A Tipping Point for Measurement-Based Care

Fortney, John C.; Unützer, Jürgen; Wrenn, Glenda; Pyne, Jeffrey M.; Smith, Gary; Schoenbaum, Michael; Harbin, Henry T.

doi:10.1176/appi.ps.201500439

Cited by 455 publications

(348 citation statements)

References 66 publications

Supporting

Mentioning

344

Contrasting

Unclassified

Order By: Relevance

“…Collaborative care has proven effective when care managers are located in primary care as well as when they are offsite or via telephone [29–31]. Interdisciplinary review of all patients’ progress, where a collaborative care team repeatedly focuses on how to achieve symptom resolution, is a central component of collaborative care, complementing measurement-based treatment (referred to as “treat to target”) [32]. Trials over the past 20 years have demonstrated the power of collaborative care to improve management and outcomes of mood disorders [33–40] and other chronic mental health and medical conditions [41].…”

Section: Conceptual and Scientific Foundations Of The Choice Modelmentioning

confidence: 99%

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Bradley

Ludman

Chavez

et al. 2017

Addict Sci Clin Pract

View full text Add to dashboard Cite

BackgroundMost patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample.Methods The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011–2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.ResultsA total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22–75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14–24] and a median readiness to change drinking score of 5 (IQR 2.75–6.25) on a 1–10 Likert scale.ConclusionThe CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).Electronic supplementary materialThe online version of this article (doi:10.1186/s13722-017-0080-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Conceptual and Scientific Foundations Of The Choice Modelmentioning

confidence: 99%

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Bradley

Ludman

Chavez

et al. 2017

Addict Sci Clin Pract

View full text Add to dashboard Cite

show abstract

“…Measurement-based care (MBC) for depression refers to the systematic and routine administration, scoring, and reviewing of depression symptom rating scales to inform clinical decision-making, and this practice is a fundamental component of many treatment modalities (Fortney et al, 2016; Trivedi & Daly, 2007). By routinely collecting standardized measures of depression severity, MBC helps providers identify response to treatment earlier than clinical judgment alone (Hatfield, McCullough, Frantz, & Krieger, 2010), yielding larger, faster, and less costly improvements in mental health symptoms (Hawkins, Lambert, Vermeersch, Slade, & Tuttle, 2004; Knaup, Koester, Schoefer, Becker, & Puschner, 2009).…”

Section: Measurement-based Carementioning

confidence: 99%

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities

2017

View full text Add to dashboard Cite

Clinical decision-making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision-making. In this paper, we provide ‘snapshots’ of research and current directions on ways that digital technologies can support clinical decision-making in depression treatment. Practical facets of clinical decision-making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision-making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision-making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision-making for depression by (a) improving tools to incorporate depression symptom data into existing electronic health record systems, (b) enhancing measurement of treatment fidelity and treatment processes, (c) harnessing smartphone and biosensor data to inform clinical decision-making, (d) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (e) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision-making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains.

show abstract

“…1,[24][25][26] Integrated care models, when implemented with use of quality measurement-based care, substantially improve clinical outcomes for depression and other mental health conditions. 27 Although treatment is commonly initiated in the primary care setting, the literature demonstrates inconsistent practitioner approaches to address mental health conditions. [28][29][30][31] Most patients who are identified as having mental health issues including depression receive inadequate treatment in primary care offices.…”

Section: Integrated Care Models In Culturally Diverse Populationsmentioning

confidence: 99%

Patient and Practitioner Perspectives on Culturally Centered Integrated Care to Address Health Disparities in Primary Care

Wrenn

Kasiah

Belton

et al. 2017

TPJ

Self Cite

View full text Add to dashboard Cite

Introduction: Addressing the multifaceted health and mental health needs of ethnically and culturally diverse individuals is a challenge within the current health care system. Integrated care provides a promising approach to improve mental health treatment-seeking disparities; however, adaptation of care models to impact African Americans is lacking. Although resources to support engagement of diverse populations in depression care exist, little has been developed to tailor patient preferences in accessing and engaging mental health services that are integrated into primary care.Objective: Our research seeks to add a cultural focus to the existing literature concerning integrated health care models to help address depression and selected co-occurring chronic health conditions in primary care settings.Methods: Thirty-two adult patients of an integrated primary care clinic participated in focus groups discussing their individual health experiences. Nine health care practitioners/administrators from five different integrated practice settings in the Atlanta, GA, area participated in key informant interviews.Main Outcome Measures: Transcripts were analyzed for key themes related to depression care, perceived unmet cultural needs, and desired adaptations.Results: Common themes emerged such as the importance of peer-support and community engagement as areas of patient interest. Participants had good knowledge in recognizing depressive symptoms but were less knowledgeable about treatment options and expectations of treatment. The administrative and practitioner perspective suggests that patient preferences are valued and perceived as valid.Conclusion: It is critical that strategies and models are developed to improve health care among underserved minorities because current models offer variable efficacy among this population.

show abstract

A Tipping Point for Measurement-Based Care

Cited by 455 publications

References 66 publications

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Digital technology and clinical decision making in depression treatment: Current findings and future opportunities

Patient and Practitioner Perspectives on Culturally Centered Integrated Care to Address Health Disparities in Primary Care

Contact Info

Product

Resources

About