Cited by 606Health Policy Implementation SciencePsychotherapy Techniques and ApplicationsPsychiatric care and mental health services

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Implementing Measurement-Based Care in Behavioral Health: A Review

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Lewis, Cara C., Boyd, Meredith, Puspitasari, Ajeng, Navarro, Elena, Howard, Jacqueline, Kassab, Hannah, Hoffman, Mira, Scott, Kelli, Lyon, Aaron, Douglas, Susan, Simon, Greg, Kroenke, Kurt·2019·JAMA Psychiatry

DOI 10.1001/jamapsychiatry.2018.3329PMC PMC6584602

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Abstract

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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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: Lewis, Cara C.
Boyd, Meredith
Puspitasari, Ajeng
Howard, Jacqueline
Kassab, Hannah
Scott, Kelli
Lyon, Aaron
Douglas, Susan
Kroenke, Kurt
Venue: JAMA Psychiatry
Publisher: American Medical Association (AMA)
Published: 2019-03-01
Volume: 76
Issue: 3
Pages: 324
ISSN: 2168-622X (ISSN-L)
DOI: 10.1001/jamapsychiatry.2018.3329
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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Implementing Measurement-Based Care in Behavioral Health: A Review

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