Presented by Caitlin Shepherd, PhD
Within Health is committed to using data to inform treatment and clinical outcomes. Therefore, they have initiated a measurement-based care initiative to ensure they are keeping up to date with the best practices in the field.
This article will look at measurement-based care (MBC) in more detail and how it can be implemented in a treatment setting.
A common misconception about measurement-based care (MBC) is that it is a “cookbook medicine” approach that reduces patients to “just a number.”
Contrary to the common misconception, MBC promotes a data-driven and patient-centered approach to healthcare. MBC is defined as the use of systematic and routine patient-reported outcome measures throughout care as a core element of evidence-based practice.1
The primary purpose of the data collected in an MBC model is to track patient progress to inform treatment decisions and engage patients in their own care. However, the data can also be aggregated and used for quality improvement and program evaluation efforts.
Evidence-based practice (EBP) is the integration of three key components:2
The three components of EBP are considered essential for providing optimal care for eating disorders and other mental health disorders.3 Ongoing monitoring of patient progress, adjustment of treatment, and consideration of individual differences are all crucial parts of EBP that are facilitated by MBC.
There are several frameworks of the MBC model. Here at Within Health, we have adopted the three-part “Collect, Share, Act” model of MBC, developed by the Veteran’s Health Administration, the MBC and Mental Health Initiative, and the Yale Measurement Based Care Collaborative. The MBC approach fosters a collaborative relationship between the clinical team and the client.
Clients are more likely to engage and follow through on a treatment plan they help create. The “Collect” phase of MBC involves:4
While the process may differ by program, the primary goal of the “Collect” phase is to engage clients in collaboration within the MBC model, with a focus on transparency. To achieve this, a clinician will:4
Once data is collected, there needs to be a clear process for sharing this information with clients so they can see how the data is being used to benefit them. The “Share” phase of MBC involves:4
Client-clinician collaboration results in clients being more satisfied with treatment and with their care team, as well as supports a shared language between client and clinician, enhancing communication.
After reviewing and discussing the data, the final phase is to “act” on the information gathered via a collaboration between clinician and client. This shows that MBC isn’t the collection of data for data’s sake; it’s data used to optimize collaboration and tailor treatment to meet an individual client’s goals. The “Act” phase of MBC involves:4
Research shows that MBC is associated with several benefits. When it comes to the clients, the benefits of MBC include:5,6
There are benefits to providers and organizations that go beyond more satisfied and empowered clients, including:5,6
Despite the research showing the benefits of MBC to clients and practitioners, it is underused, with less than 20% of behavioral health practitioners using it in their practice.7 This underuse could be due to client, practitioner, and organizational barriers.7
Some things can be done to address the barriers above. The literature suggests that challenges to MBC implementation can be overcome by:7
Another challenge for practitioners in implementing MBC is deciding on what measures to use when there is an overwhelming variety of options. The recommended measures for eating disorders fall into three categories:
Below are some of the measures that could be useful in an MBC model for eating disorders, but there are other measures available:
Depending on the client population, more focused measures could be used, such as the Nine-Item ARFID Screen or the Binge Eating Scale, to address more specific eating disorder symptoms.
Functional and QOI measures assess the impact of eating disorders across different domains, such as relationships, school/work, etc., and include:
Other measures of functionality may be more suitable for certain populations or therapeutic approaches, e.g., measures more targeted toward assessing emotional regulation difficulties.
The measures for co-occurring symptoms assess comorbid psychiatric conditions and symptoms, with mood disorders, depression, and anxiety given the highest priority. Measures include:
Additional measures include those that assess trauma, obsessive compulsive disorder (OCD), and substance use, to name a few.
It’s important to recognize the limitations of measures, particularly where marginalized populations are concerned.
Measurement tools are biased as they are based on specific samples (typically white, female, and cis-gendered) used in the development, standardization, and validation process. Therefore, incorporating MBC into broader EBP models means using clinical judgment and available client information when interpreting data.
Some research has been conducted to determine the appropriateness of using patient-reported outcome measures with different populations and establish group-specific cutoffs, norms, and levels. Depending on the client, group-specific measures and values may be more useful than general ones.
For more information on how to learn more about MBC implementation, The Yale Measurement Based Care Collaborative and Cohens Veterans Network are great sources of information.