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Open Access 01-12-2015 | Study protocol

Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial study protocol

Authors: Cara C. Lewis, Kelli Scott, C. Nathan Marti, Brigid R. Marriott, Kurt Kroenke, John W. Putz, Peter Mendel, David Rutkowski

Published in: Implementation Science | Issue 1/2015

Abstract

Background

Measurement-based care is an evidence-based practice for depression that efficiently identifies treatment non-responders and those who might otherwise deteriorate [1]. However, measurement-based care is underutilized in community mental health with data suggesting fewer than 20 % of behavioral health providers using this practice to inform treatment. It remains unclear whether standardized or tailored approaches to implementation are needed to optimize measurement-based care fidelity and penetration. Moreover, there is some suggestion that prospectively tailored interventions that are designed to fit the dynamic context may optimize public health impact, though no randomized trials have yet tested this notion [2]. This study will address the following three aims: (1) To compare the effect of standardized versus tailored MBC implementation on clinician-level and client-level outcomes; (2) To identify contextual mediators of MBC fidelity; and (3) To explore the impact of MBC fidelity on client outcomes.

Methods/design

This study is a dynamic cluster randomized trial of standardized versus tailored measurement-based care implementation in Centerstone, the largest provider of community-based mental health services in the USA. This prospective, mixed methods implementation-effectiveness hybrid design allows for evaluation of the two conditions on both clinician-level (e.g., MBC fidelity) and client-level (depression symptom change) outcomes. Central to this investigation is the focus on identifying contextual factors (e.g., attitudes, resources, process, etc.) that mediate MBC fidelity and optimize client outcomes.

Discussion

This study will contribute generalizable and practical strategies for implementing systematic symptom monitoring to inform and enhance behavioral healthcare.

Trial registration

Clinicaltrials.gov NCT02266134.

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Lambert MJ, Whipple JL, Hawkins EJ, Vermeersch DA, Nielsen SL, Smart DW. Is it time for clinicians to routinely track patient outcome? a meta-analysis. Clin Psychol Sci Pract. 2003;10:288–301.CrossRef

Chambers D, Glasgow R, Stange K. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8:117.CrossRefPubMedPubMedCentral

Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, et al. Burden of depressive disorders by country, Sex, Age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10, e1001547.CrossRefPubMedPubMedCentral

Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry. 2003;64:1465–75.CrossRefPubMed

Beidas RS, Edmunds JM, Marcus SC, Kendall PC. Training and consultation to promote implementation of an empirically supported treatment: a randomized trial. Psychiatr Serv. 2012;63:660–5.CrossRefPubMedPubMedCentral

Edmunds JM, Beidas RS, Kendall PC. Dissemination and implementation of evidence–based practices: training and consultation as implementation strategies. Clin Psychol Sci Pract. 2013;20:152–65.CrossRef

Herschell AD, Kolko DJ, Baumann BL, Davis AC. The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev. 2010;30:448–66.CrossRefPubMedPubMedCentral

Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: the evidence-based practice attitude scale (EBPAS). Ment Health Serv Res. 2004;6:61–74.CrossRefPubMedPubMedCentral

Addis ME, Wade WA, Hatgis C. Barriers to dissemination of evidence-based practices: addressing Practitioners’ concerns about manual-based psychotherapies. Clin Psychol Sci Pract. 1999;6:430–41.CrossRef

10.

Intervention Summary - Partners for Change Outcome Management System (PCOMS): International Center for Clinical Excellence [Internet]. [cited 2015 Jul 3]. Available from: http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=249

11.

Scott, K, Lewis, C C. Using measurement-based care to enhance any treatment. Cog Behav Pract 2015;22(1):49-59.

12.

Bickman L, Kelley SD, Breda C, de Andrade AR, Riemer M. Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial. Psychiatr Serv. 2011;62:1423–9.CrossRefPubMed

13.

Lambert MJ, Harmon C, Slade K, Whipple JL, Hawkins EJ. Providing feedback to psychotherapists on their patients’ progress: clinical results and practice suggestions. J Clin Psychol. 2005;61:165–74.CrossRefPubMed

14.

Lambert MJ, Shimokawa K. Collecting client feedback. Psychotherapy. 2011;48:72.CrossRefPubMed

15.

Glasgow RE, Fisher L, Strycker LA, Hessler D, Toobert DJ, King DK, et al. Minimal intervention needed for change: definition, use, and value for improving health and health research. Transl Behav Med. 2013;1–8.

16.

Protection P, Act AC. Patient protection and affordable care act. Public Law. 2010;111–48.

17.

Trivedi MH, Daly EJ. Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice. Drug Alcohol Depend. 2007;88:S61–71.CrossRefPubMedPubMedCentral

18.

John Rush MD A, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR* D report. Am J Psychiatry. 2006;163:1905–17.CrossRef

19.

Hunkeler EM, Katon W, Tang L, Williams JW, Kroenke K, Lin EHB, et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ. 2006;332:259–63.CrossRefPubMedPubMedCentral

20.

Bickman L, Rosof-Williams J, Salzer MS, Summerfelt WT, Noser K, Wilson SJ, et al. What information do clinicians value for monitoring adolescent client progress and outcomes? Prof Psychol Res Pract. 2000;31:70.CrossRef

21.

Gilbody SM, House AO, Sheldon TA. Routinely administered questionnaires for depression and anxiety: systematic review. BMJ. 2001;322:406–9.CrossRefPubMedPubMedCentral

22.

Phelps R, Eisman EJ, Kohout J. Psychological practice and managed care: Results of the CAPP practitioner survey. Prof Psychol Res Pract. 1998;29:31.CrossRef

23.

Garland AF, Kruse M, Aarons GA. Clinicians and outcome measurement: What’s the use? J Behav Health Serv Res. 2003;30:393–405.CrossRefPubMed

24.

Sapyta J, Riemer M, Bickman L. Feedback to clinicians: theory, research, and practice. J Clin Psychol. 2005;61:145–53.CrossRefPubMed

25.

Kroenke K, Spitzer RL, Williams JB. The Phq-9. J Gen Intern Med. 2001;16:606–13.CrossRefPubMedPubMedCentral

26.

Association AP, others. Diagnostic and statistical manual of mental disorders. 4th ed. Wash. DC: Am. Psychiatr. Assoc; 2000. p. 553–7.

27.

Kroenke K, Spitzer RL, Williams JB, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32:345–59.CrossRefPubMed

28.

Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the patient health questionnaire (PHQ-9). J Affect Disord. 2004;81:61–6.CrossRefPubMed

29.

Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32:1–7.CrossRef

30.

Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, et al. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev [Internet]. 2010 [cited 2014 May 21];3. Available from: http://onlinelibrary.wiley.com.ezproxy.lib.indiana.edu/doi/10.1002/14651858.CD005470.pub2/pdf/standard

31.

Powell BJ, Beidas RS, Lewis CC, Aarons GA, McMillen JC, Proctor EK, et al. Methods to improve the selection and tailoring of implementation strategies. Journal of Behavioral Health Services & Research. 2015 doi:10.1007/s11414-015-9475-6.

32.

Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M. "The sustainability of new programs and innovations: a review of the empirical literature andrecommendations for future research". Implement Sci 2012;7(17):1-19.

33.

Aarons GA, Green AE, Palinkas LA, Self-Brown S, Whitaker DJ, Lutzker JR, et al. Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implement Sci. 2012;7:1–9.CrossRef

34.

Mendel P, Meredith LS, Schoenbaum M, Sherbourne CD, Wells KB. Interventions in organizational and community context: a framework for building evidence on dissemination and implementation in health services research. Adm. Policy Ment. Health Ment. Health Serv. Res. 2008;35:21–37.

35.

Powell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev. 2012;69:123–57.CrossRefPubMed

36.

Evans E, Hser Y-I. Pilot-testing a statewide outcome monitoring system: overview of the California Treatment Outcome Project (CalTOP). J Psychoactive Drugs. 2004;36:109–14.CrossRef

37.

Harding KJ, Rush AJ, Arbuckle M, Trivedi MH, Pincus HA. Measurement-based care in psychiatric practice: a policy framework for implementation. J Clin Psychiatry. 2011;72:1136–43.CrossRefPubMed

38.

Teruya C, Hardy M, Hser Y-I, Evans E. Implementation of a statewide outcome monitoring system: lessons learned from substance abuse treatment provider staff. Qual Health Res. 2006;16:337–52.CrossRefPubMed

39.

Morris DW, Trivedi MH. Measurement-based care for unipolar depression. Curr Psychiatry Rep. 2011;13:446–58.CrossRefPubMed

40.

Steinfeld B, Franklin A, Mercer B, Fraynt R, Simon G. Progress Monitoring in an Integrated Health Care System: Tracking Behavioral Health Vital Signs. Adm Policy Ment Health. 2015;1–10.

41.

Persons JB, Koerner K, Eidelman P, Thomas C, Liu H. Inreasing Psychotherapists’ Adoption and Implementation of the Evidence-based Practice of Progress Monitoring. In Review;

42.

Miller AL, Krusky AM, Franzen S, Cochran S, Zimmerman MA. Partnering to translate evidence-based programs to community settings bridging the Gap between research and practice. Health Promot Pract. 2012;13:559–66.CrossRefPubMedPubMedCentral

43.

Brown CH, Wyman PA, Guo J, Peña J. Dynamic wait-listed designs for randomized trials: New designs for prevention of youth suicide. Clin Trials. 2006;3:259–71.CrossRefPubMed

44.

Chamberlain P, Brown CH, Saldana L, Reid J, Wang W, Marsenich L, et al. Engaging and recruiting counties in an experiment on implementing evidence-based practice in California. Adm Policy Ment Health. 2008;35:250–60.CrossRefPubMedPubMedCentral

45.

Brown CH, Chamberlain P, Saldana L, Padgett C, Wang W, Cruden G. Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial. Implement Sci. 2014;9:134.CrossRefPubMedPubMedCentral

46.

Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, et al. A pragmatic–explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009;62:464–75.CrossRefPubMed

47.

Greene JC, Caracelli VJ, Graham WF. Toward a conceptual framework for mixed-method evaluation designs. Educ Eval Policy Anal. 1989;11:255–74.CrossRef

48.

Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J. Mixed method designs in implementation research. Adm. Policy Ment. Health Ment. Health Serv. Res. 2011;38:44–53.

49.

Bryk, AS., Raudenbush, SW. Hierarchical linear models: applications and data analysis methods. Sage Publications, Inc, 1992.

50.

Singer, JD, Willett, JB. Applied longitudinal data analysis: Modeling change and event occurrence. Oxford university press, 2003.

51.

Muthén LK, Muthén BO. "Mplus." The comprehensive modelling program for applied researchers: User’s guide 5 (2012).

52.

Thoemmes F, MacKinnon DP, Reiser MR. Power analysis for complex mediational designs using monte Carlo methods. Struct Equ Model Multidiscip J. 2010;17:510–34.CrossRef

53.

Feingold A. Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychol Methods. 2009;14:43–53.CrossRefPubMedPubMedCentral

54.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health. 2013;1–12.

55.

Preacher KJ, Zyphur MJ, Zhang Z. A general multilevel SEM framework for assessing multilevel mediation. Psychol Methods. 2010;15:209.CrossRefPubMed

56.

Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173.CrossRefPubMed

57.

MacKinnon DP. Introduction to statistical mediation analysis. Routledge, 2008.

58.

Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002;59:877–83.CrossRefPubMed

59.

Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40:879–91.CrossRefPubMed

60.

Millen DR. "Rapid ethnography: time deepening strategies for HCI field research." Proceedings of the 3rd conference on Designing interactive systems: processes, practices, methods, and techniques. ACM, 2000.

61.

Creswell JW, Klassen AC, Plano Clark VL, Smith KC. Best practices for mixed methods research in the health sciences. Bethesda Md Natl Inst Health. 2011;2094–103.

62.

Bickell R. Multilevel analysis for applied research. New York: Guilford Press; 2007.

63.

Preacher KJ, Kelley K. Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods. 2011;16:93.CrossRefPubMed

64.

Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59:12.CrossRefPubMed

65.

Atkins D, Baldwin SA. Design and analysis challenges with multilevel implementation data. Seattle, WA; 2013.

66.

Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363:501–4.CrossRefPubMed

67.

Bosch M, Van Der Weijden T, Wensing M, Grol R. Tailoring quality improvement interventions to identified barriers: a multiple case analysis. J Eval Clin Pract. 2007;13:161–8.CrossRefPubMed

68.

Proctor EK, Powell BJ, Baumann AA, Hamilton AM, Santens RL. Writing implementation research grant proposals: ten key ingredients. Implement Sci. 2012;7:96.CrossRefPubMedPubMedCentral

69.

Aarons GA, Miller EA, Green AE, Perrott JA, Bradway R. Adaptation happens: a qualitative case study of implementation of the incredible years evidence-based parent training programme in a residential substance abuse treatment programme. J Child Serv. 2012;7:233–45.CrossRef

70.

Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013;8:65.CrossRefPubMedPubMedCentral

71.

Minkler IM, Salvatore AL. Study Design and Analysis in Dissemination and Implementation Research. Dissem Implement Res Health Transl Sci Pract. 2012;1192.

Title: Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial study protocol
Authors: Cara C. Lewis
Kelli Scott
C. Nathan Marti
Brigid R. Marriott
Kurt Kroenke
John W. Putz
Peter Mendel
David Rutkowski
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI: https://doi.org/10.1186/s13012-015-0313-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial study protocol

Abstract

Background

Methods/design

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods/design

Discussion

Trial registration

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