As a psychiatrist, I've seen firsthand how Measurement-Based Care (MBC) can transform patient outcomes. Yet, surprisingly, only about 18% of psychiatrists and 11% of therapists have embraced it [1]. Why the hesitation? Let's dive into some common misconceptions and uncover the evidence-based facts that might just change your mind about MBC.

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Myth 1: MBC Turns Therapy into a Cold, Impersonal Process

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Reality: In my experience, MBC actually strengthens the therapeutic relationship.
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When I first introduced MBC into my practice, I was amazed at how it fostered deeper connections with my patients. We've all had sessions where patients struggle to articulate their concerns. With MBC, we now have a structured starting point. Patients often find it easier to open up, using the measures as a guide to discuss their experiences more precisely.

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Here's what the research shows:

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• Studies reveal that patients report significantly improved communication with their providers when using MBC [2]

• Far from being impersonal, MBC fosters a collaborative approach, making patients feel more engaged and informed [2]

• Patients appreciate the feedback, viewing MBC as evidence that their providers are truly invested in their mental health [2]

• The process of reviewing progress together can strengthen the therapeutic bond and boost patient trust [2]

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A key study by DeSimone & Hansen (2023) found that MBC in psychiatry can increase remission rates, lower relapse risk, improve medication adherence, and strengthen the therapeutic alliance.

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Myth 2: MBC Disrupts the Flow of Therapy and Wastes Precious Time

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Reality: I used to worry about this too, but I've found that MBC saves time while improving outcomes.

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In my practice, I've seen how MBC streamlines the therapeutic process:

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• By using tech like Osmind to send measures automatically outside of sessions, you start face-to-face time armed with objective data.

• Asynchronous MBC acts as an early warning system, helping detect symptom deterioration faster in between visits [5]

• It allows for early identification of acute situations that might slip through the cracks of observation alone [5]

• Research shows MBC can nearly double the therapeutic effect size in some cases [6]

• Measuring patient progress can lead to twice as many patients improving [6]

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In essence, the time invested in MBC pays dividends in more efficient and effective treatment. Because I can automatically send measures outside of sessions through the Osmind patient app, I've found that I get more quality time to focus on my patients' needs during our sessions.

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Myth 3: My Clinical Judgment is All I Need

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Reality: You didn’t go to med school to not use clinical judgement. I've learned that MBC is not a replacement – it's an enhancement cat is used to inform care.

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In fact, many of us MBC evangelists prefer the term Measurement-Informed Care as it is one tool in a clinician’s toolkit. Endocrinologists do not consider checking Hemoglobin A1c in a patient with diabetes as negating their clinical judgment and the same can be true in psychiatrist.

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Think of MBC as the Spock to your Captain Kirk, guiding you with data through the depths of inner space. Here's why combining your expertise with MBC leads to better outcomes:

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• Without MBC, providers catch clinical deterioration in only about 20% of patients who've experienced worsening symptoms [7]

• MBC provides hard data to back up and enhance your clinical decision-making [8]

• Validated patient-reported symptom scales are just as accurate as clinician-administered ones in tracking treatment response [9]

• Combining your expertise with standardized measures leads to more comprehensive and accurate assessments [8]

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By integrating MBC with my clinical judgment, I've found that I'm able to provide more precise and effective care. It's like having an extra set of eyes on each case.

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Myth 4: MBC Oversimplifies Complex Mental Health Issues

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Reality: In my practice, I've found that MBC actually offers a nuanced, comprehensive view of patient progress.

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Rather than oversimplifying, MBC has helped me gain deeper insights into my patients' experiences:

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• It provides a holistic picture by tracking multiple aspects of a patient's mental  and physical health as well as their level of functioning in the world.

• MBC helps patients become more attuned to their own progress. I make a consistent effort to go over the results of any measures the patient has completed during the sessions and share graphs so they can track their progress visually.

• Rather than replacing clinical insights, it complements and enhances patient-clinician discussions

• It helps patients better understand and articulate their mental health experiences

• MBC serves as a springboard for deeper discussions about symptoms and experiences

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Instead of simplifying patient experiences, I've found that MBC often leads to richer, more informed conversations about mental health.

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Myth 5: Implementing MBC is a Headache

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Reality: I'll admit, I was intimidated by the idea of implementing MBC at first. But with modern technology, it's surprisingly straightforward.

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Tech like the Osmind all-in-one EHR and Learning Health System makes implementing MBC as easy as shopping on Amazon. Here's what Osmind offers to streamline the process:

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• A toolkit of over 50 validated psych-tailored measures

• Automated data collection, scoring, and interpretation

• Visualized progress dashboards that make data interpretation a breeze

• Patient app for secure messaging, scheduling, and journaling

• All-in-one integration with other essential practice management tools

• Access to an exclusive Practice Community. Connect and discuss cases, stay on top of the latest research, and attend private virtual events.

• Education around MBC best practices and access to cutting-edge measures through our collaborations with the American Psychiatric Association and leading clinical researchers.

• Designed by psychiatrists, for psychiatrists

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Implementing MBC can be much simpler than you might think, putting it on "autopilot" so you can focus on what you do best – caring for your patients.

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Myth 6: There's No Financial Upside to MBC in Fee-for-Service Models

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Reality: While improving patient care is our primary goal and I am intrinsically motivated to use MBC, practices still need to consider the business case for it. Using MBC can be financially recognized by some insurance companies, both in the short term and as the healthcare landscape evolves.

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It also plays a crucial role in getting patients insurance coverage for interventional treatments that require prior authorization such as Transcranial Magnetic Stimulation and esketamine.

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Here's what I've observed in my practice:

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Current advantages:

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• Boosts patient adherence to medication and treatment protocols, potentially reducing no-shows as they get immediate, objective feedback on their treatment trajectory.

• Improves therapeutic efficiency, allowing for more effective use of session time for therapeutic work.

• Enhanced patient engagement and satisfaction could lead to better retention and referrals as patients increasingly digitally measure many things about their health and value when clinicians participate in that process.

• Provides evidence-based practice data to support insurance coverage prior authorizations and continuation of care.

• MBC can reduce no-show appointments, potentially improving practice efficiency and revenue

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Looking to the future:

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• The field is moving toward value-based care models, where demonstrating positive outcomes will be crucial

• MBC aligns perfectly with precision psychiatry principles, allowing you to show, with data, that your interventions are working

• Early adopters of MBC will be ahead of the curve in proving the value of their care

• The ability to demonstrate better outcomes with data may lead to improved reimbursement rates in future value-based payment models

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Conclusion: Embracing the Future of Psychiatric Care

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Implementing MBC has transformed my practice, and I believe it can do the same for you. It's not about replacing your expertise – it's about enhancing it with data-driven insights. By adopting MBC, you're not just improving outcomes; you're future-proofing your practice.

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Ready to join the vanguard of evidence-based psychiatric care? Tools like Osmind’s all-in-one Psychiatry EHR can help you seamlessly integrate MBC, allowing you to focus on what you do best – providing excellent patient care.

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As the field evolves, tools such as fMRI, eeg and other biomarkers will have a larger role to play in MBC but there will always be a place for inquiring how patients are thinking and feeling that no biological measurement will be able to fully capture. MBC helps us provide more effective, personalized treatment. Let's move forward together, using the best tools available to help our patients thrive.

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References

[1] Jensen-Doss, A., Haimes, E. M. B., Smith, A. M., Lyon, A. R., Lewis, C. C., Stanick, C. F., & Hawley, K. M. (2018). Monitoring treatment progress and providing feedback is viewed favorably but rarely used in practice. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 48-61.

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[2] Carlier, I. V., Meuldijk, D., Van Vliet, I. M., Van Fenema, E., Van der Wee, N. J., & Zitman, F. G. (2012). Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. Journal of evaluation in clinical practice, 18(1), 104-110.

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[3] DeSimone, J., & Hansen, B. (2023). The Impact of Measurement-Based Care in Psychiatry: An Integrative Review. Journal of the American Psychiatric Nurses Association, 10783903231177707.

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[4] Janse, P. D., De Jong, K., Van Dijk, M. K., Hutschemaekers, G. J., & Verbraak, M. J. (2017). Improving the efficiency of cognitive-behavioural therapy by using formal client feedback. Psychotherapy Research, 27(5), 525-538.

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[5] Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520-537.

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[6] Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta‐analysis. Clinical Psychology: Science and Practice, 10(3), 288-301.

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[7] Hatfield, D., McCullough, L., Frantz, S. H., & Krieger, K. (2010). Do we know when our clients get worse? An investigation of therapists' ability to detect negative client change. Clinical Psychology & Psychotherapy, 17(1), 25-32.

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[8] Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2017). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188.

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[9] Rush, A. J., Carmody, T. J., Ibrahim, H. M., Trivedi, M. H., Biggs, M. M., Shores-Wilson, K., ... & Kashner, T. M. (2006). Comparison of self-report and clinician ratings on two inventories of depressive symptomatology. Psychiatric Services, 57(6), 829-837.