Measurement-based care in military and veteran mental health care systems

Funding opportunity

Literature review and synthesis of best practices and approaches to measurement-based care in military and Veteran mental health care systems

Anticipated timeline and budget

Background

Measurement based care (MBC) refers to an evidence-based approach that routinely collects patient reported outcome (PRO) measures to track treatment progress for patients and uses such data to identify cases that are not-on-track (NOT) to quickly refine the treatment approach as needed. Similar in concept to other approaches such as routine outcome monitoring (ROM) and clinical feedback systems (CFS), MBC in its more recent operationalizations can be distinguished from these other approaches by its requirement of all four of the following core components:

1. “a routinely administered symptom, outcome, or process measure (i.e., PRO), ideally before each clinical encounter;
2. practitioner review of data;
3. patient review of data; and
4. collaborative re-evaluation of the treatment plan informed by data” (Lewis et al., 2020, page 2).

A 2022 multi-level meta-analysis found that MBC was associated with greater symptom reduction and reduced dropout rates (Jong et al., 2022). Although the effect sizes of MBC are small, the benefits to large healthcare systems, including increased efficiency in provision of care and reduced wait times and backlogs are potentially substantial and meaningful.

Given the potential benefits of MBC, in 2014, the Canadian Forces Health Services (CFHS) introduced an MBC tool originally developed by Veterans Affairs Canada (VAC) - Client-Reported Outcomes Monitoring Information System (CROMIS) - to be used in the delivery of mental healthcare to active military personnel.

CROMIS is based on one of the most commonly used MBC tools to date, the Outcome Questionnaire (OQ-45) and its associated software tool, the OQ Analyst. An early evaluation report by CFHS (Garber, Rusu, & Khan, 2015) of the piloting of CROMIS at a CAF clinic from 17 November 2014 to 22 March 2015 found that both the proportion of eligible clinical visits in which an OQ-45 was completed by the patient and uploaded into the CROMIS database and the proportion of completed OQ-45 reports which were viewed by the treating clinician within one hour of the report being uploaded into the system were low, ending at around 56% and 21% by the end of the pilot period, respectively.

Anecdotal reports from CFHS indicate that despite additional resources having been devoted to further implementation of CROMIS, uptake of MBC remains low among CFHS mental health providers. The finding of less-than-optimal uptake of MBC among mental health clinicians in CFHS is similar to what has been reported within VAC (Ross et al., 2016) and other large veteran (Warnecke & Teng, 2020) and civilian healthcare systems (Barkham et al. 2023).

Research objectives

This funding opportunity is seeking submissions to conduct a review and synthesis of the academic literature and public documents regarding emerging trends, current and best practices and challenges in MBC in military, veteran, and civilian mental healthcare systems across the Five Eyes (FVEY) nations (Australia, Canada, New Zealand, United Kingdom, and United Stated). While the focus should be on military and veteran mental healthcare systems, lessons learned from civilian healthcare systems should also be included where relevant. The literature review should be guided by implementation science models, theories, and frameworks, and consider the potential utility of specific implementation strategies that have been identified in the literature (Powell et al., 2012, 2015, 2017; Proctor et al., 2013).

Final report to include the following:

• Identify academic literature and public documents regarding emerging trends, current and best practices and challenges in MBC in military, veteran, and civilian mental healthcare systems.
• Identify factors associated with implementation success/failure
• Identify promising implementation strategies, both individually and in combination
• Identify possible causal mechanisms (Lewis et al., 2022) for commonly used implementation strategies
• Gender-based analysis and considerations
• Recommendations for best practices within military and veteran healthcare systems.
• High priority-high impact research directions for MBC within CFHS in particular and military/veteran health care systems in general

It is anticipated this project will be completed in 18 months with 3 expected milestones, at 6, 12, and 18 months.

Milestone 1 (6 months): 2-3 Stakeholder engagement sessions with CFHS researchers and clinical leaders, as well as DND/DRDC researchers to develop a literature review strategy using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Milestone 2 (12 months): Conduct the literature review including peer-reviewed publications, government reports, and other grey literature.

Milestone 3 (18 months): Synthesize and summarize findings from the literature review and write report.

Desired outputs

• Final research report that outlines emerging trends, current and best practices and challenges in MBC in military, veteran, and civilian mental healthcare systems, including key factors and considerations as outlined above.
• Bibliography of documents used to produce the final report.
• Virtual presentation of findings to project sponsor (may take place after the project end date).
• Documentation and outputs must be submitted in the English language.

Applicant qualifications and requirements for selection

• Proposals must be led by a senior investigator with a PhD in a relevant field.
• The desired research group must include scientists in implementation science with expertise in implementation of evidence-based clinical practices in large healthcare system settings.
• The desired research group should be a multidisciplinary team with expertise in clinical practice and research in evidence-based mental healthcare, especially measurement-based care.
• Have conducted and published studies and literature reviews on implementation of evidence-based practices, especially in mental health.
• Have at least one of the following: publication, research grant, award or project, as a proven record of conducting research on the implementation of evidence-based practices.
• Composed of a team with access to a variety of databases online.
• Preference will be given to research groups located within the National Capital Region (NCR) for in-person meetings and project updates with the clinical and research team leaders at CFHS.

Application deadline

Please download and submit the Research Funding Application form.

Enquiries

Questions about this funding opportunity can be sent to the VAC Research office.