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Behavioral health outcomes management


Behavioral health outcome management (BHOM) involves the use of behavioral health outcome measurement data to help guide and inform the treatment of each individual patient. Like blood pressure, cholesterol and other routine lab work that helps to guide and inform general medical practice, the use of routine measurement in behavioral health is proving to be invaluable in assisting therapists to deliver better quality care.

In behavioral healthcare (mental health and substance abuse treatment) routine health outcomes measurement has expanded beyond aggregating measurements for quality improvement studies and has placed equal emphasis on the therapeutic gain delivered by real-time patient-level outcome feedback. With the $200 billion behavioral health marketplace in a state of public health crisis as defined by the US Surgeon General with most patients receiving substandard care, outcome management is helping to provide quality controls, data and structure for a large subsection (more than 27%) of the US population.

Almost by definition, psychotherapy is a rather unstructured process, leaving many people who are going through the process of guided self-discovery and behavioral change to wonder whether therapy is helping. Tracking progress with repeated administrations of a self-report questionnaire allows both therapist and client to know what is getting better from the perspective that matters most—the patient's.

The data collected through formal (typically self-report) measurement (like the PHQ-9 for depression) has been used to enhance the accuracy of clinical assessments, provide a basis for treatment planning, deliver an objective methodology for tracking treatment progress, alert therapists with clinically proven guidelines to get refractory cases back on track, help prevent hospitalizations with warning guidance, and provide primary care physicians and other referral sources with outcome-based referrals linking new patients to therapists with a proven track record of delivering exceptional care to patients with similar behavioral health needs.

Behavioral healthcare rarely uses genetic markers or blood tests to assist in diagnosing major depression or other behavioral health disorders like schizophrenia and substance abuse. Instead, the field relies on the careful assessment of symptoms, like changes in mood and behavior, to make a formal diagnosis. However, with more than half of behavioral healthcare delivered by primary care physicians where there is rarely sufficient time or expertise to conduct a formal interview, a standardized assessment and screening process using formal questionnaires administered in the waiting room or over the internet are invaluable. Even for behavioral health specialists like psychologists, psychiatrists and social workers who are trained to interview and diagnose behavioral health problems, their efforts are hampered by patient's willingness, or lack thereof, to honestly report relevant symptoms. For example, in an initial interview, only half of patients honestly disclose previous suicide attempts, greatly hampering therapists' efforts to keep patients safe. By contrast, six controlled studies document that patients not only like completing paper-and-pencil or web-based questionnaires, patients are more accurate when they do so, giving therapists and primary care physicians more accurate assessments of client's symptoms and issues, and a new and potentially different perspective than seen in face-to-face interviews.


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