Table 6 Deconstructing the PRISM framework for MBC in adult ambulatory psychiatry based on the results of the virtual BPM
PRISM Component | Target | Recipients | Critical Points |
|---|---|---|---|
External Environment | Adult ambulatory psychiatry - Department of Psychiatry and Behavioral Medicine’s (PBM) outpatient clinic in a US regional hospital | Clinicians | Agents of administration of measurement-based care (MBC) - Includes MD, NP, PhD, and LCSW |
Staff | Agents assisting implementation of MBC | ||
Patients | Receiving MBC by clinicians and provided help by staff | ||
Intervention | Measurement-Based Care - Evidence-based practice (EBP) - Regularly evaluating patients’ mental and emotional state to facilitate treatment and inform clinical decision making - Utilizes patient-reported outcome measures (PROMs) | Clinicians | Implement MBC into their clinical practice - Utilize MBC to guide, track, and monitor treatment and patient’s symptoms - Review the results and have discussion with the patients - Incorporate PROMs results and inform clinical decision making |
Staff | Assisting administration - Prompt and guide patients to complete their PROMs - Problem-solve technical issues | ||
Patients | Participate in MBC - Complete PROMs regularly - Review their PROMs’ results and participate in collaborative evaluation with the clinician - Embrace information maximizing patient-centered care | ||
Implementation & Sustainability Infrastructure | Focus Groups & Trainings - The present study conducted focus groups as a precursor to help develop and implement appropriate standardized MBC trainings - Brainwriting premortem method was utilized - Both clinicians and staff focus groups were conducted | Clinicians | Clinician focus groups resulted in 291 individual codes - Similar number of barriers and facilitators were identified - Main negative themes indicated clinician’s difficulty with patients (e.g., non-adherence), time burden, skepticism on PROMs’ usefulness, and lack of designated staff when utilizing MBC - Main positive themes indicated clinicians’ positive attitude toward MBC implementation into their practice |
Staff | Staff focus groups resulted in 97 codes - More barriers (67%) were identified than facilitators (24.7%) regarding MBC - Staff raised technology/virtual visit difficulties, patients’ negative attitude towards MBC and MFS, as well as chart integration issues | ||
Reach & Effectiveness | Focus group results indicated current limitations and future directions for improved reach and effectiveness | Both clinicians and staff | Suggestions - Need for designated MBC/technology staff - Address patient non-adherence - Address ways to utilize MBC with certain type of patients (e.g., how to address high suicide risk patients, substance use/elderly patients are less likely to use MBC) - Plan for easy chart integration and visualization - Increase overall positive attitude and understanding of patients toward MBC |
Adoption | Adopt MBC to adult ambulatory psychiatry | Clinician | Perceive the need for systematic and standardized training to better implement MBC into their clinical practice |
Staff | More resistant to implementing MBC policies and appear to have more negative perceptions of MBC and identify greater barriers to adoption | ||
Implementation | Implement MBC to adult ambulatory psychiatry | Both clinicians and staff | Although MBC is already implemented, results of the BPM suggest that specific training is warranted and desirable for both staff and clinicians |
Maintenance | Sustain the intervention (i.e., MBC) and systematically institutionalize MBC | All recipients of MBC | Implement routine trainings and assessments for implementation failures - Ensure systematic support and ongoing consultation by hospital to facilitate continuous utilization of MBC |