28 Sep Using Measurement-Based Care to Improve Clinical Outcomes

In the behavioral healthcare field, a divide exists between research outcomes and clinical outcomes. A significant factor in this disparity is data-driven treatment. Measures such as symptom rating scales are core components of research trials, but they are less common in clinical settings. Only about 18% of psychiatrists and 11% of psychologists use rating scales in routine practice. Despite infrequent use, measurement-based care is a powerful tool for improving clinical outcomes. 

What is Measurement-based Care?

Measurement-based care is defined as the practice of basing clinical care on client data collected throughout treatment. Clinicians use a step-by-step approach for assessing, treating, and reviewing outcomes, then altering their approach when patients are not responding to treatment. This process of using systematic feedback systems is also called progress monitoring or outcome monitoring.

Numerical frameworks can support any treatment plan and are essential to many evidence-based practices. Routine data collection provides insight into client progress and helps keep the focus on current targets. Measurement-based care can also reduce symptom deterioration and improve client outcomes.

Symptom Rating Scales

Clinicians can employ quantitative measures to get a precise picture of an individual client’s needs. Symptom rating scales streamline the assessment process and help in making differential diagnoses. Both therapist and client can participate in using rating scales. Psychiatric research often uses clinician-rated scales, which aren’t always practical in clinical settings. Patient-rated scales are less time-consuming and provide essential insights into the patient’s experience.

There are many different symptom rating scales for various behavioral health conditions. You can determine the quality of each rating scale based on several attributes.

• Objectivity—The results the same regardless of who administers or interprets them.
• Reliability—The assessment conveys consistently reproducible data across time and clients.
• Validity—The scale measures what it is supposed to measure. For example, the results detect the presence of depressive symptoms and distinguish them from other mental illnesses. 
• Practicability—Administering the assessment is feasible to administer, considering time, staff, and material restraints. 
• Norm-reference—The values are compared to those of similar clinical groups.

Effective Approaches

The crux of measurement-based care is meeting the individual needs of a client. Effective progress monitoring involves client-centered, whole-persons approaches that use up-to-date information to improve outcomes. 

• Routine Monitoring—Best practices for measurement-based care include routine progress monitoring. Screening alone does nothing to improve outcomes. Instead, clinicians need to have systems in place to monitor responses throughout treatment. 
• Person-centered—Self-reported symptom rating scales support a person-centered approach to treatment, and clients are the best informants regarding their mental well-being. As an added benefit, self-rating can deepen a client’s awareness of their mental health. 
• Whole-person—People are complicated and often a single rating scale does not give the entire picture of a client. In addition to monitoring symptoms, you can also evaluate other variables such as life satisfaction and functioning. Gathering information across various domains supports a whole-person approach to behavioral healthcare. 
• Timely Feedback— Symptoms and severity fluctuate over time. To properly implement Measurement-based care, therapists need up-to-date symptom data. Research indicates that asynchronous feedback is ineffective. In one study, patients who filled out symptom scales via mail every three months did not improve. It is better to have clients complete rating scales during (or right before) sessions. 

Collaboration and Value-based Care

In the current healthcare environment, there is an increasing demand for accurate assessments and outcome measures. Payers are putting increased scrutiny into objectively monitoring behavioral healthcare. With the advent of value-based care, Medicare and Medicare increasingly require objective documentation of improvement. Measurement-based care provides empirical evidence of clinical outcomes. 

Moreover, screening and monitoring over time support an integrated care model. Tracking outcomes based on rating scales offers an objective look into the client’s mental health. Quantitative measures are easily accessible for collaborating providers when viewing the client’s chart. Numerical measurements augment narrative documentation and give a clearer picture for the entire care team. 

Measurement-based Care and Technology 

Health information technology streamlines measurement-based care, making it easier to collect, chart, and share data. Electronic Health Records (EHRs) specifically designed for behavioral healthcare provide the tools needed to chart symptom rating scales. 

Using a single, robust system saves time and effort. Flexible EHRs let you track quantitative measures into a range of treatment programs. The information is integrated into dashboards, alerting clinicians to unusual events and correlations. Web-based services even make it possible for clients to chart their own data in the system. Plus, client progress monitoring reports are readily available to support value-based reimbursements.

Overall, health information technology makes it more feasible for clinics to implement measurement-based care practices. Regular rating scales, charted over time, provide insight into what works and what doesn’t for each client. This way, therapists can use data to make informed clinical decisions and provide the best possible care for their clients.