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Psychotherapy research needed to integrate measurement-based care into behavioral health

In a narrative review published in JAMA Psychiatry, researchers recommended a 10-point research agenda to improve the integration of measurement-based care into behavioral health.

Although evidence supports measurement-based care as an evidence-based practice that can improve patient behavioral health outcomes, it is underused, according to Cara C. Lewis, PhD, of Kaiser Permanente Washington Health Research Institute, and colleagues.

“Less than 20% of practitioners (17.9% of psychiatrists, 11.1% of psychologists and 13.9% of masters-level practitioners) engage in [measurement-based care], and as little as 5% use it according to its empirically informed schedule,” they wrote.

After examining clinical literature, Lewis and colleagues found that barriers to implementing measurement-based care occur at the patient, practitioner, organizational and systematic levels. For example, patients were concerned about breaking confidentiality, practitioners believed measurement-based care isn’t better than their clinical judgement, organizations were without resources for training and systems worried about competing requirements, according to the review.

Integrating evidence-based practices such as measurement-based care into routine care using implementation science can help address these barriers, Lewis and colleagues wrote.

The researchers recommended that the research agenda to improve the integration of measurement-based care into clinical care should focus on:

1. clarifying terminology and core components of measurement-based care;
2. creating standard methods for monitoring fidelity;
3. testing mechanisms of change in clinical trials (especially for psychotherapy);
4. identifying algorithms for measurement-based care to guide psychotherapy;
5. developing then combining brief and psychometrically strong measures;
6. evaluating administration needed to attain improved outcomes;
7. updating measurement feedback systems to include critical elements and improve electronic health record usability;
8. applying discrete, evidence-based strategies to support implementation in any setting;
9. making evidence-based policy decisions about admission frequency and using data to inform care; and
10. aligning reimbursement structures.

The review also highlighted some multifaceted strategies to target barriers that impede successful implementation of measurement-based care into behavioral health. These included using measurement feedback systems; including local practitioners who actively associate themselves with the evidence-based practice to improve other’s attitudes toward measurement-based care; collaborating with and training leadership; and improving expert consultation with clinical staff. – by Savannah Demko

Disclosure: Lewis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.