Beyond PHQ-9: Measurement-Based Care in Psychiatry

“Measurement-Based Care (MBC) entails the systematic administration of symptom rating scales and uses the results to drive clinical decision making at the level of the individual patient,” began Steve Daviss, MD, Chief Medical Officer, M3 Information LLC, at the annual APA meeting in San Diego.

What exactly does this enhanced precision and consistency in disease assessment, tracking, and treatment to achieve optimal outcomes, mean?

Daviss explained that it’s not just doing a Patient Health Questionnaire-9 (PHQ-9) to assess somebody or determine a diagnosis, but also to track those changes over time. While there are challenges in using such tools, primarily incorporating such practices into workflows, their use can increase efficiency.

Because symptom ratings would be directly delivered from the patient, MBC “helps to guide clinical decision-making”. MBC is highly acceptable to patients, so patient engagement is another positive aspect to this process.

Acceptance is important, because the MBC tool should be something that the patient can complete on their own, freeing health care providers to perform their other duties involving treatment of the patient. MBC also facilitates communication within treatment teams and with other providers who might be treating the patient. On MBC related specifically to psychiatry, Daviss said, “MBC also helps to demystify mental health, particularly for primary care providers.”

Daviss discussed various multi-condition tools (MINI, DSM Cross Cutting, BH-Works, M3 Checklist) for psychiatric MBC beyond PHQ-9 (which measures only depression). Daviss described these tools as being broader and more comprehensive than PHQ-9.

Daviss emphasized the utility of multi-condition questionnaires by referencing a 2005 study that revealed 60% of patients with a psychiatric diagnosis display more than one psychiatric condition. “The organizations that set quality standards such as the National Committee for Quality Assurance (NCQA), Joint Commission, US Preventives Services Task Force (USPSTF), and Centers for Medicare and Medicaid Services (CMS) are increasingly recognizing the importance of broader assessments for measurement-based behavioral health,” said Daviss.

Daviss also touted the utility of MBC in population health as it can help provide an overall look at the practice. Additionally, it can be useful when trying to assess how different providers are performing at detecting a particular condition. MBC data can also assist in driving interventions for education to improve performance.

Daviss concluded, “Using MBC in population health as a quality improvement tool even allows you to compare how your program is doing compared to other programs.”