How Are ConnectingCare Outcome Measurement Tools Used?
Patient reported outcome measures (PROMs) are used to create conversations between patients and healthcare professionals that include:
the patient history and experience that may have led them to seek treatment,
their symptoms and functional ability,
their quality of life, and
their level of satisfaction and progress during treatment.
In no way are the ConnectingCare PROMs used to compare therapists or limit the treatment that a patient receives. PROMs provide data that informs conversations between therapists, physicians and patients.
Treatment providers who already use PROMs in Healthcare
Mental Health and Substance use conditions are treated by professionals representing such specialty disciplines as psychiatry, psychology, social work, counseling, marriage and family counseling, as well as physicians in family medicine, internal medicine and many other medical specialties, ob/gyn, oncology.
Methodologies & approaches
Treatment of MH/SUD consists of a variety of methodologies and approaches including medications, numerous “talk therapies,” and novel approaches such as equine therapy, pet therapy, wilderness therapies, cranial electrical therapy, social recovery models, etc. Given the diverse approaches it is challenging for consumers, payers, and practitioners to evaluate what works, for which conditions, over what period of time, and under what conditions.
Tracking response to treatment, quantifying outcomes & informing care
Kenneth Howard’s pioneering work, based upon a dose response methodology and the phase model of therapy, lead to the development of an “Expected Response to Treatment methodology as an empirical approach to document response to therapy and quantify outcomes. This work at Northwestern University (Howard and Kopta) led to work by others: Lambert and Burlingame; Brown; Miller and Duncan; Kraus; and others which all seek to establish an empirical basis for tracking response to treatment, quantifying outcomes, and informing care though technological systems using standardized instruments and statistical algorithms. Such systems are characterized as Routine Outcome Monitoring.
Howard’s pioneering work continue and is embodied in three factors for which patients often seek treatment:
Distressing symptoms burden
Diminished ability to function
In a recent paper, Lamkass, Wampold, and Hoffart (2018) challenge a number of the assumptions of the above mentioned systems constructed to evaluate response to therapy. That article examined the various types of error that occurs when using ROMs or PROMs for that matter. The authors affirm that ROMs (and PROMs) are inherently necessary. We assert that that error can be reduced and measures can be improved when clinicians consider wider purposes.
What do Patient Reported Outcomes Monitoring Systems really measure and for what purposes?
The following is a brief peer reviewed description of what PROM Systems really measure and the potential purposes.
Developing systems that improve quality that can be define as reducing the “burden of disease/symptom status” improving functioning—physical and social, and enhancing well-being are important goals for all of healthcare, and thus of ROM. Mental health however has distance itself from the healthcare field by not adopting medial fields approach identified as Patient Reported Outcomes (PRO) based on Patient Reported Outcome Measures (PROMs). The focus of PRO is to provide information regarding how the patient experiences the treatment, quantifying the patients rating of symptoms, functioning, well-being, quality of life.
ROM & PROM purposes
PROMs elicit from the patient information to inform treatment approach; a medication side-effect may be such that the person stops taking the medication. For example, a medication leads to sexual impotence and the person prefers the anxious feelings over the impotence. PROMs can inform the clinician about this development that leads to a decision about treatment alternatives. It is important to not get “caught up” in the statistical traps of the MH ROMs but to address the importance of standardized feedback on the patient’s experience and response to treatment. The clinician uses this information to build the therapeutic alliance with the patient regarding treatment approach and the expected course of treatment.
Behavioral health executives and Healthplans know that therapists who do not have full schedules often see patients up to 7 times longer than patients are seen by therapists who have full schedules; this applies to patients with the same diagnosis and severity. ROM data has been used to bench mark this pattern in the Oregon Health Plan; county mental health measurements can be used compare county therapists with those private practice.
In Oregon, the Oregon HealthPlan and Commercial insurance payers are collaborating on large studies in 6 counties that can be used to better define medical necessity. A certification process has been proposed based on provider participation outcome measurement. The data nationally estimates that most change takes place in 8 to 16 sessions (50% in the first 8 session); after which authorization for services may be required and approved based on case review.
In the ConnectingCare model PROMs do NOT compare therapists but rather support and protect patients. PROMs support therapist referrals and income by incorporating more than 8 different PROM purposes:
Measurement to document (e.g. quality)
Measurement to coordinate care (e.g. patient progress)
Measurement to improve (e.g. therapy)
Measurement to affirm (e.g. patient progress)
Measurement to protect (e.g. therapists)
Measurement to alert (e.g. therapists)
Measurement to justify (e.g. medical necessity)
AND lastly measurement to compare (e.g. populations)
The popular ROM models are the OQ, PCOMs and ACORN. Those 3 are well documented “measurement to improve” models which have been vetted and are used by researchers nationally and internationally. The OQ, PCOMs and ACORN require additional data to compare therapists.
The ConnectingCare model promotes and supports measurement that protect and inform therapists by demonstrating quality and improving outcomes when measurement is clinically appropriate. Ultimately the data gathered using ROM or PROMs is not as important clinically as how the patient and provider relate to the data and each other.
ConnectingCare measurement and analytics software is designed to gather information pertaining to (1) therapist-patient alliance, (2) core mental health symptoms, (3) complex trauma of childhood, (4) quality of life, (5) substance use, (6) wellness, (7) physical health and (8) medication side effects.
ConnectingCare measurement and analytics software was designed (1) to promote data informed conversations between therapists and patients and (2) to give therapists effective means to respond to audits, (3) to better coordinate care, and (4) meet requirements to provide evidence that demonstrates the medical necessity of care. Measurement occurs when the clinician feels it is clinically appropriate and the client agrees.