title: A Tipping Point for Measurement-Based Care.
abstract: Measurement-based care involves the systematic administration of symptom rating scales and use of the results to drive clinical decision making at the level of the individual patient. This literature review examined the theoretical and empirical support for measurement-based care.
  
  
  
  Articles were identified through search strategies in PubMed and Google Scholar. Additional citations in the references of retrieved articles were identified, and experts assembled for a focus group conducted by the Kennedy Forum were consulted.
  
  
  
  Fifty-one relevant articles were reviewed. There are numerous brief structured symptom rating scales that have strong psychometric properties. Virtually all randomized controlled trials with frequent and timely feedback of patient-reported symptoms to the provider during the medication management and psychotherapy encounters significantly improved outcomes. Ineffective approaches included one-time screening, assessing symptoms infrequently, and feeding back outcomes to providers outside the context of the clinical encounter. In addition to the empirical evidence about efficacy, there is mounting evidence from large-scale pragmatic trials and clinical demonstration projects that measurement-based care is feasible to implement on a large scale and is highly acceptable to patients and providers.
  
  
  
  In addition to the primary gains of measurement-based care for individual patients, there are also potential secondary and tertiary gains to be made when individual patient data are aggregated. Specifically, aggregated symptom rating scale data can be used for professional development at the provider level and for quality improvement at the clinic level and to inform payers about the value of mental health services delivered at the health care system level.
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: John C
authors: JC
authors: Fortney
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: Jürgen
authors: J
authors: Unützer
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: Glenda
authors: G
authors: Wrenn
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: Jeffrey M
authors: JM
authors: Pyne
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: G Richard
authors: GR
authors: Smith
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: Michael
authors: M
authors: Schoenbaum
authors: Dr. Fortney and Dr. Unützer are with Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (e-mail: fortneyj@uw.edu ). Dr. Fortney is also with the HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Veterans Healthcare System, Seattle. Dr. Wrenn is with the Department of Psychiatry, Morehouse School of Medicine, Atlanta. Dr. Pyne and Dr. Smith are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock. Dr. Pyne is also with the HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock. Dr. Schoenbaum is with the Department of Epidemiology and Economics, Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland. Dr. Harbin is a consultant in Baltimore.
authors: Henry T
authors: HT
authors: Harbin
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data*
keywords: Health care reform; Measurement-based care; Psychiatric assessment; Rating scales