Measurement-Based Care in Psychiatric Practice: A Policy Framework for Implementation
ABSTRACT This article describes the need for measurement-based care (MBC) in psychiatric practice and defines a policy framework for implementation. Although measurement in psychiatric treatment is not new, it is not standard clinical practice. Thus a gap exists between research and practice outcomes. The current standards of psychiatric clinical care are reviewed and illustrated by a case example, along with MBC improvements. Measurement-based care is defined for clinical practice along with limitations and recommendations. This article provides a policy top 10 list for implementing MBC into standard practice, including establishing clear expectations and guidelines, fostering practice-based implementation capacities, altering financial incentives, helping practicing doctors adapt to MBC, developing and expanding the MBC science base, and engaging consumers and their families. Measurement-based care as the standard of care could transform psychiatric practice, move psychiatry into the mainstream of medicine, and improve the quality of care for patients with psychiatric illness.
[Show abstract] [Hide abstract]
ABSTRACT: Objective In order to inform outcomes assessments in personalized medicine research, we evaluated the level of agreement between self-reported (SR) and clinician-rated (CR) measures of depression severity before and after treatment with an antidepressant medication.Methods We pooled data from three trials (totaling 2075 patients) assessing the efficacy of antidepressant monotherapy in major depressive disorder. Differences between CR (17-item Hamilton Rating Scale for Depression [HAM-D17]) and SR (30-item Inventory of Depressive Symptomatology—Self-Rated) scale scores were used to determine concordance between CR–SR ratings. The effect of anxiety (HAM-D17 anxiety-somatization subscale score ≥7) on SR–CR agreement was also assessed.ResultsThe CR–SR scale agreement was good for response (κ = 0.64) and moderate for remission (κ = 0.57). Patients who rated their depression as less severe than the clinician were significantly more likely to respond to treatment than over-reporters (odds ratio = 1.62; 95% confidence interval: 1.17–2.25). Although anxiety did not impact the level of agreement, among patients with SR–CR discordance, high anxiety was associated with over-reporting of depression severity.Conclusion The levels of disagreement for response and remission were too high for CR and SR scales to be considered interchangeable for research on patient-level outcomes. Anxiety does not meaningfully impact SR–CR agreement. Copyright © 2014 John Wiley & Sons, Ltd.Human Psychopharmacology Clinical and Experimental 11/2014; 29(6). DOI:10.1002/hup.2428 · 1.85 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace.PEDIATRICS 03/2013; 131 Suppl 1:S38-49. DOI:10.1542/peds.2012-1427e · 5.30 Impact Factor
10/2014; 13(3). DOI:10.1002/wps.20154