What is Measurement-Based Care (MBC)?
Measurement-based care (MBC) is the practice of clinical care that uses ongoing data collection of patient-reported measures to monitor treatment progress and inform clinical and organizational decision-making.
MBC is an evidence-based practice that supports improved patient outcomes in a variety of settings, especially behavioral health. In the context of behavioral health, MBC has proven beneficial in routinely tracking patient outcomes, informing clinical decisions based on patient-centered feedback data, and improving care outcomes.
The Four Key Ingredients of Measurement-Based Care
Measurement-based care in behavioral health is an iterative process that follows four key steps.
Step 1. Patient Engages
The practice of measurement-based care creates a patient-driven positive feedback loop. The process starts with patients completing assessments, also called measures, before, during, or after their appointment with a therapist.
Completing measures provides patients with an opportunity to communicate their experiences and ideas with their clinician and increase engagement with their own treatment.
Measures are questionnaires designed to gauge a patient’s behavioral health status through a series of questions. Many behavioral health measures are standardized, meaning that there are established norms or benchmarks which compare an individual’s test results to others who have taken the same assessment, and provide a basis for interpreting the test results in a meaningful way. Some of the most common standardized measures are the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7), which screen for depression and anxiety, respectively. However, hundreds of other measures exist across the spectrum of behavioral health conditions.
With Mirah, the patient completes measures electronically through a mobile device, computer, or tablet. The assessments allow the patient to raise important issues that they may feel uncomfortable expressing aloud or issues they may not have thought to bring up.
Step 2. Provider Receives Signal
After a patient completes a measure, the responses are collected and reported to their provider. The provider reviews the results prior to or during the patient’s appointment, analyzing the data and identifying any trends or concerns that need action. Providers also use assessment results to monitor response to treatment, identify patient strengths, and highlight patient progress.
If an organization is using Mirah as their measurement tool, the assessment results are aggregated into a clinical feedback report that visualizes the results as well as any applicable benchmarks or norms. Clinicians and organizations can view the assessment results in a variety of easily understandable graphs that provide quick and actionable feedback.
Step 3. Provider Takes Action
In the next step, providers use the data collected from measures to share patient feedback in session and take action. To effectively conduct MBC, providers should utilize MBC results to inform treatment decisions using insights from the data to guide treatment planning on an ongoing basis.
When clinicians share assessment results with the patient in session, the patient is able to collaboratively engage in their own treatment plan. Clinicians are therefore able to meet the patient where they are at, and individualize the plan to their specific needs. MBC augments, but does not replace, clinical decision-making by providing valuable assessment data that can be utilized in combination with all other sources of information.
When patients outcomes are monitored over time, providers can measure the effectiveness of treatment methods and adjust accordingly, thereby enhancing clinical responsiveness to the individual patient. Because the MBC cycle creates a patient-driven feedback loop, the process is self-correcting, and clinicians and patients can quickly identify and respond when treatment is not leading to the desired outcomes.
Note that assessment results can occasionally be biased depending on how the measure was developed, who it was developed by, and which population it was intended to be used with. The provider should have an understanding of the assessment’s origin, validity, and potential biases and utilize clinical judgment when reviewing and responding to assessment results.
Step 4. Treatment Engagement
The last step in the measurement-based care process is for the patient to re-engage. After the provider reviews and discusses the feedback with the patient in session, patients often recognize that their input and perspectives are valued by the clinician and are important to the process of treatment. This frequently leads patients to become more engaged in the treatment process. Patients may be more motivated to engage in completing measures when they understand how these measures are being used and how this process will help them experience improvement over time.
This starts the process over again, and so a positive feedback loop is established. MBC can also support clinician engagement, as therapists and providers are able to concretely see the meaningful impact of their work with patients.
Benefits of Measurement-Based Care in Behavioral Health
While measurement-based care can be integrated into any type of clinical care, it is especially impactful in behavioral health. From the patient to the organizational level, measurement-based care in behavioral health creates a continuous improvement cycle that can promote improved outcomes for patients across the board.
Here are just a few of the benefits of incorporating MBC into behavioral health organizations.
Improves Patient Outcomes
Measurement-based care helps patients take a more active role in their care. By completing measures before and between appointments, patients are encouraged to reflect on their experiences regularly, thus increasing patient engagement within their own treatment. Patients not only receive personalized treatment, they also feel better understood by their providers, are empowered to make important decisions about their own care, and can view their progress in real time.
The successful implementation of measurement-based care can reduce the risk of treatment failure. Patients, especially adolescent patients, have been known to experience quicker symptom improvement when the provider has been receiving feedback regarding treatment progress when compared to providers who do not receive treatment progress.
Research also shows that MBC helps patients better understand their experience and can lead to faster improvements in symptoms.
Informs Treatment Decisions
Mental health treatment typically lacks consistent data collection to track progress and determine the effectiveness of treatments. MBC provides a much-needed solution to this problem by using patient-reported data via measures to inform treatment direction and enhance clinical decision-making.
Standardized measures provide an objective assessment of treatment progress that can be used to identify patient needs, areas of concern, and response to treatment over time.
Monitors Overall Organizational Performance
Measurement-based care also improves organizational performance by providing data that can be used to monitor progress and guide quality improvement initiatives at the program and organizational levels.
When measurement-based care is standard practice, organizational leadership can evaluate performance across the entire organization. Quality improvement efforts supported by MBC data ensure that patient voice and perspectives are centered in the decision-making process. Further, organizations can utilize MBC data to objectively measure the impact of their quality improvement initiatives. This data collected can also be used to inform funding decisions, resource allocation, and program development.
Supports Collaborative Care Model
In addition to the patient-provider relationship, measurement-based care also supports the collaborative care model. In this type of care, providers within an organization can work as a team to provide comprehensive treatment.
MBC facilitates collaborative care by providing a common language for providers to discuss treatment progress with other providers, such as primary care physicians. This ensures that a patient's full care team is on the same page and can make informed decisions about their care.
Implementing Measurement-Based Care
Despite the evidence supporting the efficacy of measurement-based care, many providers have been slow to adopt this approach in their practices; less than 20% of behavioral health practitioners use any type of measurement-based care.
There are several reasons for this, including administrative burden and lack of training.
We are here to change that. Mirah provides an all-in-one solution for measurement-based care, equipping providers with the tools and training necessary to effectively measure patient progress, personalize treatment planning, and improve clinical outcomes.
Successfully Implement Measurement-Based Care with the Right Tools
Successfully implementing MBC requires addressing barriers at every level of an organization, from the front desk to the executive team. This is precisely what Mirah was built to do—facilitate lasting change across an entire organization.
The Mirah platform makes it easy for organizations of any size to get started with measurement-based care. Mirah seamlessly integrates with your EHR, so clinicians can easily adapt MBC into their clinical workflow. For organizations implementing measurement-based care for the first time, our Clinical Team provides training and support to ensure a successful transition.
If you’re interested in learning more about measurement based-care or would like to request a demo, contact us here.
