Measurement-based care (MBC) gives healthcare providers the essential data they need to inform treatment decisions and improve patient outcomes. Standardized cognitive assessment tools are especially important for brain care, and can improve workflow for neurologists, mental health providers, primary care doctors, and other healthcare professionals.
In this article, we will explore practical steps for MBC implementation in a clinical setting, as well as which assessment tools are best for tracking patient progress.
What Is Measurement-Based Care?
Measurement-based care is a systematic approach to treatment that uses standardized tools to regularly assess patient symptoms and progress. These assessments occur before, during, and after treatment to guide clinical decision making.
Along with tracking specific symptoms, measurement-based care can help track other elements of treatment progress, including:
- The perceived quality of patients’ relationships with providers
- The degree of satisfaction patients are feeling in their lives
- How prepared patients are to take on necessary lifestyle changes
- Overall behavioral health and its impact on patients’ quality of life
Measurement-based care practices are patient-centered, and strive for enhanced patient engagement. Clinical data collected via objective assessment tools can lend credence to suggested treatment options for uncertain patients, and create a therapeutic alliance between patients and providers.
One study found that approximately 30% of participants with dementia were not aware of the extent of their cognitive decline. Implementing a regular cognitive screen can help patients and their caregivers identify signs of deterioration and contribute to a personalized treatment plan.
What are the Core Components of Measurement-Based Care?
Four core components of measurement-based care include:
- Routine assessments of patient symptoms, progress, and treatment outcomes. This would ideally happen before the clinical encounter, and could be achieved through at-home behavioral health questionnaires.
- A practitioner review of the data that includes time to do any necessary additional research to inform treatment decisions.
- A patient review of the data with the provider where they have time to ask questions and establish a personalized treatment plan.
- Collaborative reevaluations of the treatment plan based on the data gathered about client progress.
Is Measurement-Based Care the Same as Evidence-Based Practice?
Measurement-based care and evidence-based practice are closely tied together, but are slightly different. Measurement-based care focuses on gathering patient data to track progress and improve clinical outcomes. Evidence-based practice is a care model that prioritizes using the best available resources for clinical decision-making, including scientific research and clinical expertise.
Both of these practices are data-driven and patient centered, and use patient reported outcomes as essential data.
Examples of Measurement-Based Care
In his book Prevention of Treatment Failure, Dr. Michael J. Lambert survey findings indicate that although 85% of therapists believed their patients had improved, actual improvement rates were only around 40 to 60%. While clinical diagnosis often relies on a combination of subjective measure and data, utilizing credible objective assessment tools in cognitive and mental health services helps gather essential client data that can be used to supplement subjective assessment and diagnosis.
Here are examples of measurement-based care for cognitive and mental health treatment:
Cognitive Care
Cognitive testing can be used to track patient progress or level of impairment in age-related cognitive decline, neurodegenerative and developmental disorders, ADHD, brain injury and mental health conditions. These tests can be used to assess specific components of cognitive ability including memory, executive function, language, and more.
The Montreal Cognitive Assessment (MoCA) is a cognitive assessment tool that screens for dementia and mild cognitive impairment (MCI). It’s a commonly used tool for gathering data on a patient’s cognitive condition.
Its strengths include that it only takes 10 minutes to complete, and has high sensitivity—when it comes to severe cognitive impairment. However, it’s limited in its ability to detect earlier signs of mild cognitive impairment, and is often done on paper, leading to laborious manual record keeping.
More robust cognitive tests, such as those offered in Creyos Health, can equip healthcare providers to detect earlier indicators of cognitive conditions, get a baseline of cognitive health, test routinely, and demonstrate longitudinal and meaningful change in brain health.
Read more: Beyond the MoCA Test: How to Improve Early Dementia Detection
Mental health
Measurement-based care is also useful for tracking symptoms of mental health disorders such as depression, anxiety, stress and mood disorders, and others. Comprehensive testing can take comorbidities into consideration, and document patient-reported outcome measurements.
Examples include:
- Patient Health Questionnaire (PHQ-9) measures symptoms of depression.
- Generalized Anxiety Disorder screener (GAD-7) measures symptoms of anxiety.
Along with assessing mental health symptomatology, another example of measurement-based care is a patient satisfaction quiz related to mental health care. A 2024 report from Canadian Alliance on Mental Illness and Mental Health (CAMIMH) found that the majority of surveyed Canadians gave publicly-funded mental health services an average grade of “F” in experiences including:
- Wait times to access publicly-funded mental health care services
- Confidence in their ability to find mental health care services in a timely manner
- Satisfaction in the government’s evaluation of and efforts to improve mental health access
As work continues to be done in the mental health sector, mental health providers can build trust with patients by collecting and implementing feedback in their own clinical processes.
Strengths and Limitations of Measurement-Based Care
Like any health care model, measurement-based care has unique strengths and limitations for patients and healthcare providers.
Strengths
Measurement-based care strategies increases the quality of clinical care by:
- Improving patient-centered care practices by encouraging collaboration between patients and providers, and empowering patients to lead their care.
- Gather the most relevant data regarding cognitive, mental, and behavioral health to help identify trends and improve outcomes.
- Streamline reports for all members of a patient’s care team, potentially reducing the redundancy of patient progress notes.
Limitations
Despite the benefits of measurement-based care, less than 20% of providers are currently integrating MBC into their clinical practice.
Some limitations and barriers may include:
- Self-reporting inconsistencies. While self-report measures provide insight into patient perspectives, psychiatric symptoms might skew results. For example, in cases of some mood disorders, individual snapshots of a patient’s mood might not give an accurate look at the overall picture of a patient’s progress.
- Resistance to change on the part of providers who may be unfamiliar with the benefits afforded by a measurement-based care model or face barriers such as limited training and education, lack of trust, fatigue, and culture clash.
- Patient concerns about data privacy and confidentiality. One 2023 article reported study findings that 95% of surveyed patients were concerned about a medical data breach. Thorough healthcare cybersecurity is necessary for protecting patient records.
Benefits of Measurement-Based Care
Measurement-based care can help track patient symptoms at baseline and over the trajectory of the treatment process. Cognitive, mental, and behavioral health assessments save patients and providers guesswork, and create more time for the relationship-building that most patients want.
85% of primary care providers wish they had more time to get to know their patients, but 83% say the demands of their job often prevent this opportunity. The right assessment tools provide clinicians with data as a jumping off point for creating personalized treatment that feels attainable for patients.
For patients, measurement-based care:
- Helps patients self-identify changes to their symptoms and empowers self-advocacy
- Reduces the need for patients to repeat themselves to different providers
- Improves the quality of preventative care for better long-term health outcomes
- Significantly reduces treatment time
For providers, measurement-based care helps:
- Improve therapeutic alliance and increase patient compliance
- Monitor treatment outcomes and identify early indicators of cognitive decline
- Reduce the administrative workload associated with healthcare burnout
- Support clinical judgment and build confidence in the diagnostic process
When talking about Creyos cognitive assessment tools, Gabrielle Thompson, FNP-C and Founder of GT Healthcare, stated: “What Creyos helps with most is helping me confirm what I think is going on and find out if there’s a possibility of something else causing the same symptoms. I can narrow down a diagnosis using measurements like scoring.”
How to Incorporate Measurement-Based Care Into Practice
While the benefits of measurement-based care are clear, changing clinical practice is often challenging for healthcare workers. Along with this, many primary care providers are still uncertain about the effectiveness of cognitive screening tools—specifically pen-and-paper tests such as the Mini-Mental Status Exam MMSE, Clock Drawing, Delayed Word Recall.
Computerized cognitive assessments with more robust testing and reporting capabilities, like Creyos Health, are designed to address the issues physicians have had with traditional tools.
In addition, preparation and education for staff members can help to ease the transition without adding more administrative labor.
One 2018 review of MBC implementation (JAMA, Lewis, Boyd, Puspitasari, et al.) in behavioral health services suggested the following ten steps for providers:
- Harmonize terminology and specify MBC’s core components. Measurement-based care has been referred to using at least 16 different terms across 17 countries. Clarity around terminology will make sure the whole health team is on the same page about a new clinical process.
- Develop criterion standard methods for monitoring fidelity and reporting quality of implementation. The data that cognitive, behavioral, and mental health assessment tools gather is most accurate when the tools are optimized for use across settings and practitioners. Importance should be placed on establishing both internal and external validity within adopted methods.
- Develop algorithms that leverage MBC to inform care. While personal assessment tools can be useful at multiple stages of the therapeutic journey, 33% of psychotherapists report that they do not use surveys when treating PTSD with cognitive behavioral therapy. A clear guide on when to use which surveys or assessment measures can help improve therapeutic alliance and gather new information about patients.
- Test putative mechanisms of change across varied contexts. Tracking what MBC strategies are conducive to positive change within practice can help improve treatment planning moving forward.
- Develop or use combinations of brief and psychometrically strong measures. Mental health comorbidities are very common, and so using multiple short but scientifically-backed assessment tools can help form a more comprehensive picture of a patient’s individual experience.
- Assess the timing of administration needed to optimize patient outcomes. Studies suggest that up to 35.2% of American adults over 70 display signs of mild cognitive impairment. Determining how often to run cognitive health tests can help track symptoms of cognitive decline and make sure patients get the support they need. Learn more about how you can optimize assessment by combining cognitive tests and psychological/health questionnaires efficiently on one platform using Creyos.
- Streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability. Streamlining and simplifying the data that is collected will make it easier for providers to interpret the results and share them among the health care team.
- Identify discrete strategies to support implementation. Administrative overload is a key factor contributing to burnout among physicians. The smoother the transition is to a measurement-based model, the more likely it is to be followed.
- Make evidence-based policy decisions regarding administration and data usage. In one study, mental health providers stated that implementing MBC helped treatment decisions in 93% of visits with depression patients. Measurement-based care is a part of evidence-based practice, which extends all the way through to implementing new policies.
- Align reimbursement structures to incentivize evidence-based practices. Using the correct CPT billing codes can cover many behavioral health assessments, such as the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) questionnaires. They can also cover neuropsychological testing and cognitive assessments.
Read more: How to Bill Using CPT Code 96132 for Neuropsychological Testing
Measurement-Based Cognitive Tools to Support Clinical Decision Making
The success of measurement-based care comes down to the quality of its assessment tools, as well as how easy they are to implement. These tools should be research-backed, standardized, and user-friendly.
Validated through research in over 400 peer-reviewed studies, the Creyos platform offers a suite of brain health assessment tools with features including:
- A set of 12 online cognitive tasks that collectively assess multiple domains of cognition and are able to detect signs of impairment that may relate to dementia, Alzheimer’s disease, ADHD, mental health disorders, brain injuries, and more
- Digitized questionnaires for mental and behavioral health screening
- Pre-made, scientifically-validated protocols for conditions including ADHD and dementia
- Easy-to-interpret data reports that integrate with electronic health records
With tools that can be used in-clinic or at home, Creyos makes testing cognitive function easy for patients and providers.
Creating Personalized Treatment Plans With MBC
When it comes to cognitive, behavioral, and mental health, standardized assessment tools are a powerful resource for providers and patients alike. Patients who understand the reasoning behind their treatment plan are more likely to be compliant, and measurement-based care provides them with informative data.
This care model also encourages patients to express their thoughts and feelings, which leads to a more personalized treatment plan. Mental and cognitive health treatment does not have a one-size-fits all model, and the data providers gather helps address individual patient needs and capacity.