Measurement-based care

Measurement-based care (MBC) describes the evidence-based practice of using systematic and routine assessment of the patient’s perspective through patient-reported progress and outcomes, such as symptoms and functioning, throughout the course of mental and behavioral care, to inform treatment decisions and engage patients in their treatment (Scott & Lewis, 2015).

MBC promotes data-informed, patient-centered care.

MBC is a clinical process consisting of three essential components:

1. Routinely collecting patient-reported outcomes throughout the course of treatment
2. Sharing timely feedback with the patient about their reported progress scores and trends over time
3. Acting on these data in the context of the provider’s clinical judgment and the patient’s experiences to guide the course of care (i.e., shared-decision making regarding treatment; Lewis et al., 2018; Oslin et al., 2019; Resnick & Hoff, 2019)

View a larger version of the Mechanisms of Action infographic with a detailed description

MBC shares overlapping characteristics with related organizational practices such as routine outcomes monitoring and program evaluation, though is understood to be conceptually distinct from these applications as the data collected in MBC are specifically intended to make dynamic changes during treatment at the individual level (Lewis et al., 2018).

However, organizations can use aggregated MBC data to support organizational goals such as quality improvement efforts and satisfying accreditation or other accountability standards (Connors et al., 2021; Jensen-Doss et al., 2020).

Evidence-based practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (APA Presidential Task Force on Evidence-Based Practice, 2006).

What this means is that clinical decision making should occur in partnership with the patient, informed by the best research evidence, taking into consideration the available options and the patient’s individual circumstances and preferences. Treatment planning, in this manner, should be ongoing, updating and adjusting care as needed through regular monitoring of patient progress.

The key elements of MBC including measuring progress, using that information to adjust care, and sharing that information with patients make MBC a core element of evidence-based practice.

Evidence base for MBC

Since research into MBC began in 2001 (Lambert et al., 2001), a number of reviews and meta-analyses have been conducted to investigate its effects.

• Researchers analyzed 51 randomized controlled trials exploring how frequently providers collected feedback on patient-reported symptoms during medication management and psychotherapy encounters and found that almost all the trials that consistently used MBC showed significantly improved patient outcomes, while one-time screenings and assessing symptoms infrequently were less effective (Fortney, J. C., et al., 2017).
• A narrative review of several meta-analyses and qualitative studies found that not only did measurement-based care outperform usual care; it was also associated with decreased costs and a lower likelihood of patient deterioration while in treatment (Lewis, C. C., et al., 2019).
• De Jong and colleagues (2021) utilized a multilevel meta-analysis analyzing 110 effect sizes in 21,699 patients and reported a small effect on symptom reduction across all case types (d=0.15), as well as a small, favorable effect on dropout rates (OR=1.19). Greater effects were seen in subpopulations of cases identified as “not on track.”
• In the absence of MBC, research demonstrates that clinicians struggle to identify the patients who are at a higher risk for nonresponse, or even deterioration in functioning (Constantino et al., 2019; Walfish et al., 2012).

Numerous studies looking at the impact of MBC have found

• Improved symptom and functioning outcomes (de Jong et al., 2021; Goodman et al., 2013; Reese et al., 2009, 2010)
• Lower rates of separation/divorce in couples therapy (Anker et al., 2009)
• Reduced rates of nonresponse and lower dropout rates (de Jong et al., 2021)

The benefits of MBC to psychologists and patients extend beyond symptom outcomes and retention

• MBC is associated with increased feedback to patients regarding progress (Bobbitt et al., 2012; Lambert, 2010) and improved customer/patient satisfaction (Johnson & Shaha, 1996; Knaup et al., 2009; DeSaeger et al., 2014).
• Patients in treatments that integrate MBC report experiencing a higher level of engagement in their treatment, as well as a higher level of respect from treatment providers because it communicates that their perspective is highly valued (Dowrick et al., 2009; Eisen et al., 2000; Moltu et al., 2018).
• MBC enhances clinical responsiveness to the individual patient (Boswell et al., 2015; Brooks Holliday et al., 2020; Constantino et al., 2013), for example, by adjusting the treatment plan or revisiting expectations and goals.
• MBC is associated with increases in patient-reported working alliance quality, relative to as-usual treatments that do not include MBC (Brattland et al., 2019).