Implementation of a digital measurement-based care approach in an early intervention service for psychosis: the PEPP-Montreal electronic data capture protocol and its alignment with learning health system principles

Abstract

Measurement-based care, crucial for improving outcomes in psychiatric disorders, remains underutilized, particularly during the impactful early treatment phases. Inspired by a learning health system approach, a hybrid paper/electronic data capture platform was developed at PEPP-Montreal, an early psychosis program, gathering data on patient socio-demographics, symptoms, functioning, pathways to care, substance use, and medication monitoring. This article evaluates the year-one deployment of this innovative infrastructure (2022−2023). The novel 2022 hybrid infrastructure was compared with the 2016 paper-based version, using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Phase 1 identified evidence-based clinical measures including patient-reported, clinician-reported, and evaluator-reported outcomes, while phase 2 further streamlined and implemented the electronic data capture platform. Continuous data collection through the platform was deployed at six time points. Results included: Reach: N = 53/81 patients used paper/electronic data for their year-one service evaluation. Effectiveness: The automated, hybrid paper/electronic protocol optimized data management. Adoption: Rates of electronic patient-reported outcomes were higher in 2022–2023 than 2016–2017 (paper version). Completion rates for clinician-reported outcomes were highest at baseline (year-one). Implementation/maintenance: Barriers and facilitators, essential adaptations, and sustainable impacts were identified. Using electronic, measurement-based data collection accelerates feedback closer to real time and alignment with learning health system principles. Implementing the hybrid data collection platform at PEPP-Montreal provided valuable insights into using measurement-based care to inform quality of services. In the complex transition to a digital protocol within a learning health system, including engagement of key stakeholders, using the hybrid protocol was a necessary first step.