(PS8-53) A Real World Evaluation of a Technology-enabled Measurement Based Care System

Abstract Text:

Introduction: Measurement-Based Care (MBC), an evidence-based practice that includes the collection, sharing, and use of patient data to collaboratively guide clinical decision-making, can improve clinical outcomes when used effectively. Scaling MBC, however, faces challenges— including complexity, high provider burden, and low engagement, leading to < 20% provider adoption (Jensen-Doss et al., 2018). Using technology to collect data, boost adherence, and integrate MBC into clinician workflows offers a promising solution. This study describes outcomes of a tech-enabled practice using MBC and treating a diverse outpatient population. Clinicians were required to complete a MBC education series on how to use MBC in their practice and received oversight and coaching from their clinical managers.

Methods: This retrospective study analyzed data from 2984 adults who initiated outpatient psychotherapy at Two Chairs from January 1 - June 30, 2024 and had PHQ-9 or GAD-7 scores >10 at their first therapy session. Prior to each therapy session, clients were automatically prompted to complete standardized self-report measures of depression (PHQ-9) and anxiety (GAD-7) symptoms and therapeutic alliance. Data was ingested real-time into a secure provider platform, enabling progress tracking, analytics, and providing clinical decision support.
The following outcomes were assessed at session 12 or the last available data point between sessions 4-11: (1) Recovery: PHQ-9 < 10, GAD-7 < 10; (2) Reliable Improvement: improvement of ≥5 on PHQ-9, improvement ≥4 on GAD-7; (3) Remission: PHQ-9 < 5, GAD-7 < 5.

Results: The 2984 adults were 38.4 years on average (SD=13.6), 60% women, 23% men, 6% trans/nonbinary/other, 11% unknown gender, and 43% non-Hispanic white. 78% used HMO insurance to access care. MBC survey completion rate was 96%.

Clients with PHQ-9 baseline scores >10 (n=2465) had a mean PHQ-9 baseline score of 14.5 (SD=3.8) and mean outcome score of 9.5 (SD=5.5; Cohen’s d=0.92). At the outcome session, 55% (95% CI: 53%, 57%) recovered, 53% (95% CI: 51%, 55%) reliably improved, and 20% (95% CI: 18%, 21%) met remission.

Clients with GAD-7 baseline scores >10 (n=2204) had a mean GAD-7 baseline score of 13.8 (SD=3.1) and mean outcome score of 8.7 (SD=5.1; Cohen’s d=1.03). At session 12, 61% (95% CI: 59%, 64%) recovered, 64% (95% CI: 62%, 66%) reliably improved, and 21% (95% CI: 19%, 22%) met remission.

Conclusions: These results suggest that digital tools paired with training and clinical oversight can promote high adherence of MBC and strong clinical outcomes. The model described provides evidence for how to promote evidence-based practices at scale.

Limitations: Limitations include a lack of assessment of non-depressive or anxiety symptoms. Clinicians were required to complete MBC training and received ongoing support, limiting generalizability to settings where this level of oversight is not feasible. Long-term follow-up is also needed to assess the sustained impact of the model on patient outcomes.