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Published Online: 23 October 2024

Using Technology to Support Measurement-Based Care: Design and Implementation of the Measurement-Assisted Care Program

Dana Steidtmann, Ph.D. [email protected], Katie E. Raffel, M.D., Joel Green, M.S.W., Edward MacPhee, M.D., Sarah Nagle-Yang, M.D., Sarah Schwenk, N.P., Danielle Cooke, Ph.D., Alejandra C. Santisteban, M.P.H., and Allison G. Dempsey, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Preprint
https://doi.org/10.1176/appi.ps.20240135
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Abstract

Objective:

The authors aimed to increase measurement-based care in an outpatient academic psychiatry service.

Methods:

The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire–9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians’ electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3–6 months after the start of the program.

Results:

After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care.

Conclusions:

MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Preprint

History

Received: 19 March 2024
Revision received: 31 May 2024
Accepted: 11 July 2024
Published online: 23 October 2024

Keywords

  1. measurement-based care
  2. outpatient treatment
  3. quality improvement
  4. evidence-based practice
  5. patient-reported outcome measures

Authors

Details

Dana Steidtmann, Ph.D. [email protected]
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Katie E. Raffel, M.D.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Joel Green, M.S.W.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Edward MacPhee, M.D.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Sarah Nagle-Yang, M.D.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Sarah Schwenk, N.P.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Danielle Cooke, Ph.D.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Alejandra C. Santisteban, M.P.H.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Allison G. Dempsey, Ph.D.
Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Green, MacPhee, Nagle-Yang, Schwenk, Cooke, Santisteban, Dempsey); Brain and Behavior Innovation Center, University of Colorado Anschutz Medical Campus, Aurora (Steidtmann, Cooke, Santisteban, Dempsey); Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora (Raffel); Institute for Healthcare Quality, Safety and Efficiency, University of Colorado School of Medicine, Aurora (Raffel).
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Notes

Send correspondence to Dr. Steidtmann ([email protected]).

Competing Interests

Dr. Raffel has received payments for her contributions to articles published through UpToDate. Dr. Nagle-Yang has received honoraria for continuing medical education presentations through Physicians’ Education Resource, the Annenberg Center for Health Sciences, and Postpartum Support International. Ms. Schwenk receives consulting fees from the Fairbanks Native Association. Dr. Dempsey has a contract to conduct a pilot implementation of Babyscripts, a digital-based platform for postpartum mental health education and symptom monitoring. She has received grant funding from Health Rhythms and has received speaker honoraria from the National Perinatal Association, Cornell School of Medicine, and Dell Medical School at the University of Texas at Austin. The other authors report no financial relationships with commercial interests.

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