| Description |
Background: Measurement-based care (MBC) is a systematic approach to clinical decision-making that involves collecting, analyzing, and applying patient-reported data to guide treatment planning and decisions. The use of MBC has become increasingly common across various healthcare fields, including mental health, where it has demonstrated positive outcomes. However, while the implementation of MBC is wide, clinicians may not fully understand the reasons behind its use and its fiscal implications. As it has become integrated into clinical practices, its financial impact on the healthcare system has also become critical for clinicians to understand. Local Problem: An urban community mental health clinic serving underserved populations requires using two MBC tools: the Outcome Questionnaire-45.2 (OQ) and the Patient Health Questionnaire-9 (PHQ-9). Financial reimbursement and a federal grant require compliance with using these tools. Lack of documentation and low compliance with these MBC tools puts the clinic's financial stability at risk. Methods: This quality improvement (QI) project implemented targeted interventions to improve low compliance rates with the OQ and PHQ-9 through pre- and post-intervention surveys, education, process development, and data surveillance. Interventions: Surveys incorporating a Likert scale and open-ended questions assessed the clinician's baseline understanding and perceptions of MBC, OQ, and PHQ-9. Based on this data, the project implementation phase included a tailored training plan and monitoring to improve compliance rates. Clinicians were required to chart OQ and PHQ-9 scores during designated weeks. Throughout the project, the team monitored compliance rates. One month after the intervention, compliance was reassessed to evaluate sustainability. A post-survey measured changes in clinician understanding and perception while identifying ongoing barriers to MBC adoption. Results: Clinical and administrative staff completed the pre-intervention survey with an 86% response rate (n = 31) and the post-intervention survey with a 72% response rate (n = 26). Most participants (58.1%) were therapists or therapy students with or working on graduate degrees. The rest were nurses, peer support specialists, administrative staff, or reception staff. OQ compliance showed no statistically significant change from pre- to post-intervention (p = 0.672) but significantly improved during the intervention period (p = 0.003). PHQ-9 compliance increased significantly from pre- to post-intervention (p = 0.001) and during the active intervention phase (p = 0.001). PHQ-9 compliance remained relatively low at the end of the project at 21%. Overall, the clinician's perceptions and understanding of MBC, OQ, and PHQ-9 improved from pre- to post-intervention. Conclusion: While clinician understanding and perception of MBC improved, compliance rates increased the most during the active intervention period. However, compliance declined after the intervention ended. These findings suggest that clinicians recognize the importance of MBC; however, system-related barriers, particularly limitations with the current electronic health record (EHR), hinder its sustainability. Increased administrative burden and workflow inefficiencies may prevent long-term adoption, even when clinicians acknowledge MBC's benefits. Future efforts should focus on integrating MBC into EHR systems, reducing administrative workload, and implementing automated reminders to support sustained compliance. |
