Measuring, Evaluating, Adjusting, and Improving Treatment and Outcomes: Available within the CloudMD365 EMR
Now with aggregated reporting across all levels of care.
Required by The Joint Commission as of January 1, 2018 and recommended by The Kennedy Forum
FIT Defined: It’s All About Measuring Outcomes.
Feedback Informed Treatment (FIT) refers to the practice of providing psychotherapy treatment that is informed by repeated administrations of patient-reported treatment outcomes. FIT was recently listed by SAMHSA as a recognized evidence based practice. Feedback informed treatment is also variously referred to as outcomes informed care, outcomes management, and patient focused care. All imply the use of patient self-report questionnaires, combined with feedback, to enable improvement in outcomes from the patients’ perspective.
How FIT Works
FIT is a recognized evidence-based practice that supports patient-facing assessments and may be administered online via a tablet or smartphone for instant feedback. This method requires that patients complete a self-report questionnaire to provide feedback on the treatment that they receive. The goal of collecting feedback from patients is to evaluate the quality of services provided to them and to adjust ongoing treatment to ensure that the patient receives the maximum benefit and improved outcomes.
- Measuring progress and outcomes is necessary to judge the appropriateness of specific treatment modalities and programs used to treat patients.
- Measuring progress and outcomes is required by The Joint Commission and strongly recommended by the Kennedy Forum and dozens of other experts in the field.
- Measuring progress and outcomes is required by many large scale providers such as the VA Health System and the U.S. Army. This method will be a requirement by CMS, insurance payers, and other accreditation agencies.
The Fast, Easy, and Accredited FIT Surveys.
Questionnaires are sent to patients via a fast, easy, and secure HIPAA-compliant messaging platform. Patients may complete the questionnaires on any electronic device, usually a tablet or smartphone, and send it back to be evaluated. Patients complete the questionnaire consisting of 4-17 questions based on the FIT program that is selected. Depending on predetermined requirements, the FIT questionnaire may be administered on a monthly or weekly basis.
Credentials: FIT is “Evidence-Based”
Recommended by the U.S. Surgeon General in his landmark report: “Technology can play a key role in supporting these integrated care models. Electronic health records (EHRs), telehealth, health information exchanges (HIE), patient registries, mobile applications, Web-based tools, and other innovative technologies have the potential to extend the reach of the workforce; support quality measurement and improvement initiatives to drive a learning health care system; electronically deliver prevention, treatment, and recovery interventions; efficiently monitor patients; identify population health trends and threats; and engage patients who are hesitant to participate in formal care. Performance measurement has the dual purpose of accountability and quality improvement.”
- FIT tools are implemented nationally in the VA Health System’s 46 hospitals that treat SUD.
- The Group for the Advancement of Psychiatry officially endorses the use of standardized symptom rating scales to supplement clinical interviews.
- The National Council for Behavioral Health endorses the use of research-backed outcomes measurement tools to help clinicians address functional deficits of individualized care plans.
- The United States Army routinely uses a tablet-based symptom rating scale system in its specialty mental health clinics.
- Federally Qualified Health Centers in the state of Washington routinely use a web-based patient outcomes tracking system to assess symptom improvement among its integrated mental health primary care patients.
- The National Committee for Quality Assurance (NCQA) has proposed depression symptom monitoring and feedback as health plan performance measures for the 2016 Healthcare Effectiveness Data and Information Set (HEDIS). Likewise in 2015, Anthem Blue Cross Blue Shield,® UnitedHealthcare® and CMS (the Centers for Medicare and Medicaid Services) all announced value-based payment programs which incentivize measurement-based care.
Fixing Behavioral Health in America – The Kennedy Forum
From The Kennedy Forum: “Patients with mental health and substance use disorders (MH/SUD) treated in routine care experience worse outcomes than patients enrolled in clinical trials that have demonstrated the effectiveness of evidence- based treatments. One of the main contributors to poor outcomes in MH/SUD care is that providers do not typically use symptom rating scales in a systematic way to determine quantitatively whether their patients are improving. Yet, virtually all randomized controlled trials with frequent, timely feedback of diagnostic-specific, patient-reported symptom severity to the provider during the clinical encounter found that outcomes were significantly improved compared to usual care across a wide variety of mental health and SUD disorders.”
FIT and the CloudMD365 EMR
Research clearly indicates that regardless of the type or intensity of approach (12-step, cognitive-behavioral therapy, etc.), client engagement is the single best predictor of outcomes.
Findings report that in SUD therapy, 50% to 66% of the variance in outcomes is attributable to quality of the alliance between the patient and the therapist. In other words, the therapeutic relationship contributes 5-10 times more to outcomes than the particular model or approach employed. FIT helps measure, adjust, and improve the therapeutic alliance.
Accurate Measurement Despite the Complexities of Substance Abuse
People with substance use disorders are heterogeneous, with wide variations across groups in terms of substances used, comorbid disorders, and their strengths and resources. Specialized therapies have been developed to target specific types of substance use disorders: alcohol, opiates, cocaine, and marijuana. Treatment services have been developed to address not only the substance use, but also the range of other problems that often predate, co-occur with, and are caused by substance use disorders. These issues can include family or social relationships, legal matters, job or vocational concerns, medical conditions, and co-occurring psychiatric disorders.
The evidence is ubiquitous, inherently biased, and complicated to evaluate. Clinicians sit with patients who present with specific complaints, a range of symptoms, and a historical narrative. They are influenced by education, training, supervision, the setting within which the clinician works, intuition, economics, and experience. Within that setting, clinicians conduct assessments and make diagnoses and treatment decisions about particular patients. This reflects clinical experience and scientific evidence, derived from the clinician’s experience with similar patients.
Patients want to get better and seek help. Patients may want to know that the assessment and diagnosis they receive will guide the treatment offered. Patients hope, perhaps even expect, that this treatment has been studied carefully for safety and has been found to work with substance users with similar characteristics. Finally, patients wish to be confident that the person treating them has a long track record of success with this intervention. Patients also may have evidence-based expectations, based on their previous history and experiences in the offices of health care practitioners. They may also wish to hear about treatment alternatives and be partners in clinical decision making.
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