The impact of measurement based care at scale: examining the effects of implementation on patient outcomes and provider behaviors

Introduction Measurement-based care (MBC) is an evidence-based practice; however there are challenges associated with implementing and sustaining this practice in care. This study examined the outcomes of an organization-wide implementation of MBC in a technology-supported psychotherapy practice. Outcomes were patient symptom change, clinician behaviors, and clinician performance. Methods A total of n = 18,721 patients and 755 clinicians were included in the 6-month implementation. Change efforts targeted organizational alignment, technology integration, education and support, and cultural and operational change. Outcomes were assessed across three phases: pre-implementation, implementation, and post-implementation. Primary outcome measures for patients were percent change on the PHQ-9 and GAD-7. Estimates of differences between phases of implementation were computed using linear mixed effects models, adjusted for patient characteristics. Clinician behaviors associated with MBC were extracted from progress notes. Changes in individual clinician performance were assessed for clinicians with sufficient data across the implementation phases. Results Patient outcomes improved significantly from pre- to post-implementation by approximately 5 percentage points for all outcomes. This represents a relative improvement of 23.5% on a combined PHQ-9 and GAD-7 measure. Clinicians demonstrated significant increases in MBC-related documentation behaviors. Among clinicians with sufficient data, 95% showed evidence of improved performance. Notably, clinicians whose baseline performance was superior showed greater improvements in performance. Discussion Overall, this study suggests that structured MBC implementation was associated with improved patient outcomes, clinician behavior change, and clinician performance, although causal attributions are not possible given the retrospective non-randomized design. These results have implications for scalable implementation approaches in regular practice settings.