Pre-implementation patient, provider, and administrator perspectives of remote measurement-based care in a safety net outpatient psychiatry department

Abstract

Introduction

Psychiatric measurement-based care (MBC) can be more effective than usual care, but health systems face implementation challenges. Achieving attitudinal alignment before implementing MBC is critical, yet few studies incorporate perspectives from multiple stakeholders this early in planning. This analysis identifies alignment and themes in pre-implementation feedback from patients, providers, and administrators regarding a planned MBC implementation in a safety net psychiatry clinic.

Methods

We used interview guides informed by Conceptual Model of Implementation Research to gather qualitative pre-implementation attitudes about perceived Appropriateness, Acceptability, and Feasibility of an MBC measure (Computerized Adaptive Test—Mental Health; CAT-MH) from five patients, two providers, and six administrators. We applied rapid qualitative analysis methods to generate actionable feedback for department leadership still planning implementation. [Correction added on 22 January 2025, after first online publication: In the previous sentence, the word ‘general’ was replaced with the word ‘generate’.] We used a multistep process to generate thematic findings with potential relevance for other similar mental health settings.

Results

There was more attitudinal alignment across stakeholder groups regarding MBC's Acceptability and Feasibility than its Appropriateness. All three groups agreed that it was important to contextualize MBC for patients and providers, anticipate MBC's impact on patient–provider relationships, and consider the system's capacity to respond to patient needs unearthed by CAT-MH before implementation began. Our thematic analysis suggests: (1) Introducing MBC may complicate patient–provider relationships by adding a new and potentially conflicting input for decision making, that is, MBC data, to the more typical inputs of patient report and provider expertise; [Correction added on 22 January 2025, after first online publication: In the previous sentence, the word ‘complicated’ was replaced with the word ‘complicate’.] (2) MBC poses theoretical risks to health equity for safety net patients because of limitations in access to MBC tools themselves and the resources needed to respond to MBC data; and (3) Tension exists between individual- and system-level applications of MBC.

Conclusions

Our analysis highlights shifting treatment dynamics, equity considerations, and tension between individual- and population-level needs that our participants anticipated when planning for MBC implementation in a safety net psychiatry clinic.