Identifying Measurement-Based Care Practices of VHA Co-Located Collaborative Care Providers

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Abstract

The use of measurement-based care (MBC) is a routinely accepted practice in medical settings as a means to assess health status and guide evidence-based interventions. The continued expansion of integrated primary care within the Veterans Health Administration (VHA) offers ongoing opportunities for co-located collaborative care (CCC) providers to implement MBC. The present study aimed to identify and describe the degree to which MBC is used by CCC providers across VHA clinics in Upstate New York. A retrospective chart review of 448 CCC encounters was evaluated for evidence of MBC practices, including the use of quantitative mental health symptom screening tools, brief mental health symptom measures, and standardized functional assessment tools. Evidence of nonstandardized, idiographic assessments was also recorded. Providers’ use of measurement data to guide treatment initiation, modification, and termination was coded when available. Descriptive statistics were calculated for variables of interest. Results indicated that approximately 61% of patients were formally screened or completed mental health measures at least once during their course of care, though repeat administrations were rare. Detailed chart reviews found overall limited use of mental health screens and brief symptom measures (9.8% and 9.2% of all encounters, respectively), with measurement data infrequently (8.5%) linked to specific documented treatment decisions. Consistent with prior studies, CCC providers typically did not evidence use of standardized measures but did routinely record estimates of subjective distress and global functioning, lethality risk, and idiographic functional assessments. Obstacles and facilitators to the broader promotion and use of MBC among CCC providers are discussed.

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