Abstract
Background: Mental health disorders pose serious global health challenges, particularly affecting children and adolescents. Early identification and diagnosis of these disorders alongside access to effective mental health treatments are crucial for improving health outcomes in pediatric populations. Measurement-Based Care (MBC), which involves the systematic, longitudinal, and repeated use of patient-reported outcomes of symptoms and functioning, serves as a valuable approach to enhance health service delivery, guide clinical decision-making, and promote patient-centred care. However, the application of MBC in pediatric settings remains limited. We aimed to develop and implement hospital-wide MBC in a pediatric tertiary care centre.
Approach: To facilitate the implementation of MBC for mental health issues, including anxiety and depression, we engaged clinicians and researchers throughout the hospital in envisioning the mental health needs across the hospital. We addressed several challenges during this process, including: (1) determining the appropriate data to collect (e.g., symptoms, functioning, or other relevant outcomes); (2) selecting suitable patient-reported outcome measures (PROMs); (3) integrating MBC data into the electronic medical record (EMR) in real-time; and (4) managing the mental health needs of patients completing PROMs. We utilized Voxe, a youth-friendly electronic PROM application, which enables young patients to submit their mental health data into their EMR and into clinical workflows. The Voxe platform also allows youth to track their symptoms and actively participate in their care alongside healthcare providers. To date, MBC has been implemented in over 15 clinics across the hospital.
Results: Successful implementation of MBC required selection of PROMs that are: (1) brief and user-friendly; (2) clinically relevant; (3) sensitive to longitudinal changes in treatment; and (4) routinely administered during clinical visits. Collaborative review of PROMs by patients and healthcare providers during clinic visits is essential for proactively identifying mental health concerns, evaluating progress, and facilitating shared decision-making. The Voxe platform has been instrumental in overcoming barriers to MBC implementation, effectively integrating youth data and addressing the growing demand for mental health services.
Implications: The ongoing longitudinal assessment of mental health symptoms through the effective implementation of MBC will allow for earlier identification of mental health concerns and diagnoses amongst all youth, especially those who may be hesitant to bring forward their mental health concerns with their healthcare providers. This approach enhances access to timely and effective treatments in a more integrated manner. By addressing the mental health needs of all youth, we aim to improve overall healthcare outcomes for patients and families, ultimately leading to more effective utilization of healthcare resources.