VA Connecticut Healthcare System, West Haven, CT 06516, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
Mil Med. 2023 Nov 3;188(11-12):3613-3620. doi: 10.1093/milmed/usac218.
Measurement-based care (MBC) has been implemented in Veterans Affairs since 2016 and is increasingly used in other mental health care organizations. Little quantitative research exists that assesses patient-level barriers and facilitators of MBC. This study examines correlates of receiving patient-reported outcome measures (PROMs) among veterans receiving both psychotherapy and pharmacotherapy (Both), psychotherapy only (Psychotherapy), and pharmacotherapy only (Pharmacotherapy).
Data on PROM administration were obtained for a 12-month period for 1,726,578 veterans who initiated outpatient mental health care during fiscal year 2019. Clinical, treatment, and PROM data were extracted from the electronic health record. Logistic regression was used to model the association between veteran and treatment characteristics and PROM administration.
Thirty-two percent of veterans in Both, 26.0% in Psychotherapy, and 8.8% in Pharmacotherapy received at least one PROM. The probability of PROM administration was positively associated with the number of treatment encounters during the fiscal year 2019. Major depressive, generalized anxiety, and other depressive disorders were associated with an increased probability of PROM administration. Psychotic disorders, personality disorders, older age, dementia, and electronic health record suicide risk flag were associated with decreased odds of PROM administration across treatment types.
Rates of PROM administration differ depending on the type of treatment received. The probability of PROM administration is influenced by the frequency of encounters and, to a lesser extent, having a diagnosis congruent with symptoms assessed in the set of PROMs considered. Consistent with hypotheses from the MBC implementation literature, potential indicators of clinical severity and cognitive impairment decrease the likelihood of PROM utilization.
基于测量的护理（MBC）自 2016 年以来就在退伍军人事务部实施，并在其他心理健康护理组织中越来越多地使用。很少有定量研究评估 MBC 患者层面的障碍和促进因素。本研究检查了在接受心理治疗和药物治疗（Both）、仅接受心理治疗（Psychotherapy）和仅接受药物治疗（Pharmacotherapy）的退伍军人中，接受患者报告的结果测量（PROM）的患者水平障碍和促进因素的相关性。
在 2019 财年，从电子健康记录中提取临床、治疗和 PROM 数据，获得了 1726578 名开始门诊心理健康护理的退伍军人在 12 个月期间接受 PROM 管理的数据。使用逻辑回归模型来模拟退伍军人和治疗特征与 PROM 管理之间的关联。
在 Both 中，32%的退伍军人接受了至少一次 PROM，在 Psychotherapy 中为 26.0%，在 Pharmacotherapy 中为 8.8%。在 2019 财年接受 PROM 管理的概率与治疗次数呈正相关。主要抑郁、广泛性焦虑和其他抑郁障碍与 PROM 管理的概率增加相关。精神病障碍、人格障碍、年龄较大、痴呆和电子健康记录自杀风险标志与所有治疗类型的 PROM 管理几率降低相关。
PROM 管理的比例因所接受的治疗类型而异。PROM 管理的概率受治疗次数的影响，在较小程度上受与考虑的 PROM 集评估的症状相符的诊断的影响。与 MBC 实施文献中的假设一致，临床严重程度和认知障碍的潜在指标降低了 PROM 使用的可能性。
