Tool School: Clinical Tools for Measurement-Based Care by Monique Johnson, MD, CCMEP

This Clinical Compass™ article is the first in a series that will be devoted to enhancing clinicians’ commitment to the practice of measurement-based care for patients with mental illness. This article defines measurement-based care and outlines the goals of its implementation. Subsequent Tool School articles will review existing validated assessment instruments used to document and track disease status in patients with mood disorders, anxiety disorders, substance use disorders, and sleep disorders.

To set the stage, let’s recall those SOAP notes—those systematic entries into the patient record that focus on Subjective, Objective, Assessment, and Plan. Certainly, the SOAP format helped us during clinical training to be organized, problem-focused, and to cover all the bases.(1) Covering all the bases, particularly during patient follow-up visits, is of key importance. Too often, clinicians are quick to make an assessment and generate a treatment plan without first obtaining the best subjective and objective information. This is where measurement-based care comes into play.

Measurement-based care involves consistently using validated tools to assess and monitor patient status and to guide treatment choice. In recent years, renewed focus has been placed on measurement-based care as a key component of continuous quality improvement, particularly in mental health.(2-4) Notably, the Institute of Medicine (IOM) report titled Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series outlines that clinicians and provider organizations should measure and continuously improve the quality of the care they provide. Moreover, the IOM suggests that validated tools should serve as clinical decision support for clinicians.(5)

The use of validated assessment tools enhances the ability to gather more information and improve measurement accuracy for various aspects of disease. Most existing tools are itemized symptom questionnaires or rating scales. These validated instruments provide more sensitive measures of the patient’s clinical status than global judgements by the clinician or patient. Thus, decisions about medical interventions are based on a more accurate foundation of information. Additionally, the use of these measurements can be combined with the use of treatment algorithms, so that at critical decision points, appropriate management choices are made.

It seems that at least some patients find such tools very useful, as is evident from the recent increase in popularity of mood charting.(6,7) Also, commentary from the HealthCentral Bipolar Connect website highlights a supportive patient viewpoint.(8)

“How often do we find ourselves in our psychiatrists' office for a 12-minute check-up telling them "I'm fine" or "I'm not doing well" when we have no way to measure or rate that feeling? [Using these tools], our doctor can see how we've been doing over a span of time. Then, we might be able to have a practical interaction with our doctor, based on something more than just guesswork.”

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Reference

1. Sleszynski SL, et al. Standardized medical record: a new outpatient osteopathic SOAP note form: validation of a standardized office form against physician's progress notes. J Am Osteopath Assoc 1999;99:516-529.
2. Hermann RC, et al. Quality indicators for international benchmarking of mental health care. Int J Qual Health Care 2006;18:31-38.
3. Hermann RC, et al. Aligning measurement-based quality improvement with implementation of evidence-based practices. Adm Policy Mental Health 2006;33:636-645.
4. Hermann RC. Improving Mental Healthcare: A Guide to Measurement-Based Quality Improvement. Washington DC: American Psychiatric Press, Inc.; 2005.
5. Committee on Crossing the Quality Chasm. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Institute of Medicine of the National Academies. http://www.iom.edu/Reports/2005/Improving-the-Quality-of-Health-Care-for-Mental-and-Substance-Use-Conditions-Quality-Chasm-Series.aspx. Accessed July 8, 2010.
6. Sachs GS. Strategies for improving treatment of bipolar disorder: integration of measurement and management. Acta Psychiatr Scand 2004;110:7-17.
7. MoodTracker.com FAQ. http://www.moodtracker.com/faq.php. Accessed July 8, 2010.
8. Bergeson S. Measurement-based care: What’s your number today? http://www.healthcentral.com/bipolar/c/116/19830/care-whats-today. Accessed July 8, 2010.