June 12, 2024

How to Get Started with Measurement-Based Care

Written by

Carlene MacMillan, M.D.

The World Health Organization projects that depression will have the largest global disease burden by 2030, underscoring the need for evidence-based practices to address this growing crisis.

To meet rising rates of mental health issues, we encourage clinicians to use measurement-based care (MBC), which mental health leaders have been recommending for several decades.

What is Measurement-Based Care?

MBC refers to the systematic evaluation of patient progress throughout treatment, including the use of validated symptom rating scales to drive personalized clinical decision-making. A large body of evidence has shown that MBC improves clinical outcomes, therapeutic efficiency, and patient adherence.

In this comprehensive guide to measurement-based care, we'll cover:

  • Barriers and benefits of MBC for mental health clinicians and patients
  • The 4 essential psychiatric scales to get started with MBC
  • The importance of MBC, especially with newer treatments
  • How to easily implement MBC in your practice using Osmind

Why do less than 20% of Clinicians Use MBC?

Despite MBC's proven benefits, recent studies suggest only around 20% of psychiatrists and 11% of therapists implement it in their practice, citing obstacles such as extra time without additional reimbursement and technological barriers to implementation.

You may feel overwhelmed by the idea of implementing MBC in your practice. With the challenges of running a private practice and demands of clinical work, the thought of adding more charting and paperwork can feel daunting. You might not know where to start or how to make MBC feasible without adding to your workload.

But here's the good news: this guide is your MBC starter kit, designed to help you get the most out of MBC without adding to your workload.

By focusing on the essential scales and best practices, you can reap the benefits of MBC while minimizing the burden on your time and energy and not overwhelming patients with a barrage of rating scales. And with Osmind's psychiatry-tailored EHR, you can put MBC on autopilot, streamlining data collection, analysis, and visualization so you can focus on what matters most: providing exceptional care to your patients.

Let’s dive in.

The MBC Starter Kit: Essential Psychiatric Scales

To help you get started with MBC, here are four essential scales to consider sending to all your adult patients:

1. PHQ-9 for Depression Screening and Monitoring

The Patient Health Questionnaire-9 (PHQ-9) is widely regarded as the standard for screening for depression and assessing the severity of depressive symptoms in clinical practice. Its strong psychometric properties, alignment with DSM-5 criteria, brevity, and wide adoption make it an essential tool for any MBC protocol. Many insurance companies will expect to see the PHQ-9 if you provide interventions such as Transcranial Magnetic Simulation (TMS) or esketamine. This scale can be sent initially and then every 2 weeks if clinically appropriate.

2. GAD-7 for Anxiety Screening and Monitoring

The Generalized Anxiety Disorder-7 (GAD-7) is the go-to measure for screening for and evaluating anxiety symptoms. Like the PHQ-9, it is brief, valid, reliable, and widely used, allowing for easy benchmarking and progress tracking. This scale can be sent initially and then every 2 weeks if clinically appropriate.

3. DSM-5-TR Level 1 Cross-Cutting Measure (DSM-XC) for Comprehensive Symptom Review

Developed by the American Psychiatric Association and integrated into Osmind's EHR, the DSM-XC provides a comprehensive overview of a patient's mental health symptoms across 13 domains. By casting a wide net, the DSM-XC can help identify comorbidities, guide further assessment, and provide a more holistic picture of a patient's well-being.

4. World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) evaluates functional impairment across six domains: cognition, mobility, self-care, getting along, life activities, and participation. In the DSM-5, the WHODAS 2.0 has replaced the Global Assessment of Functioning (GAF) scale from the DSM-IV, offering a more nuanced and reliable assessment, endorsed by the APA.

See also: Top Mental Health Rating Scales to Make Measurement-Based Care Easy

Understanding Measurement-Based Care (MBC)

Measurement-Based Care (MBC) is a patient-centered, data-driven approach to mental health treatment that involves the routine collection of standardized symptom ratings and other clinically relevant information. MBC helps you:

  • Guide treatment planning
  • Monitor progress
  • Adjust interventions as needed

By quantifying the patient's experience and response to treatment, MBC let’s you deliver more precise, personalized, and effective care. The use of validated measures don’t replace clinical judgment, but augments it.

The Importance of MBC

MBC is crucial because it allows clinicians to detect if a patient is not responding well to treatment. Without MBC, clinicians detect clinical deterioration for only about 20% of patients who have experienced an increase in symptom severity, resulting in poor outcomes.

Benefits of Measurement-Based Care

Research has consistently demonstrated the numerous benefits of MBC for both patients and clinicians:

  1. Improved patient outcomes: MBC leads to significant reductions in symptom severity, faster improvement, and higher rates of remission compared to usual care.
  2. Enhanced therapeutic efficiency: MBC can help you respond more quickly and effectively to patient needs, leading to faster symptomatic improvement and more targeted interventions.
  3. Increased patient engagement: By involving patients in tracking their own progress, MBC fosters a sense of control and empowerment, leading to better treatment adherence and reduced no-show appointments.
  4. Early detection of deterioration: MBC helps you identify patients who are not responding to treatment or are at risk of worsening symptoms, allowing for timely course correction and prevention of negative outcomes.
  5. Objective data for collaboration: MBC provides a shared language and evidence base for coordinating care across multiple clinicians and settings.

Measurement-Based Care for Psychedelic Medicine

As psychedelic therapies gain traction for treating conditions like depression, PTSD, and substance use disorders, MBC will play a crucial role in maximizing their potential. By tracking long-term treatment effects, monitoring patients between sessions, and generating real-world evidence, MBC can help answer post-marketing research questions and give objective information to patients and clinicians about how these treatments are working.

Osmind is at the forefront, providing an intuitive platform for collecting and analyzing outcomes data in psychedelic medicine.

Automating Measurement-Based Care with Osmind

Osmind is built for forward-thinking clinicians who want to harness the power of data to optimize patient care. Our all-in-one platform includes:

  • 40+ validated scales
  • Visualized progress dashboards
  • A patient app for easy remote monitoring and journaling
  • Scheduling, insurance billing, payments, telepractice tools, eRX, Labs, and a forward-thinking community with private virtual events and curated forums.

By automating data collection, scoring, and interpretation, Osmind makes MBC seamless and hassle-free, letting you focus on what matters most: delivering personalized, evidence-based care.

Learn more about how Osmind’s all-in-one psychiatry EHR modernizes your practice.

Conclusion

Measurement-based care represents a paradigm shift in psychiatric practice, one that has the potential to transform the way we diagnose, treat, and monitor mental illness. By leveraging standardized assessments and data-driven insights, MBC helps you deliver more targeted, efficient, and effective care to your patients.

As the field continues to evolve, with exciting developments like biomarkers and digital phenotyping on the horizon, MBC will only become more powerful and indispensable. By getting started with the essential scales and best practices outlined in this guide, and partnering with platforms like Osmind, you’ll position yourself at the forefront of psychiatry’s tomorrow.

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