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3 Reasons Why Behavioral Health Needs Measurement-Based Care

Measuring progress is an integral part of any behavior-change program. Any fitness trainer will tell you that if you want to increase the number of pushups you can do, the first thing is to do is start counting how many pushups you can do. Measuring progress seems like common sense – so why does behavioral healthcare still lag in measurement-based care? Researchers have validated that various treatments and medicines can improve patient outcomes when measured rigorously. In fact, the very act of measurement itself has been demonstrated to improve patient outcomes. We even have validated assessment tools that can measure the severity of behavioral health conditions that are notoriously difficult to quantify. The tools are there. Now it’s time to use them.


Here are 3 reasons why your organization should make measurement-based behavioral healthcare a priority:


1. Measurement-based care saves lives.

In a JAMA article published last month, oncologists found that measuring patient self-reported outcomes increased median survival in cancer patients by about 5 months. These are patients with cancer, and two-thirds of them died by the end of the study. How could simply measuring their responses to 12 basic questions about self-reported symptoms make them live longer? While the study did not conclude why they observed this effect, one hypothesis is that they received greater responses from nurses and care providers. The same is true in mental health. Studies have shown that when clinics systematically measure patient’s progress, they tend to get better care and get even better than they would in usual care.


2. Measurement-based care changes behavior.

In the oncology example, we see a complex version of the idea that measuring changes behavior. That is, when the patients were prompted to report symptoms, those symptoms were treated more aggressively and more successfully. A simpler version of this principle is demonstrated by Fitbit and other pedometer applications. In randomized controlled trials, just the use of a pedometer alone increases the number of steps a person takes by almost 2,500 steps per day, more than a mile. The same is true in mental health care. A study published in the American Journal of Psychiatry showed that simply measuring response to treatment increased depression remission rates from 29% to 74%. The article goes on to explain that in the measurement-based care group, milder symptoms were caught and treated more aggressively, which likely led to this finding


3. Tracking outcomes improves memory.

Because change is often gradual, it can be difficult to notice when symptoms have improved or worsened. The act of tracking results on standardized scales or any agreed upon metric helps us more accurately recall our progress over time. Atul Gawande demonstrates this point nicely in his piece profiling a headache doctor’s breakthrough with patients who had been resistant to prior treatments. Her trick? She had patients track their peak level and hours of headache in a diary.


As the trainers and diet experts have figured out, tracking progress is the first step towards any real behavior change. In the behavioral healthcare world, we are fortunate to have access to excellent evidence-based treatments and medicines that work. We must now focus on systematically institutionalizing measurement-based care to ensure that patients are receiving the right treatment (and if they are not, to adjust accordingly). In the process, we will change provider behavior for the better and help improve patient outcomes.


Ravi N. Shah, MD, MBA is Assistant Professor of Psychiatry at Columbia University Medical Center and Clinical Advisor at Valera Health.