Measurement-based care (MBC) is the clinical approach of using regularly collected patient-reported outcome measures to monitor progress and inform treatment decisions. These data track how a patient (hereafter ‘client’) is responding to treatment and inform treatment adjustments for individuals who are not getting better. MBC produces “real-time” data to help clinicians and clients communicate about the client’s experience in treatment and decide how and when to adjust treatment to improve outcomes. MBC can also help clients and clinicians know when treatment is working and can help inform decisions to make treatment less intensive or to conclude a treatment episode. MBC has been shown to improve clinical outcomes; however, is underutilized in community mental health practice.1
Key Components
What Does MBC Look Like for Clinicians?
Here are the steps of MBC:
- Client completes an outcome measure or measures, ideally before each clinical encounter.
- Clinician reviews data from the measure.
- Client reviews data from the measure.
- Clinician and client discuss to ensure that the data are consistent with the client’s experience.
- Clinician and client collaboratively reevaluate the treatment plan informed by the data.2
Where possible, patient-reported outcome measures (PROMs) are recommended for MBC because they foster client engagement and can be implemented in community settings with limited technology infrastructure. These measures should be brief, easy to collect, validated and sensitive to change. PROMs can measure symptoms, typically for a particular diagnosis, or other domains such as functioning and quality of life. Organizations may choose to use standardized measures and/or individualized progress monitoring approaches, which allow clinicians and clients to identify and track personalized goals over time.3
Steps to Implement MBC
To implement MBC in an organization, there are several common steps:4
- Clarify the goals and priorities for using MBC.
- Choose measures that will support those goals and priorities.
- Select the group of clients for implementation.
- Identify, train, and support MBC clinician implementers.
- Decide how the measures will be completed and how results will be shared with clinicians and clients.
- Determine frequency of measure collection.
- Implement organizational strategies to support the use of MBC.
- Monitor and support ongoing uptake and implementation of MBC.
- Develop strategies to finance and sustain MBC over time.5
Repository of PROMS
We convened a panel of national experts in MBC to compile a list of standardized, patient-reported outcome measures (PROMs). The process was guided by a review of the peer-reviewed literature as well as reports and white papers addressing implementation of MBC in community mental health settings. The committee identified a set of PROMs that were validated, brief, publicly available at no cost, and sensitive to change over time. This repository includes measures for youth and adults, that address symptomatic and functional outcomes, that are standardized and individualized approaches to measurement, and that are applicable to a wide range of mental health conditions. The repository is intended to be a starting point for measure selection; other patient-reported measures not included here may also be useful in MBC.
How We Can Help
What We Can Do
- Support you in choosing patient reported outcome measures (PROMs) for your setting/services
- Recommend tools to identify barriers and facilitators to implementing measurement-based care
- Assist you in developing a plan to implement measurement-based care
Support We Have Provided
- We provided consultation to Early Psychosis Intervention Network (EPINET) first episode psychosis (FEP) programs in one state to identify challenges and opportunities for implementing measurement-based care in their clinics. The consultation assisted the programs in identifying strategies for increasing: the usability and accessibility of the data, provider engagement and use of dashboards, client engagement through access to outcome data in real-time, and routinization of MBC across the care team.
- We held a multi-session foundational introduction to the implementation of Measurement-Based Care (MBC). Content included an overview of the clinical practice, its components, and evidence for MBC, as well as interactive activities such as a checklist to explore MBC implementation efforts. Content was geared toward organizations and implementers new to MBC, as well as improving implementation for those already using the practice.
Key Resources
Patient-Reported Outcome Measures (PROMS): Repository List and Details
The Center for Mental Health Implementation Support (CMHIS) convened a panel of national experts in measurement-based care (MBC) to compile a list of standardized, patient-reported…
Measurement-Based Care Infographic
This infographic provides an overview of measurement-based care, its key components, and why it matters when implementing a new effective mental health practice. The infographic…
Use of Measurement-Based Care for Behavioral Health Care in Community Settings, a Brief Report
This report is an overview of measurement-based care and strategies for incorporating it into community mental health settings produced by the Interdepartmental Serious Mental Illness…
Implementing Measurement-Based Care in Behavioral Health: A Review
This article contains the results of a systematic review of the core features MBC and approaches to implementation.
What Gets Measured Gets Done: How Mental Health Agencies Can Leverage Measurement-Based Care for Better Patient Care
This article provides a practical overview of strategies for implementing MBC for mental health agency directors.
Yale Measurement Based Collaborative
The Yale Measurement Based Collaborative provides a wide range of resources related to understanding and utilizing MBC
MBC Implementation Planning Worksheet
Planning worksheet for organizations seeking to implement MBC, from the Yale Measurement Based Collaborative.
Financing Measurement-Based Care in Community Behavioral Health Settings
Overview of strategies for reimbursing and financing MBC in behavioral health.