Clinics are strongly encouraged to utilize patient-level metrics to inform treatment planning for patients in the clinic. This is consistent with guidelines for measurement-based care, and yields many benefits. Clinic leaders are also encouraged to regularly examine how the clinic is functioning using several clinic-level metrics. These types of measures inform and quantify the results of process improvement efforts within a clinic.
We will discuss patient level metrics and associated toolkit items first, and then review the need for clinic level metrics and the toolkit items that support collecting and using these measures.
Collect and use patient level metrics: Collecting outcome data can be challenging, as patients may not agree to regularly complete the measures, providers may resist the process due to the additional time commitment or because they are concerned that they may be judged on performance based on this data. Even after collecting outcomes data, there can be challenges to integrating this type of data into treatment planning decisions. The toolkit has multiple items to help address these challenges so that you can 1) routinely use the BHDP platform to collect the outcome data for clinic patients and 2) have providers examine this outcomes data in a systematic manner for treatment planning.
The Best Practices in Implementing and Utilizing Patient-Level Outcome Measures training deck has information on the benefits of collecting and using outcome measures data, including how to address common challenges to collecting and integrating this information into treatment planning. This is a great starting point to learn more about improving the use of outcome measures in your clinic. You can also look at the factsheet, Models for Implementing Outcome Measures to see a breakdown of the pros and cons of various models of implementing outcome measures in the clinic. There is also a template for a Patient-Level Outcome Measures SOP/OI, which can help with standing up the use of BHDP within your clinic.
In order to increase the ease of collecting outcome measures, the Toolkit also has factsheets for providers on commonly used outcome measures in DoD mental health, such as the Behavior and Symptom Identification Scale (BASIS), Alcohol Use Disorders Identification Test (AUDIT), Brief Addiction Monitor (BAM), Patient Health Questionnaire (PHQ), Generalized Anxiety Disorder Scale (GAD), Insomnia Severity Index (ISI), PTSD Checklist (PCL), and Columbia Suicide Severity Rating Scale (C-SSRS) . These are meant to help providers feel more comfortable with collecting and interpreting these measures. Additionally, we have handouts for providers on the Benefits of Using Outcome Measures, Best Practices in Administering Patient-Level Outcome Measures, DoD Recommended Outcome Measures for Psychological Health, and Steps to Change PCL Frequency in BHDP.
There is a handout for patients that helps address some of the Frequently Asked Questions: Outcome Measures. This factsheet can help providers motivate patients to continue completing these measures.
Once collected, information from outcome measures should be integrated into treatment planning decisions. Detailed information on how to do this is provided in the Treatment Planning deck from the Patient Management Module. This training provides information on using treatment plans, with additional emphasis on special groups of patients: those who are subclinical, under-engaged, or seeking administrative outcomes. The module also has excellent information and tools to help manage special populations
Collect and use clinic level metrics:
The Best Practices in Implementing and Utilizing Clinic Level Outcome Measures training deck has information on the benefits of collecting and using clinic level metrics data, including what measures are most likely to be useful. This is a great starting point to learn more about what measures your clinic might benefit from tracking.
Example clinic level metrics include: average wait times for follow up appointments, types of diagnoses over time, high-utilizer patients, return to duty rate and rate of hospitalization for outpatients. The deck provides an overview of how to secure the data for these metrics, and the toolkit has a step-by-step Guide to Creating Clinic Level Reports in Excel. This document covers how to request data from your command’s M2 department and modify the data in excel to produce a number of graphs and reports.
Relevant toolkit items: Patient level Metrics
| Item Name | Description | Audience |
|---|---|---|
| Best Practices in Implementing and Utilizing Patient Level Outcome Measures Slides (PDF) Slides (PDF with notes) |
Training presentation implementing patient-level outcome measures within the clinic. | Clinic Managers |
| Benefits of Using Outcome Measures | Fact sheet describing the benefits of using outcome measures with patients. | Providers |
| DoD Recommended Outcome Measures for Psychological Health | Fact sheet summarizing common DoD/VA recommended outcome measures to include scoring and interpretation. | Providers |
| Steps to Change PCL Frequency in BHDP | Handout providing step-by-step instructions for changing the frequency with which the PCL is administered in BHDP to facilitate monitoring at each visit. | Providers |
| PTSD Checklist (PCL) | Fact sheet regarding the use of the PCL to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Patient Health Questionnaire (PHQ) | Fact sheet regarding the use of the PHQ to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Alcohol Use Disorders Identification Test (AUDIT) | Fact sheet regarding the use of the AUDIT to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Behavior and Symptom Identification Scale (BASIS) | Fact sheet regarding the use of the BASIS to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Brief Addiction Monitor (BAM) | Fact sheet regarding the use of the BAM to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Columbia Suicide Severity Rating Scale (C-SSRS) | Fact sheet regarding the use of the C-SSRS to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Generalized Anxiety Disorder Scale (GAD) | Fact sheet regarding the use of the GAD to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Insomnia Severity Index (ISI) | Fact sheet regarding the use of the ISI to include availability, scoring, interpretation, and treatment planning application. | Providers |
| Frequently Asked Questions: Outcome Measures | Fact sheet addressing questions patients may have about the need to complete outcome measure or how the information will be used. | Providers |
| Models for Implementing Outcome Measures | Handout outlining the pros and cons of different types of outcome measures and frequency of measure | Clinic Managers |
| Best Practices in Administering Patient-Level Outcome Measures | Handout outlining the best practices in administering patient level outcome measures including patient messaging, patient status and environmental variables, and how to instruct staff in administration and interpretation | Clinic Managers |
| SOP/OI for Patient-Level Outcome Measures | Customizable standard operating procedure to establish clinic procedures for the administration, scoring, and use of patient level outcome measures. | Clinic Managers |
Relevant toolkit items: Clinic level Metrics
| Item Name | Description | Audience |
|---|---|---|
| Best Practices in Implementing and Utilizing Clinic Level Outcome Measures Slides (PDF) Slides (PDF with notes) |
Training presentation covering how to implement clinic-level outcome measures within the clinic. | Clinic Managers |
| Guide to Creating Clinic Level Reports in Excel | This document provides simple step-by step instructions to walk the user through the process. The main steps covered are: Requesting data from the DoD medical data repository (M2), Preparing the data for use and Steps for creating PivotTables and PivotCharts. In addition to these general instructions, this guide provides the steps to create specific reports that can be used to understand clinic function. |
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