How the APA’s Transdiagnostic Measure is Getting the Attention it Deserves

Measurement Based Care: If you build it (into your EHR) they will come
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Since its introduction with the DSM-5, the APA's Level 1 Cross-Cutting Symptom Measure has held promise as a comprehensive tool for mental health assessment - yet its adoption has remained limited, largely due to practical barriers. Now, through a groundbreaking collaboration between Osmind and the American Psychiatric Association (APA), this valuable assessment tool is finally gaining traction in clinical practice.
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The key to this transformation? Integration into clinicians' daily workflow through modern technology. By embedding the cross-cutting measure (known as the DSM-XC) directly into Osmind's EHR and supporting its implementation through targeted education and engagement, we've demonstrated dramatic increases in adoption across independent mental health practices.
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Methods

The implementation study leveraged Osmind's Learning Health System to introduce the DSM-XC into independent mental health practices. Originally available only as a PDF, this 23-item assessment tool evaluates 13 domains of psychopathology and was designed to be both transdiagnostic and dimensional. The integration included educational content, social media campaigns, and in-product announcements to support clinician adoption.

Simultaneously, researchers conducted a factor analysis study using data from 2,157 psychiatric outpatients to examine the measure's underlying structure. This analysis employed both exploratory and confirmatory factor analysis approaches, including testing a theoretically-derived three-factor model based on Caspi's p-factor framework of psychopathology.

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See the factor analysis poster here.

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Results

The implementation study demonstrated rapid adoption and sustained use:

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• 115 practices adopted the measure within 5 months
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• Usage increased dramatically from 143 implementations in month one to 2,124 by month five
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• Average uses per practice reached 18.6 (SD=32.77)
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• 63% used it for initial visits, 30% for follow-ups, and 7% reported irregular use
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• Clinicians rated overall usefulness as 6.6/10 (95% CI [4.72, 8.54])

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The factor analysis revealed three distinct structural solutions, all showing acceptable fit indices:

• A six-factor general model representing traditional symptom clusters
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• A five-factor bifactor model incorporating overall symptom burden
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• A three-factor hierarchical model based on a higher-order general psychopathology factor (p-factor) with first-order factors (internalizing, externalizing, and thought disorder)

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Clinical Implications
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The successful implementation highlights how technology platforms can overcome traditional barriers to measurement-based care adoption. Clinician feedback identified several key benefits:

• Comprehensive screening capabilities during initial assessments
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• Strong patient acceptance
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• Effective progress tracking
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• Functions as a psychiatric "Review of Systems"

Areas for improvement included:

• Need for standardized score interpretation
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• Interest in built-in Level 2 measure administration
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• Desire for ADHD domains in the adult version

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The factor analysis further validates the DSM-XC's utility by demonstrating its ability to capture both overall symptom burden and distinct areas of dysfunction, supporting its use as a transdiagnostic assessment tool.

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Future Directions

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These studies demonstrate how strategic collaborations between technology platforms and professional organizations can effectively support measurement-based care adoption while validating assessment tools' theoretical underpinnings. The success of this initiative suggests potential applications beyond clinical practice, including:

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• Validation of composite endpoints in clinical trials
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• Enhancement of measurement-based care protocols
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• Development of more sophisticated assessment algorithms
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• Generation of robust real-world evidence to advance precision psychiatry

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As part of Osmind's collaboration with the APA's PsychPRO registry, this implementation represents a significant step toward broadening access to personalized care and improving patient outcomes. The integration of standardized measures into everyday clinical workflow, supported by technology, could help accelerate psychiatry's evolution toward precision medicine.

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Clinicians and Researchers: Join us in advancing measurement-based care

At Osmind, we're committed to generating evidence that advances mental health care through our Learning Health System approach. To explore more of our breakthrough research or to get involved, visit osmind.org/research and join us in transforming mental healthcare.