Measurement Feedback Systems Research Articles

Interpreting Progress Feedback to Guide Clinical Decision-Making in Children's Mental Health Services.

Measurement feedback systems (MFSs) can help improve clinical outcomes by enhancing clinical decision-making. Unfortunately, limited information exists to guide the use and interpretation of data from MFSs. This study examined the amount of data that would provide a reasonable and reliable prediction of a client's rate of symptomatology in order to help inform clinical decision-making processes. Results showed that use of more data predicted greater levels of accuracy. However, there were diminishing returns on the ability for additional data to improve predictive accuracy. Findings inform efforts to develop guidelines on the interpretation of data from MFSs.

Implementing for Sustainability: Promoting Use of a Measurement Feedback System for Innovation and Quality Improvement.

Measurement feedback systems (MFSs) are increasingly recognized as evidence-based treatments for improving mental health outcomes, in addition to being a useful administrative tool for service planning and reporting. Promising research findings have driven practice administrators and policymakers to emphasize the incorporation of outcomes monitoring into electronic health systems. To promote MFS integrity and protect against potentially negative outcomes, it is vital that adoption and implementation be guided by scientifically rigorous yet practical principles. In this point of view, the authors discuss and provide examples of three user-centered and theory-based principles: emphasizing integration with clinical values and workflow, promoting administrative leadership with the 'golden thread' of data-informed decision-making, and facilitating sustainability by encouraging innovation. In our experience, enacting these principles serves to promote sustainable implementation of MFSs in the community while also allowing innovation to occur, which can inform improvements to guide future MFS research.

Provider-Driven Development of a Measurement Feedback System to Enhance Measurement-Based Care in VA Mental Health

Given the importance of implementing measurement-based care (MBC) to enhance the quality of care provided to veterans with mental health disorders, the Department of Veterans Affairs (VA) has developed guidelines and a mandate for MBC and use of specific measures. Nonetheless, current use of MBC for mental health in VA is low and easily extractable outcomes are not available within the electronic medical record (EMR). This paper reviews obstacles to MBC for mental health in VA and the potential for a measurement feedback system (MFS) to overcome these obstacles. This paper reports the results of a local VA provider survey of barriers to MBC and describes a multidisciplinary, provider-driven local process to develop a software-based MFS to address some of these barriers. This MFS, named COMMEND (Collaborative Mental health Management ENhanced Dashboard), was developed in an iterative fashion with ongoing feedback from providers. It was created to interface with VA’s EMR and provide a way to easily input patient intervention and outcome information, create a progress note, and visualize interventions and outcomes over time on a single graph. This paper describes a pilot implementation of this tool, including a qualitative description of how it was incorporated into a particular provider’s workflow, how features were adapted based on provider feedback, and initial implementation data. Lastly, plans are described to study factors affecting successful implementation and explain how local experiences may be applicable for providers in a variety of settings.

Clinician use of standardized assessments following a common elements psychotherapy training and consultation program.

Despite increasing emphasis on the implementation of evidence-based treatments in community service settings, little attention has been paid to supporting the use of evidence-based assessment (EBA) methods and processes, a parallel component of evidence-based practice. Standardized assessment (SA) tools represent a key aspect of EBA and are central to data-driven clinical decision making. The current study evaluated the impact of a statewide training and consultation program in a common elements approach to psychotherapy. Practitioner attitudes toward, skill applying, and use of SA tools across four time points (pre-training, post-training, post-consultation, and follow-up) were assessed. Results indicated early increases in positive SA attitudes, with more gradual increases in self-reported SA skill and use. Implications for supporting the sustained use of SA tools are discussed, including the use of measurement feedback systems, reminders, and SA-supportive supervision practices.

Abstract 275: A Randomized Controlled Trial of Compression Rates (COMPRATE trial) During Cardiopulmonary Resuscitation

Purposes: This prospective, randomized, multicenter-, controlled trial was conducted to compare the efficacy of CPR with compression rate of 100/min to CPR with compression rate of 120/min in patients with cardiac arrest. Methods: Patients with non-traumatic out-of-hospital cardiac arrest whose age is equal and over 19 years old were randomized into two groups when the patient arrived at emergency department. The patients received manual CPR either a compression rate of 100 /min (CPR-100 group) or a compression rate of 120/min (CPR-120 group). Chest compressions were performed by pre-trained AHA certified healthcare providers according to guidance of metronome and a real-time CPR measurement feedback system. Quality of chest compression was assessed by reviewing the depth and rate of compressions recorded in the high quality electronic monitoring system of the defibrillator. The case was excluded if the accuracy of the depth and rate of chest compressions could not be maintained over 90%. The primary outcome measure was sustained return of spontaneous circulation (ROSC). The secondary outcome measures were survival discharge from the hospital, 1-month survival, and 1-month survival with good functional status, categorized as a score of 2 or less on the cerebral performance category. Results: 470 patients were enrolled in the study. 221 patients were assigned to CPR-100 group and 249 patients assigned to CPR-120 group. A total of 136 patients (61.5 %) in the CPR-100 group and 156 patients (62.7 %) in the CPR-120 group were included in the analysis. In comparison of primary outcome, 69 patients (50.7%) in CPR-100 group and 67 patients (42.9%) in CPR-120 group had ROSC (p=0.183). In secondary outcome measures, the rates of survival discharge from the hospital, 1-month survival, and 1-month survival with good functional status were not different between two groups (16.9% vs. 12.8%, p=0.375; 12.5% vs. 6.4%, p=0.073; 5.9% vs. 2.6%, p=0.154). Conclusions: In patients with out-of-hospital non-traumatic cardiac arrest resuscitated in emergency department, no differences in the resuscitation outcomes were found between those who received CPR with a compression rate of 100/min and those who received CPR with a compression rate of 120/min.

From distal to proximal: Routine educational data monitoring in school-based mental health.

Research and practice in school-based mental health (SBMH) typically includes educational variables only as distal outcomes, resulting from improvements in mental health symptoms rather than directly from mental health intervention. Although sometimes appropriate, this approach also has the potential to inhibit the integration of mental health and schools. The current paper applies an existing model of data-driven decision making (Daleiden & Chorpita, 2005) to detail how SBMH can better integrate routine monitoring of school and academic outcomes into four evidence bases: general services research evidence, case histories, local aggregate, and causal mechanisms. The importance of developing new consultation protocols specific to data-driven decision making in SBMH as well as supportive infrastructure (e.g., measurement feedback systems) to support the collection and use of educational data is also described.

The Technology of Measurement Feedback Systems.

Usual care in the community is far from optimal. Sufficient evidence exists that dropout rates are significant, treatment is effective for only a small proportion of clients, and that the translation of evidence-based treatments to the real world is problematic. Technology has been shown to be helpful in health care in improving the effectiveness of treatment. A relatively new technology being used in mental health is measurement feedback systems (MFSs). MFSs are particularly applicable to couple and family psychology (CFP) because of its ability to provide information on the multiple perspectives involved in treatment. The Contextualized Feedback Systemstm (CFS®), developed at Vanderbilt University is used as an example of what can be accomplished with an MFS. The advantages and limitations of this technology are described as well as the anticipated reimbursement requirements that mental health services will need.

Developing Effective Research-Practice Partnerships for Creating a Culture of Evidence-Based Decision Making

With growing evidence that treatment as usual may have limited effectiveness in mental health the pressure on service providers to be accountable and produce evidence as to the effectiveness of their services has increased. Measurement Feedback Systems, such as the Contextualized Feedback System (CFS), have the potential to be powerful tools for service providers in assessing their own effectiveness at multiple levels with an organization. These systems represent an amalgamation of the data driven world of science and the experience driven world of clinical practice. However, the synthesis of these two worlds is not without significant challenges as these two very different cultures can easily clash. The key for successful collaboration in developing and implementing Measurement Feedback Systems is a good university-practice partnership that has a strong foundation in common goals and the positive relationships among its members. In addition, the partnership needs to be flexible so that it can adapt to new challenges and continuously grow with each obstacle. These are some of several lessons learned the authors of this article will share as part of their experience with developing and implementing CFS in one of the largest behavioral health service providers in the U.S.

Change What? Identifying Quality Improvement Targets by Investigating Usual Mental Health Care

Efforts to improve community-based children’s mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and “usual care.” These discrepancies highlight potentially potent quality improvement interventions. This article reviews existing research on routine or “usual care” practice, identifies strengths and weaknesses in routine psychotherapeutic care, as well as gaps in knowledge, and proposes quality improvement recommendations based on existing data to improve the effectiveness of children’s mental health care. The two broad recommendations for bridging the research-practice gap are to implement valid, feasible measurement feedback systems and clinician training in common elements of evidence-based practice.

Beyond outcomes monitoring: measurement feedback systems in child and adolescent clinical practice.

To review the literature published during the past year relevant to identifying the best measures for monitoring progress in the treatment of child and adolescent clients and their families. The current literature shows an increasing focus on clinical utility in measure development as demonstrated by the recent emphasis on evidence-based assessment. However, there is very little research on how the inclusion of monitoring might enhance clinician practice and ultimately youth and family outcomes. There is great promise in expanding our thinking beyond mere outcome measurement to a measurement feedback system that provides timely feedback that is comprehensive and concurrent with treatment. Investment in the development of measurement feedback systems is needed to enhance clinical judgment and increase effectiveness of treatment. Clinical utility and consumer appeal need to be key considerations for measures intended to be used in everyday clinical practice. Most importantly, we must harness the power of technology and advances in measurement to provide clinicians with the tools to use effectively the systematic data provided through frequent measurement with measurement feedback systems.

A Measurement Feedback System (MFS) Is Necessary to Improve Mental Health Outcomes

This article takes the position that mental health (MH) services for youths are unlikely to improve without a system of measurement that is administered frequently, is concurrent with treatment, and provides feedback. The system, which I characterize as a measurement feedback system (MFS), should include clinical processes (mediators), contexts (moderators), outcomes, and feedback to clinicians and supervisors. In spite of the routine call to collect and use outcome data in realworld treatment, progress has been painstakingly slow. 1Y3 For example, Garland and colleagues 4 found that even when outcome assessments were required, more than 90% of the clinicians surveyed used their own judgment and paid little heed to the data. A more recent national survey of MH service organizations serving children and families indicated that almost 75% reported collecting some standardized outcome data. 5 However, just collecting data on an annual basis will not result in improvement. MEASUREMENT IS NOT ENOUGH Feedback from clients and families naturally occurs in treatment, but it is highly filtered, biased, and subject to distortions caused by the use of cognitive heuristics and schemas. 6 This informal and flawed feedback needs to be supplemented by an MFS that uses valid, reliable, and standardized measures. This system is central to quality improvement, professional development, as well as enhancing accountability. Feedback has been successfully applied outside MH for several decades. 7,8 However the application of a fully implemented MFS is in its infancy in MH. An MFS has been shown to improve outcomes in adult MH, especially for those clients who were either not

Rheumatologists' opinions on the feasibility of a measurement feedback system in rheumatoid arthritis and the influence of motivation.

To assess rheumatologists' opinions about the feasibility of a measurement feedback system in rheumatoid arthritis (RA) and to analyse if motivational aspects play a role in assessing the value of the system and in determining the extent to which it is used. A survey sample (n=105) was randomly selected from participants of a measurement feedback system. A survey questionnaire assessed opinions on system outcome, structures and processes, motivation and overall satisfaction. Survey results are given descriptively and groups differing in motivation are compared. The overall response rate was 62%. The system was generally perceived to fulfil its aims, but the effort required to use the system was rated less positive. Rheumatologists had as their motivation either 'science/obligation' or 'individual patient evaluation'. Rheumatologists with the latter motivation were more satisfied with the measurement feedback system, perceived its feasibility as better, and made more use of it. Motivation for participating in a measurement feedback system has a significant impact on overall satisfaction with the system and the use of the system. Influencing motivation and reduction of the amount of effort required to use the system might increase overall acceptance.