Examining Real-World Implementation of Measurement-Based Care and its Influence on Emergency Department Visit Risk...

The practice of using validated rating scales to guide treatment-measurement-based care (MBC) remains underutilized in behavioral health. This study examined the association between real-world MBC implementation, ascertained by measure completion, and emergency department (ED) visits. A retrospective cohort design made use of medical insurance claims data (2015-2023) to examine adult psychiatric outpatients exposed to real-world MBC ("MBC" sample; n = 524); 482 were propensity score-matched to patients who received care as usual ("CAU" sample; n = 964). The index visit was the date of registry enrollment for the MBC sample and the first psychiatric encounter while enrolled for the CAU sample. Time-to-event and negative binomial models were used to estimate hazard ratios (HRs) and incidence rate ratios (IRRs) for ED visits. The overall sample included 1,488 patients (63% female and 44 years old, on average). Among the MBC sample, 171 (33%) experienced at least 1 ED visit in one year of follow-up versus 299 (31%) in the CAU sample. There was no significant group difference in time to the first ED visit. However, the MBC sample had a 34% lower ED visit rate (IRR = 0.66; 95% CI: [0.54, 0.80]). Compared to patients who received MBC at less than 6% of their visits, those who received MBC at 15% or more had lower ED visit risk (HR = 0.61 [0.40, 0.94]; median time to ED visit 123 days vs. 101, among those who visited). Completion of measures at as little as 15% of behavioral healthcare visits was associated with significantly fewer ED visits in a dose-dependent manner.