Measurement-based care implementation in a Veterans Affairs primary care-mental health integration program

Area of Science:

• Behavioral Health
• Primary Care Integration
• Implementation Science

Background:

• Measurement-based care (MBC) systematically uses validated tools to guide clinical decisions and treatment planning.
• Despite proven benefits for clinicians and patients, MBC is underutilized in clinical settings.

Purpose of the Study:

• To examine the effectiveness of an MBC implementation plan.
• To assess changes in clinician MBC behaviors over 18 months.
• To evaluate the utility of the theory of planned behavior in guiding MBC implementation.

Main Methods:

• A large, integrated primary care program at a Veterans Affairs hospital.
• An 18-month implementation plan informed by the theory of planned behavior.
• Multiple data sources: self-report clinician data and aggregated clinic data.

Main Results:

• Increased administration of symptom measures per clinical encounter and per patient.
• Decreased ratio of patients receiving measures to total patients treated, indicating wider MBC adoption.
• Positive clinician attitudes toward MBC and increased measure use at assessment and termination.

Conclusions:

• The theory of planned behavior effectively guided systematic MBC implementation.
• The study demonstrated increased MBC utilization in integrated primary care.
• Identified MBC implementation challenges and provided recommendations for practice.