Person-Centered Versus Measurement-Based Care in Mental Health
| Status: | Completed |
|---|---|
| Conditions: | Depression, Schizophrenia, Major Depression Disorder (MDD), Psychiatric, Bipolar Disorder |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/28/2019 |
| Start Date: | August 2014 |
| End Date: | March 31, 2017 |
Amplifying the Patient's Voice: Person-Centered Versus Measurement-Based Approaches in Mental Health
Fifteen minutes is the typical length of an outpatient medication management appointment for
people with serious mental health conditions. These brief interactions with prescribers are
frequently provider-driven with insufficient time focused on the patient's needs and personal
recovery. Shared decision making is a strategy that could improve this interaction. This
study examines how technology can be used in the care process to amplify the voice of the
patient, support shared decisions, and improve treatment outcomes.
Investigators will compare the effectiveness of Measurement-Based vs. Person-Centered Care on
two primary patient-centered outcomes: the patient experience of care with medication
treatment and the level of shared decision making. Investigators hypothesize that:
1. Person-Centered Care will result in greater improvement in patient experience of care
with medication treatment than Measurement-Based Care.
2. Person-Centered Care will result in a greater level of shared decision making during the
medication visit than Measurement-Based Care.
The study team will collect information from patients, caregivers, and clinic staff at
different points in time during the study. Patients will be asked to complete questionnaires,
and additional data on their service use will be gathered. Some patients and providers will
also be interviewed about their experiences with care. Investigators are especially
interested to learn if and how these two approaches are perceived to change medication
treatment, if patients are more satisfied and empowered in their care, and why and how
providers perceive and adopt changes to their clinical care.
people with serious mental health conditions. These brief interactions with prescribers are
frequently provider-driven with insufficient time focused on the patient's needs and personal
recovery. Shared decision making is a strategy that could improve this interaction. This
study examines how technology can be used in the care process to amplify the voice of the
patient, support shared decisions, and improve treatment outcomes.
Investigators will compare the effectiveness of Measurement-Based vs. Person-Centered Care on
two primary patient-centered outcomes: the patient experience of care with medication
treatment and the level of shared decision making. Investigators hypothesize that:
1. Person-Centered Care will result in greater improvement in patient experience of care
with medication treatment than Measurement-Based Care.
2. Person-Centered Care will result in a greater level of shared decision making during the
medication visit than Measurement-Based Care.
The study team will collect information from patients, caregivers, and clinic staff at
different points in time during the study. Patients will be asked to complete questionnaires,
and additional data on their service use will be gathered. Some patients and providers will
also be interviewed about their experiences with care. Investigators are especially
interested to learn if and how these two approaches are perceived to change medication
treatment, if patients are more satisfied and empowered in their care, and why and how
providers perceive and adopt changes to their clinical care.
An important attribute of patient-centered care is the active engagement of patients in
making health care decisions. Despite advances in health care to support shared decision
making, the patient experience of mental health care remains provider-driven. For individuals
with serious mental illness (SMI), important decisions involve the choice of medications and
how best to use medications to support individualized, person-centered recovery goals. By
comparing the effectiveness of two approaches for promoting shared decision making around
medication treatment on outcomes that matter most to individuals with SMI, the proposed study
will advance ongoing and much-needed efforts to evolve toward a more personalized,
recovery-oriented system of mental health care.
Building on the work of a multi-stakeholder collaboration, investigators will compare two
interventions, Person-Centered Care and Measurement-Based Care, both focused on
patient-prescriber interactions around medication treatment. The investigators' study will
address three questions that patients have identified as important to them:
1. Are there ways I can be more involved in my care that will result in better outcomes?
2. How likely am I to benefit from improved communication with my prescriber?
3. How will shared decision making support my personal recovery and overall wellness?
Study aims will compare the effectiveness of measurement-based vs. person-centered care on
the patient experience of care and on shared decision making. Investigators hypothesize that:
1. Person-Centered Care will result in greater improvement in patient experience of care
with medication treatment than Measurement-Based Care.
2. Person-Centered Care will result in a greater level of shared decision making during the
medication visit than Measurement-Based Care.
In addition, investigators will compare the effectiveness of the two approaches on seven
secondary patient-centered outcomes, and examine differences in outcomes within the two
approaches for subgroups of patients based on their: (1) current status regarding psychiatric
medication, (2) engagement with the interventions, and (3) illness severity.
The target population is 2,460+ Medicaid-enrolled adults with SMI who receive medication
treatment at one of 15 community mental health centers (CMHC). Using a prospective
cluster-randomized design with a mixed-methods approach, investigators will randomly assign
CMHCs to one of the two interventions. Quantitative (self-report, claims, process) and
qualitative (interviews) data will be gathered at multiple time points across the two-year
intervention period (baseline, 8 months, 16 months, and 24 months). Multi-level longitudinal
analyses will examine the impact of the interventions on outcomes and explore the role of
moderating variables. Qualitative data will be used to understand patient and stakeholder
perspectives and to promote dissemination and sustainability.
making health care decisions. Despite advances in health care to support shared decision
making, the patient experience of mental health care remains provider-driven. For individuals
with serious mental illness (SMI), important decisions involve the choice of medications and
how best to use medications to support individualized, person-centered recovery goals. By
comparing the effectiveness of two approaches for promoting shared decision making around
medication treatment on outcomes that matter most to individuals with SMI, the proposed study
will advance ongoing and much-needed efforts to evolve toward a more personalized,
recovery-oriented system of mental health care.
Building on the work of a multi-stakeholder collaboration, investigators will compare two
interventions, Person-Centered Care and Measurement-Based Care, both focused on
patient-prescriber interactions around medication treatment. The investigators' study will
address three questions that patients have identified as important to them:
1. Are there ways I can be more involved in my care that will result in better outcomes?
2. How likely am I to benefit from improved communication with my prescriber?
3. How will shared decision making support my personal recovery and overall wellness?
Study aims will compare the effectiveness of measurement-based vs. person-centered care on
the patient experience of care and on shared decision making. Investigators hypothesize that:
1. Person-Centered Care will result in greater improvement in patient experience of care
with medication treatment than Measurement-Based Care.
2. Person-Centered Care will result in a greater level of shared decision making during the
medication visit than Measurement-Based Care.
In addition, investigators will compare the effectiveness of the two approaches on seven
secondary patient-centered outcomes, and examine differences in outcomes within the two
approaches for subgroups of patients based on their: (1) current status regarding psychiatric
medication, (2) engagement with the interventions, and (3) illness severity.
The target population is 2,460+ Medicaid-enrolled adults with SMI who receive medication
treatment at one of 15 community mental health centers (CMHC). Using a prospective
cluster-randomized design with a mixed-methods approach, investigators will randomly assign
CMHCs to one of the two interventions. Quantitative (self-report, claims, process) and
qualitative (interviews) data will be gathered at multiple time points across the two-year
intervention period (baseline, 8 months, 16 months, and 24 months). Multi-level longitudinal
analyses will examine the impact of the interventions on outcomes and explore the role of
moderating variables. Qualitative data will be used to understand patient and stakeholder
perspectives and to promote dissemination and sustainability.
Inclusion Criteria:
- Adults age 18 and older
- Non-SMI (anxiety, post-traumatic stress disorder, depression, dysthymia, depression
NOS) or SMI (schizophrenia, bipolar disorder, major depression)
- Receiving services at one of the 15 participating community mental health centers
- At least three claims for medication management services in past 12 months
- Insured by Community Care Behavioral Health Organization
Exclusion Criteria:
- Assessed by clinicians as being too ill to be treated on an outpatient basis
- Unable to speak, read, or understand English at the minimum required level
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