Improving measurement feedback systems for measurement-based care.

AbstractObjectives: Measurement feedback systems (MFS) are a class of health information technologies developed to facilitate measurement-based care. The individual clinical decision support features within MFS are diverse and their influence on clinicians is largely unknown. This study tested the impact of MFS features on clinicians' progress assessments and treatment decisions in different scenarios. Method: Clinicians (n = 299) were randomly assigned to view one of six combinations of the following MFS features: graph, expected change trajectory line, alert, and treatment suggestions. The assigned feature combination was paired with three vignettes and clinical data representing three clinical scenarios: patient deterioration, no progress, and approaching remission. Clinicians answered questions after each vignette, and at the conclusion. Results: MFS features differentially impacted clinicians' progress assessment accuracy, their likelihood of making a treatment change, and their treatment choices. Which feature was most impactful varied depending on the clinical scenario. Clinicians reported graphs influenced their assessments and choices significantly more than the other features, and the majority stated they would prefer to use all of the features. Conclusions: Specific MFS features impact clinicians' assessments and choices to greater degrees, and the impact of those features can be influenced by the clinical state of the patient.

Leveraging Health Information Technology to Meet The Joint Commission's Standard for Measurement-Based Care: A Case Study.

INTRODUCTION: Three decades of research have shown that routinely collecting patient-reported outcomes throughout treatment to inform clinical decision making or measurement-based care (MBC) can improve clinical outcomes, yet widespread adoption continues to be elusive. APPROACH: This article describes how a community behavioral health center addressed Element of Performance (EP) 1 of The Joint Commission's revised MBC standard using health information technology (HIT)-facilitated MBC and a comprehensive implementation plan grounded in the Consolidated Framework for Implementation Research. RESULTS: Across the initial 15-month implementation period, 96.8% of patients who had an intake evaluation also completed baseline measurements via an HIT known as a measurement feedback system (MFS), and 91.5% (78.6%-100%) completed at least one repeated measure. CONCLUSION: MFS reduces many of the logistical barriers of MBC, but implementation of MFS-facilitated MBC requires a comprehensive implementation plan that includes strategies to address barriers across all relevant domains for successful uptake.

Evaluation of the Brief Adjustment Scale-6 (BASE-6): A measure of general psychological adjustment for measurement-based care.

The current study evaluated the Brief Adjustment Scale-6 (BASE-6), a measure of general psychological adjustment. The psychometric properties of the BASE-6 are documented using 3 adult samples, including online participants (Sample 1: n = 459), college students (Sample 2: n = 244), and a clinical sample (Sample 3: n = 296). Acceptability ratings comparing the BASE-6 to the Outcome Questionnaire-45.2 (OQ-45.2; Lambert et al., 1996) are provided. Factor analyses showed the items were well represented by a single factor, indicating a unidimensional factor structure. The BASE-6 demonstrated good internal consistency (α = .87-.93) and there was good test-retest reliability (intraclass correlation = .77) across 1 week. In Samples 1 and 2, there was moderate to high convergent validity with the OQ-45.2 total score (r = .66-.81, p < .001), and Symptom Distress (r = .66-.80, p < .001), Interpersonal (r = .54-.68, p < .001), and Social Role (r = .57-.69, p < .001) subscales. In Sample 3, there was high convergent validity with the Patient Health Questionnaire-9 (r = .80, p < .001) and the Generalized Anxiety Disorder-7 (r = .76, p < .001). BASE-6 item and total scores were generally higher in the clinical sample compared with the nonclinical samples. Participants perceived the BASE-6 as easier to use, and more acceptable on a weekly basis compared with the OQ-45.2. Results provide preliminary evidence that the BASE-6 has acceptable psychometric properties and may show promise in the context of measurement-based care. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Internet-Based Approaches to Collaborative Therapeutic Assessment: New Opportunities for Professional Psychologists.

Collaborative (or therapeutic) assessment is an empirically supported procedure that involves the client as an active participant in the assessment process. Clients discuss data they provide with the assessor in a collaborative manner designed to provide insights and assist in setting mutually agreeable treatment goals. Internet-based procedures allow for ongoing (including daily) tracking of psychological variables and provision of immediate graphic feedback to therapists, clients, and clinical supervisors. As an example, we describe one such system: Evidence-Based Assessment System for Clinicians (EAS-C) that contains more than 30 brief and empirically validated assessment instruments that can be completed via the internet or smartphone. We also provide examples from a stress management intervention demonstrating how single-client data from a web-based daily stress and coping diary tied to the EAS-C were utilized to provide clients with individualized feedback, assess progress, identify idiographic patterns of cognitions, affect, and coping strategies, and test clinical hypotheses. Internet- and computer-based technological advances can improve service delivery and help bridge the gap that currently exists between science and practice.