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Date of Graduation
Fall 2019
Document Type
Dissertation
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
Advisor(s)
Jeannie Garber
Abstract
Background: Healthcare is moving toward a value-based system with reimbursement based on performance. Charitable organizations providing health services need to demonstrate positive outcomes for continued grant funding. Measurement-Based Care (MBC) is evidence-based, can improve patient outcomes and objectively document success. Studies show most psychiatric providers do not utilize MBC in their own practices citing lack of time, and a belief that their clinical judgment supersedes a measurement tool. The purpose of the study was to establish the use of patient-reported symptom measurement tools in a non-profit psychiatric clinic and determine if an office-based strategy to proactively and regularly report to providers their patient’s scores affected treatment outcomes and overall adoption of MBC.
Methods: The study entailed an explanatory mixed methods design with a pre-test/post-test quantitative measurement and a semi-structured qualitative interview with providers following data collection. Office staff facilitated completion and electronic medical record entry of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) patient self-report measurement tools for depression and anxiety on each patient at every visit. Trended scores were proactively reported to providers prior to the visit during months 3 through 6. Score comparisons were made prior to and after the reporting period. Qualitative questions explored usefulness of MBC and the effectiveness of proactive reporting.
Results: Dependent t-tests measured differences in the means at three measurement points. A repeated measures ANOVA tested the effects of client gender, provider discipline and treatment modality on scores. Qualitative data was recorded, transcribed, and coded for thematic pattern identification. Results showed significant reduction on scores for both depression and anxiety over the full measurement period with statistically significant decreases in anxiety scores during the intervention period. A between-factors response was found for gender. Qualitative responses showed younger providers more likely to use MBC to guide treatment decisions. MBC was viewed as having utility as an adjunct. All recommended continued office facilitation but wanted control over choice of tool and to see scores in real time.
Conclusion: An office process that assists with routine collection of patient data, consistently reporting it to providers, can facilitate adoption of MBC to guide treatment decisions and produce evidence of positive outcomes. Successful change may be obtained with a team approach to the removal of barriers.
Key words: Measurement-Based Care, outcome monitoring, behavioral health, psychiatry
Recommended Citation
Rea, Deirdre, "The effect of implementing symptom feedback into psychiatric care at a non-profit clinic" (2019). Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019. 29.
https://commons.lib.jmu.edu/dnp201019/29
