both patients and providers.
The study came to a few different conclusions.
MBC benefits individual patients.
Doctors can use the data to improve the skills of healthcare providers.
This enhances the quality of healthcare clinics,
This also shows insurance providers the value of mental health services.
So how does one go about measurement-based care? How do you go about collecting the information? Chartam Mental Health Planners are a useful resource in trying to find the missing link.
Table of Contents
Primary Clinical Benefits of MBC
Doctors who Track Symptoms
There's a big difference between…
How well treatments work in scientific trials
How they work in everyday mental health care
One key reason treatments do better in scientific trials is that researchers use a system to measure how severe a person's symptoms are. When patients aren't getting better, they respond by changing the treatment.
There are short, validated scales to measure how symptoms change over time. Only a small number of psychiatrists (17.9%) and psychologists (11.1%) in the United States use these scales with their patients regularly. When healthcare providers rely only on their judgment, they only notice that symptoms are getting worse for about 21.4% of their patients. They're even worse at noticing when symptoms aren't improving as expected. This lack of detection means providers stick with an ineffective treatment plan that isn't helping the patient. Using symptom scales to track progress can help healthcare providers notice when treatment isn't working and make changes.
This is where the Chartam Mental Health Planner comes into play. By using the indicator log, doctors can keep track of a patient’s symptoms over time. They can see how the symptoms change in intensity. Clinicians become more aware of a patient’s symptoms. They can see if patients are getting worse despite the current treatment plan. This ability to visually see a patient’s circumstances allows doctors to detect changes, which in turn contributes to the quality of care a patient receives.
Not using regular outcome measurements is also not good for healthcare providers, clinics, and healthcare systems. Without a systematic way to see how well treatments are working, healthcare providers can't improve their skills over time. This might also be why routine care often doesn't lead to great results.
Clinician Reimbursement Rates
Mental health services don't get enough funding. This might be because providers can't prove their treatments work.
In the U.S., mental health problems cause 27% of all disabilities. That said, only 6.8% of healthcare spending goes to mental health treatments. Low pay for mental health services and tight restrictions is a problem. It might reflect the idea that mental health services aren't a good investment compared to other types of healthcare.
To deal with this lack of funding, clinicians can use the data from symptom rating scales to show that mental health treatments are valuable. By using Chartam Mental Health Planners, clinicians can show reimbursement sources proof that patients are improving with treatments.
Symptom Rating Scales
The DSM is a book used by doctors to classify mental health conditions. It describes simple and proven scales that measure the severity and frequency of psychiatric symptoms. These scales are tools that patients use to tell their doctors about their feelings and experiences related to their mental health.
The problem with such scales is that they are memory-based. Patients might not answer the questionnaires correctly. This is because the brain isn’t meant to communicate memories effectively.
There is a phenomenon called “transience”. Memories fade over time. Some memories stick with us while others don’t. We forget when things happen and how far back in time they happened. Transience is the concept that memories are less accessible as time goes on.
For example, how many times did you have panic attacks in the last month? Did you have more or less intrusive thoughts about death this month compared to last month? What was the intensity of your desire to self-harm and how did it change over time?
Our brains aren’t meant to answer these questions with accuracy. So measuring psychiatric symptoms can prove difficult and unreliable.
Chartam Mental Health Planners help combat this issue. Users document events as they happen. By using a Chartam Planner, patients can accurately describe the severity of their depressive symptoms. This is because they don’t have to remember all their symptoms since the last time they filled out the questionnaire. Patients produce data as time goes on. This allows them to answer symptom rating scales accurately.
These patient-reported scales have been widely used in studies. Researchers use them to show that most of the medications approved by the FDA work well. Many of these symptom scales are easy to use and understand, and provide reliable results. They are just like common medical tests, such as measuring blood pressure.
For instance, the Patient Health Questionnaire (PHQ-9) is a nine-question scale for depression. It gives a clear score that shows how severe the depression is (e.g. minimal, mild, moderate, or severe). The problem with this scale, and all other scales, is the patient’s ability to remember events. This problem contributes to the patient’s ability to analyze themselves. Chartam Mental Health Planners help solve this issue.
These short scales are effective for various mental health conditions such as...
Depression
Bipolar disorder
Anxiety
Post-traumatic stress disorder
Schizophrenia
Substance use disorders
They can also ask about specific things like appetite, sleep problems, and ability to focus.
If healthcare providers haven't tested rating scales for patients, they shouldn't make their own. Using scales that aren't dependable, can't detect changes, or don't match up with other valid tests could lead to wrong decisions about a patient's care. To put the patient's needs first, doctors should pick a short rating scale that's specific to the diagnosis or a more general scale that helps with making decisions for each patient. It's quite simple to include a set of rating scales in electronic medical record systems so that doctors and patients can easily use them.
Primary Clinical Benefits of MBC
Measurement-based care (MBC) is a way to make healthcare better. Doctors assess diseases, track them, and figure out the best treatments. It means using regular symptom rating scales. They use the results to make decisions about an individual patient's care. MBC doesn't replace a doctor's judgment but helps them evaluate how well the current treatment is working.
For the past 20 years, experts in mental health agreed that we should use MBC in everyday care. One group even says we should use self-reported symptom rating scales along with regular interviews. Many psychotherapy and medication treatments are specific to certain conditions, like therapy for post-traumatic stress disorder or mood stabilizers for bipolar disorder. Using diagnosis-specific rating scales can help adjust the treatment plan.
Right now, we don't fully understand the links between diagnosis, treatment, and results. Without clear signs of which treatment is best for each patient, the first treatment choices often don't work. So, we need to closely track how patients respond using MBC.
For MBC to work, the feedback about symptom severity must help the doctor make decisions. The scales used to measure symptom severity must be reliable and able to spot important changes. The data from these scales should be current, easy to understand, and available during the doctor's visit.
This is precisely where Chartam Mental Health Planners come into play. By using the planner, a patient is able to generate visual data, allowing their doctors to make decisions based on changes in the symptoms present. The data is current and easy to understand due to the nature of the journaling process. All a doctor has to do is either request the patient send in a picture of the data before the visit or remind the patient to bring in their planner so that the data is available during the therapy session.
Using old data doesn't help. To make it easier to understand, clinicians should use categories to analyze changes in symptom severity like...
Response
Remission
Nonresponse
Relapse
Recurrence
This helps follow treatment guidelines.
MBC also helps doctors know when a patient has gotten better and when there are still symptoms present. It encourages doctors to keep adjusting the treatment until the patient's symptoms are gone. This is also known as "treatment to target".
MBC also helps different healthcare providers work together. In team-based care, clinicians share patient data among people like the ...
Care manager
Primary care provider
Consulting psychiatrist
MBC can also improve the relationship between the patient and the provider. Patients who use rating scales regularly become more informed about their conditions and better at noticing when things change. It helps them feel more hopeful and stick to the treatment plan. It also helps patients communicate better with their doctors and reduces self-blame. Using symptom rating scales can also help patients from disadvantaged groups talk with their providers. That said, we need to make sure to use validated scales for different cultural backgrounds.
Ineffective Measurement Approaches
Not every method of structured symptom assessment and feedback leads to better outcomes. For instance, assessing patients once and evaluating symptomatic patients doesn't improve results.
Screening depressed patients didn't make their outcomes better compared to those not screened. Telling doctors about positive screening results isn't any more effective than the usual care. Giving them treatment recommendations following guidelines doesn't help either.
This is a less effective approach because the initial treatments for mental health problems often don't work well. Screening alone doesn't improve outcomes. That is unless there are systems to watch how the treatment is working.
There's also proof that for MBC to work, we need to assess the severity of symptoms frequently. For instance, one study looked at patients in an eating disorder clinic. Doctors gave these patients feedback about their symptoms during the treatment session. This occurred in session 5 out of 10. When this happened, patients didn't have better outcomes compared to those receiving usual care.
There's also evidence that we should assess symptom severity at the same time as the clinical visit. This means shortly before or during the appointment. Patients who received feedback about their symptoms every three months had the same outcomes as those who received regular care.
The researchers only collected symptom data at the beginning and after...
3 months
6 months
18 months
This was not timed with clinical visits. The problem with this is that the data was often outdated and not helpful for treatment decisions.
Based on the available evidence, we can come to a clear conclusion. MBC programs must collect data from patients shortly before or during the clinical visit.
Empirical Evidence For MBC
Randomized controlled trials show that when patients report their symptoms, it improves outcomes. It also improves outcomes when doctors review the information during a patient's visit. This proved to be consistent across different patient groups and provider types. A lot of research, particularly the work by Lambert and his team, has helped establish this.
One early study analyzed six trials with over 6,000 patients and almost 300 therapists. In this study, patients assigned to MBC had better results than the standard care group. The effect was more pronounced for patients who didn't improve at first. MBC allowed changes to their treatment plan when they weren't responding. The Substance Abuse and Mental Health Services Administration recognized this MBC model as an evidence-based practice.
Other studies have supported these findings. Couples in MBC therapy had better results than those in regular care during therapy. There is another study involving young people and adults with depression. People in the MBC groups improved more than those in standard care.
Even in smaller studies, MBC can find important differences in outcomes. In a study, patients with depression who received MBC had better treatment adjustments. They also had higher remission rates compared to those in standard care.
Two analyses that combine many studies also show that MBC has benefits. They found that MBC had a positive effect on outcomes compared to standard care. The size of this effect varied depending on the type of symptom rating scale used. It also changed based on the frequency of feedback provided. Giving feedback to the patient, care coordinator, or provider also played a role.
Research shows again and again that using MBC improves patient outcomes. This approach is valuable across various healthcare settings. It is also valuable for different types of patients.
Secondary Benefits of MBC
MBC can benefit patients, healthcare providers, practices, insurance companies, and mental health services.
MBC relies on providers using patient-reported symptom severity scores to make treatment decisions. Clinicians should encourage patients to give accurate information on rating scale questions. This ensures precise data on symptom severity across providers, practices, and healthcare systems. When these data show that providers or practices are not performing well compared to benchmarks, organizations should encourage doctors to use MBC tools.
Doctors can also use this data to improve their skills and adjust their practice. They can see how well different treatments work and make changes.
Moreover, if all clinicians in a practice use the same rating scales, the data can support quality improvement efforts. For example, it can help determine whether the use of a new clinical program is actually improving outcomes. This is also known as "practice-based evidence."
Data can show competence to accreditation organizations and value to payers. Purchasers and payers can use the combined results to improve benefits and reimbursement. So, MBC offers the potential for extra benefits beyond improving individual patient outcomes.
There is one major reason providers and practices should start using MBC. Payers and accreditation organizations are requesting outcome information more and more. They expect healthcare systems to create their own MBC programs. Providers can improve clinical decisions by developing their own MBC programs. This is instead of having outcomes-monitoring systems imposed on them.
Organizations should choose symptom rating scales that are scientifically validated. This would help them meet the requirements of purchasers and payers and to achieve the best patient outcomes.
By using MBC early, doctors can improve professionally and in quality. This can happen before purchasers and payers need aggregated patient-reported outcomes.
The National Committee for Quality Assurance made depression symptom monitoring and response rates health plan performance measures in 2015. The following organizations introduced value-based payment systems in 2015:
The Centers for Medicare and Medicaid Services,
Anthem Blue Cross Blue Shield
UnitedHealthcare
These programs encourage the use of MBC.
As these programs become more common, it's important to use methods to adjust for risk and strategies to compare outcomes. This helps us understand differences across providers, practices, and healthcare systems. The differences in results are due to access and quality, not social factors.
Conclusion
For various reasons, MBC is now gaining momentum in the field of mental health. Now, there are many simple symptom rating scales that are being tested with different patients.
New tools and resources, like the Chartam Mental Health Planner, make it more efficient to collect data from patients. It also makes it easier to share it with healthcare providers during their visits.
Research shows that patients who get MBC, whether through medicine or therapy, do better than those in regular care. Patients and providers in real-world trials and clinical projects both find MBC acceptable. More and more organizations are agreeing to use MBC in measuring performance and making payments.
Healthcare providers need MBC to understand if patients are not improving, which can lead to ineffective treatments. Patients from low-income and minority groups have a big worry because of their ongoing health differences. The mental health field should adopt MBC and medical testing principles, like other specialties.
The cost of regularly using symptom severity scales is minimal. The Chartam Mental Health Planner is affordable for both patients and providers. The benefits of MBC extend to all involved parties, including patients, providers, purchasers, and payers.
Patients feel validated and less self-blame when they complete these scales and talk to providers. Patients gain power when they understand their condition and how it changes over time. This helps them be more involved in their treatment decisions. These scales are important because they help patients communicate if treatments aren't working. This allows changes to their treatment plan.
MBC helps patients. It also benefits professionals by using data for development and improving practice quality. It also shows the value of mental health services and affects reimbursement policies.
By using Chartam Mental Health Planners and MBC metrics, we can prove that mental health treatment works. This can benefit both clinicians and patients.
