Abstract
Introduction: Measurement-Based Care (MBC) enlists the use of validated Patient-Reported Outcome Measures (PROMs), in a systematic and repeated fashion before or during clinical encounters with the aim of informing treatment care decisions. While MBC has shown superior treatment outcomes compared to usual care in physical health conditions, it remains underutilized in pediatric mental healthcare. Recognizing this gap, as part of our hospital-wide Mental Health Strategy, we embarked on developing a comprehensive approach to MBC system to identify and respond to emerging and already present, mental health needs across physical health clinics in a timely and collaborative manner.
Methods: An environmental scan involved key stakeholders, including physician leaders, clinical operational directors, allied health staff, and Youth and Family Advisory committee members. Focus groups emphasized the necessity of implementing standardized mental assessment tools hospital-wide. Early identification of mental health needs and the establishment of standardized metrics for common conditions were identified as priorities. Surveys revealed anxiety and depression as predominant concerns. A review identified validated PROMs and implementation best practices.
Measurement-Based Care Design and Implementation Strategy: A steering committee and cross-functional working group were established to oversee the initiative. Key success factors were identified, which emphasized the need for brief, validated, and user-friendly tools integrated into the electronic medical record (EMR). Extensive education for both patients and providers on the value and implementation of MBC emerged as critical. Clinical workflows and implementation strategies were designed for an anxiety and depression PROM accessed through a patient-friendly application and integrated into the hospital EMR. The design and implementation strategy were presented to the Family Advisory committee for review and feedback. The Plan-Do-Study-Act methodology will be employed for iterative process improvement during a pilot phase, including in-clinic observations, quantitative data collection, and provider and patient feedback.
Early Pilot Evaluation: Quantitative and qualitative data, including assessment score variability, referral trajectories, and provider feedback, will be collected during the pilot phase. Baseline data across our pilot clinics will inform future resource needs and volumes.
Knowledge Translation and Dissemination: A knowledge translation plan has been crafted to effectively disseminate education and training materials for implementation and utilization of MBC to clinics in the pilot phase. This includes live demonstrations of the approach to MBC during clinical meetings, and compilation of essential resources to support mental health needs, including creation of case scenarios. Additionally, a focus was on the production of informative flyers and handouts for patients about the initiative, and the recruitment of volunteers to facilitate the registration processes for patients. Further, all patient-facing materials underwent a thorough review and collaborative design process involving patient and family advisors.
Conclusion: The implementation of a hospital-wide MBC approach to pediatric mental healthcare is a critical step toward achieving holistic, integrated care. By addressing barriers, designing effective workflows, and conducting a comprehensive pilot evaluation, our initiative aims to enhance the quality of patient care and contribute to the broader goal of integrating mental health metrics at multiple levels within the healthcare system.