A research team led by University of Massachusetts Amherst clinical psychology professor Michael Constantino will launch a study this month to enhance mental health care by scientifically matching patient needs to clinical providers’ strengths. The Patient-Centered Outcomes Research Institute (PCORI), a federal agency, recently approved just over $1.7 million in funding for the plan.
Constantino will collaborate with researchers and clinicians at the University at Albany, SUNY, Outcome Referrals, Inc., and Atrius Health. They will compare the effectiveness of a new, scientifically based patient-provider match system for mental health treatment to the more traditional method known as “pragmatic case assignment,” which is based on provider availability, convenience or self-reported specialty.
Constantino says, “For too long, mental health care has relied on non-personalized approaches to matching patient with provider, which often leads to substandard or even harmful mental health services.”
He points out that research shows providers differ significantly in their ability to help patients and they have different patterns of effectiveness. For example, some providers are reliably effective in treating depression and substance abuse, yet appear to struggle in other areas such as treating anxiety and social functioning.
“Unfortunately, provider performance information is not systematically used to refer or assign a particular patient to a scientifically based best-matched provider,” Constantino adds. “Mental health care systems continue to rely on random or purely pragmatic case assignment and referral, which significantly lessens the odds of a patient being assigned or referred to a high-performing provider in the patient’s area of need. It also increases the risk of being assigned or referred to a provider who may have a track record of ineffectiveness.”
The researchers will randomly assign study participants either to a group matched to providers using effectiveness and appropriateness criteria or to a group assigned by the traditional pragmatic method. They expect that patients assigned by scientific matching will report significantly better treatment outcomes, such as symptom reduction and quality of life, and report higher satisfaction with—demonstrating that using a scientific match process is feasible in a large community mental health care system.
Patients will be treated and cared for by providers at Atrius Health’s robust behavioral health department; part of an innovative health care organization that includes medical practices and a home health agency and hospice, serving 675,000 patients in eastern and central Massachusetts.
Dr. Jacob Kagan, behavioral health specialty director at Atrius Health, says, “We are honored to receive this funding to continue our work to create a collaborative and supportive community for our patients at Atrius Health. This personalized approach to mental health aligns with our mission to provide the best care possible.”
Constantino and colleagues have assembled an advisory board with members representing patient, provider, administrator and health care policy views and values.
Dr. Joe Selby, PCORI executive director, says, “This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options. We look forward to following the study’s progress and working with UMass Amherst to share the results.”
The award has been approved pending final completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.PCORI is an independent, nonprofit organization authorized by Congress in 2010, with a mission to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.
In a related development, Constantino and Boswell have been carrying out a $308,000 grant from the Robert Wood Johnson Foundation to study consumer attitudes and preferences in using provider outcome and performance information, and the relative values consumers place on provider performance track records compared to other provider/treatment characteristics. They are using interviews, focus groups and a special survey. Results will help to develop and implement ways to improve consumer success in choosing a personally appropriate and effective a mental health provider.
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