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Enhancing mental health care by scientifically matching patients to providers' strengths
Investigator (PI): Constantino, Michael
Performing Organization (PO): (Current): University of Massachusetts Amherst, School of Arts and Sciences, Department of Psychological and Brain Sciences / (413) 545-2383
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2020
Record Source/Award ID: PCORI/IHS-1503-28573
Funding: Total Award Amount: $1,784,650
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Many patients receive substandard, or even harmful, mental health care (MHC). Research has shown that MHC providers differ significantly in their ability to help patients. In addition, providers demonstrate different patterns of effectiveness across symptom and functioning domains. For example, some providers are reliably effective in treating numerous patients and problem domains; others are reliably effective in some domains (for example, depression, substance abuse) yet appear to struggle in others (for example, anxiety, social functioning); and some are reliably ineffective across patients and domains. Knowledge of these provider differences is based largely on patient-reported outcomes collected in routine MHC settings. Unfortunately, provider performance information is not systematically used to refer or assign a particular patient to a scientifically based best-matched provider. MHC systems continue to rely on random or purely pragmatic case assignment and referral, which significantly lowers the odds of a patient being assigned/referred to a high-performing provider in the patient's area(s) of need and increases the risk of being assigned/referred to a provider who may have a track record of ineffectiveness. This research aims to solve the existing non-patient-centered provider-matching problem. Specifically, we aim to demonstrate the comparative effectiveness of a scientifically based patient-provider match system compared with status quo pragmatic case assignment. We expect in the scientific match group significantly better treatment outcomes (for example, symptoms, quality of life) and higher patient satisfaction with treatment. We also expect to demonstrate feasibility of implementing a scientific-match process in a community MHC system and broad dissemination of the easily replicated scientific-match technology in diverse health care settings. The importance of this work for patients cannot be understated. Far too many of them struggle to find the right provider, which unnecessarily prolongs suffering and creates health care system inefficiency. A scientific-match system based on routine outcome data uses patient-generated information to direct "this" patient to "this" provider in "this" setting. In addition, when based on multidimensional assessment, it allows a wide variety of patient-centered outcomes to be represented (for example, symptom domains, functioning domains, quality of life). The success of this project will be driven by a comprehensive and fully integrated patient and stakeholder partner engagement plan. We have assembled a project advisory board with members representing patient, provider, administrator, and health care policy perspectives. With diverse complementary skills, our board will work collaboratively to ensure that procedures meet methodology standards, patient and stakeholder views are represented and feedback incorporated, and the results are widely and effectively publicized to the relevant targets and stakeholders.
Abstract Archived: Lay Abstract. This research project is in progress. PCORI will post the research findings on the PCORI website within 90 days after the results are final. What is the research about? About one in six Americans lives with anxiety, depression, substance use disorder, schizophrenia, or some other mental health condition. Mental health care providers can help patients manage some conditions and recover from others. However, not all mental health care providers are skilled in treating all kinds of mental health conditions. Further, when patients need mental health care, doctors often refer them to providers by chance or convenience. The research team wants to compare improvement rates for patients matched with a mental health care provider who has established effectiveness at treating the patients' specific needs with improvement rates for patients matched to a mental health care provider by chance. Who can this research help? Results from this study can help health system administrators decide whether to track mental health care providers' results in treating different conditions and use that information to match patients and providers. What is the research team doing? The research team is working with a network of community mental health care providers. The team is inviting 264 patients who have referrals for mental health care to join the study. All patients in the study are completing an initial diagnostic interview and a survey about their mental health needs. The survey includes questions about symptoms, relationships, suicide risk, sleep, substance use, and other topics. Patients then receive a referral to a mental health care provider in one of two ways: for one group of patients, an intake worker assigns a mental health care provider by chance, based on usual considerations like provider availability, schedule, or the provider's self-reported specialty; for the second group of patients, a computer matches each patient's survey results with records about mental health care providers' skill in treating that patient's most severe condition. The computer then assigns the patient to a provider whose other patients with that condition improved over time. The research team is following patients until they stop seeing the mental health care provider or through four months of treatment. Patients complete the same mental health survey that informed matching several times throughout their treatment and at their final sessions or fourth month. At the final time point, patients also report their satisfaction with their treatments. The research team is also collecting interview-based diagnostic information before and after treatment. The team is comparing how patients' outcomes change in each group. The research team is working with a project advisory board that includes mental health care patients, providers, and administrators. Research methods. Design: The study design is a randomized controlled trial. Population: The study population is adults ages 18-65 referred to behavioral health care. Interventions/comparators are random assignment to mental health care provider as usual and random assignment to mental health care provider based on an algorithm matching patients' needs and providers' effectiveness across 12 behavioral health domains. Outcomes: The outcomes are (1) primary: Treatment Outcome Package (TOP) measure of symptom and functional domains; and (2) secondary: Symptom Checklist-10, Inventory of Interpersonal Problems-32, Working Alliance Inventory, Credibility/Expectancy Scale, and TOP Satisfaction Scale. The timeframe is 16-week follow-up for primary outcome and 12-month follow-up for a subsample of patients.

MeSH Terms:
  • Anxiety /therapy
  • Comparative Effectiveness Research
  • Depression /therapy
  • Humans
  • Mental Disorders /*rehabilitation
  • /therapy
  • Mental Health Services /*organization & administration
  • Patient Satisfaction
  • Patient-Centered Care
  • Quality of Life
  • Referral and Consultation
  • Substance-Related Disorders /therapy
Country: United States
State: Massachusetts
Zip Code: 01003
UI: 20162152
CTgovId: NCT02990000
Project Status: Ongoing
Record History: ('2017: Project extended to 2020',) ("2020: Included Lay Abstract in Abstract Archived 1 field. Alternate Title: Matching patients' mental health needs with providers' strengths",)