Literature Collection

BACKGROUND: Measurement based care (MBC) is a patient-centered approach that is gaining popularity in healthcare systems, particularly in mental health settings. However, attitudes towards MBC vary among mental health clinicians and patients, leading to variable implementation. OBJECTIVE: This systematic review synthesises clinician and patient perspectives on the benefits and drawbacks of measurement-based care (MBC) in psychiatry. STUDY SELECTION AND ANALYSIS: We searched Ovid MEDLINE, EMBASE, EBM Reviews, APA PsychINFO and CINAHL databases from inception to January 2024. After screening 1644 titles and abstracts, 48 full papers were reviewed, and 24 studies were ultimately included. Quality assessment was conducted using the Mixed Methods Appraisal Tool, and key patterns were extracted using thematic analysis. FINDINGS: The review reflects opinions of 901 patients and 2831 clinicians across various settings. Patients valued MBC for enhancing communication, self-awareness and reducing stigma. However, they expressed concerns about the adequacy of measures in reflecting their clinical state and uncertainty about how responses influence treatment decisions. Clinicians appreciated MBC for improving patient involvement, tracking treatment response and enhancing communication efficiency. Concerns included inadequate capture of clinical complexity, potential reporting biases, time constraints, insufficient training and concerns with respect to data usage and privacy. CONCLUSIONS AND CLINICAL IMPLICATIONS: While patients and clinicians recognise significant benefits, including enhanced communication, improved insight and more structured clinical decision-making, they also identify important limitations. These include concerns about the adequacy of scales to capture complex clinical presentations, potential impacts on the therapeutic alliance and increased administrative burden. Moving forward, successful integration of MBC into routine care will require addressing these challenges through improved clinician training, clear guidelines for interpretation, greater transparency with respect to how data will be used and more seamless integration with existing clinical workflows. PROSPERO REGISTRATION NUMBER: PROSPERO CRD420250651562.

OBJECTIVE: To evaluate a fast-track triage model in an integrated community specialty clinic to reduce the age of diagnosis for patients with autism spectrum disorder (ASD). STUDY DESIGN: A retrospective chart review was performed for patients seen in an integrated community specialty pediatric practice using a fast-track screening and triage model. The percentage of ASD diagnoses, age at diagnosis, and time from referral to diagnosis were evaluated. The fast-track triage model was compared with national and statewide estimates of median age of first evaluation and diagnosis. RESULTS: From January 1, 2020, through December 31, 2021, 189 children with a mean (SD) age of 32.2 (12.4) months were screened in the integrated community specialty. Of these, 82 (43.4%) children were referred through the fast-track triage for further evaluation in the developmental and behavioral pediatrics (DBP) department, where 62 (75.6%) were given a primary diagnosis of ASD. Average wait time from referral to diagnosis using the fast-track triage model was 6 months. Mean (SD) age at diagnosis was 37.7 (13.5) months. The median age of diagnosis by the fast-track triage model was 33 months compared with the national and state median ages of diagnosis at 49 and 59 months, respectively. CONCLUSIONS: With the known workforce shortage in fellowship-trained developmental behavioral pediatricians, the fast-track triage model is feasible and maintains quality of care while resulting in more timely diagnosis, and reducing burden on DBP by screening out cases who did not require further multidisciplinary DBP evaluation as they were appropriately managed by other areas.