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Implementing Measurement-Based Care in Behavioral Health: A Review
Open accessAbstract
Importance: Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. Observations: Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. Conclusions and Relevance: This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
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“MBC has been associated with multi-faceted clinical benefits, including greater retention, engagement, and therapeutic alliances during treatment with better patient outcomes that occur more quickly and last longer than traditional care (14-19).”
From Initial insights from a quality improvement initiative to develop an evidence-informed young adult substance use program (2022) · cites this paper as [14]
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“fewer than 20% of mental health practitioners use it consistently, and only 5% implement it at the recommended frequency [19]”
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Metadata
- Authors
- Lewis, C. C., Boyd, M., Puspitasari, A., Navarro, E., Howard, J., Kassab, H., Hoffman, M., Scott, K., Lyon, A., Douglas, S., Simon, G., & Kroenke, K.
- Affiliations
- Kaiser Permanente Washington Health Research Institute (US)
- University of California, Los Angeles (US)
- Mayo Clinic (US)
- Indiana University Bloomington (US)
- Ohio University (US)
- West Virginia University (US)
- Brown University (US)
- University of Washington (US)
- Vanderbilt University (US)
- Regenstrief Institute (US)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-03-01
- Volume
- 76
- Issue
- 3
- Pages
- 324
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6584602
- OpenAlex
- W2904026243
- Cited by
- 605
- References
- 90
- Citations by year
- 2026: 91 · 2025: 97 · 2024: 110 · 2023: 80 · 2022: 75 · 2021: 92 · 2020: 49 · 2019: 11
- FWCI
- 6.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (F31MH111134, R01MH103310)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- measurement-based care, behavioral health, implementation barriers, implementation fidelity, psychotherapy, electronic health records interoperability, learning collaborative, local champions, reimbursement policy
- MeSH terms
- Mental Disorders, Humans, Mental Health Services, Treatment Outcome
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