C ontemporary medicine is faced with a multitude of challenges, 2 of which are determining which treatments are most effective in routine clinical care, and continually optimizing care in a finite resource environment. 1 These challenges were exemplified by the STAR*D studies, which not only revealed disappointing real-world remission rates for commonly used antidepressants, but also showed no difference in outcomes among any medication switches or augmentation strategies. 2 These trial results are mirrored in real-world practice, where antidepressant drug treatment is often quickly discontinued and patients switching drug therapy have the highest healthcare costs, implying poor outcomes. 3 Similarly for electroconvulsive therapy (ECT), the variation in worldwide practice is large and the corresponding outcomes were unclear. 4 The need for improvement is underscored by findings from the Community Study of ECT conducted across 7 hospitals in New York City, which showed substantial variability in long-term cognitive outcomes between hospitals, largely attributed to variation in ECT technique. 5 Enhanced knowledge about real-world clinical outcomes with ECT and the factors that affect these are therefore imperative for ensuring optimal care for our patients.
WHAT IS THE CARE NETWORK?Measurement-based care (MBC), as exemplified by the Texas Medication Algorithm Project and the German Algorithm Project, has demonstrated benefits over usual care in terms of patient outcomes, quality of life, therapeutic relationship, shared decision-making, and research. Crucially, MBC has been successfully integrated as part of standard care in real-world settings. 6 For ECT, a model example of this is the Clinical Alliance and Research in ECT and Related Treatments (CARE) Network, published in this journal 7 and lauded by other systematic data collection networks. 8 The CARE Network aims to address the substantial heterogeneity in ECT treatment methods across clinical settings by facilitating MBC and understanding how variations in clinical practice relate to treatment outcomes. It introduces structured measurements to facilitate MBC, clinical auditing and benchmarking, and quantitative research based on real-world data.The CARE system involves a standardized set of core demographic, clinical, and ECT treatment outcomes, along with additional optional assessments for more detailed information.Assessments are conducted before ECT, during and after the acute ECT course, at the end of continuation ECT, and every 6 months during maintenance ECT treatment. Detailed demographic and clinical information, including treatment resistance, concurrent medication use, main indication for ECT, and comorbid diagnoses, are collected. Critical treatment factors such as dosing method, ECT frequency, seizure threshold, ECT treatment dose, number of ECT sessions in the acute course, and anesthetic procedure are also included.The main outcome indicator is the Clinical Global Impression scale 9 as the core transdiagnostic clinical outcome measure for effi...
