At Rula, we are dedicated to providing you and your patients with the best clinical tools available to drive meaningful, effective care. One way we do this is through the use of Measurement-Informed Care (MIC), which is defined as the routine, brief assessment of patient-reported data, specifically symptom severity and therapeutic alliance, that can then be used collaboratively to inform care decisions, treatment planning, and drive positive clinical progress.
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Measurement-Informed Care at Rula
Consistent use of MIC in mental healthcare is a highly valuable clinical tool that you can use each session to better understand patient care needs, just as a primary care provider does with vitals data during each visit, such as measuring blood pressure and temperature. Ample research has shown that MIC improves patient outcomes, and patients who participate in MIC recover faster.
Rula uses a set of standardized measurement surveys that target assessment of both symptom severity and therapeutic alliance in patients age 13+. The current assessment tools utilized at Rula include the following:
- GAD-7: Generalized Anxiety Disorder - 7 items for anxiety
- PHQ-9: Patient Health Questionnaire - 9 items for depression
- C-SSRS: Columbia Suicide Severity Rating Scale
- CAGE-AID: Screener for drug and alcohol use
- Questions designed to capture Therapeutic Alliance
Rula automatically collects the data for you! Two days prior to each session, every patient age 13+ is automatically emailed a link to complete the measurement surveys. You can review their responses in advance, and use the data to understand and inform care needs for your upcoming session before it begins.
- For the Initial Assessment, patients will receive a baseline survey 2 Days prior to the appointment.
- Once treatment has begun, patients will receive an ongoing check-in survey 2 days prior to every appointment (but no more than once per week.)
- This set of surveys typically only takes a few minutes for patients to complete.
Easily find and review your patient’s survey responses. Once your patient completes the survey link, you can find a PDF of each patient's result in the Documents folder of the patient's chart in the EHR. Please check out this article for more information on how to locate these results.
You’ll see results for each individual measure represented as a score. For example, the PHQ-9 has a total possible score of 27 (9 items, worth between 0-3 points each). Lower scores indicate lower symptom severity. For more information on scoring and clinical interpretation of the measures, click here.
You've got the data, now what do you do with it? To make meaning out of the measures, it’s important to review survey results collaboratively with the patient in session, as well as consider how the data may influence care planning. MIC does not replace a provider’s comprehensive clinical assessment, but rather significantly improves assessment processes by informing individualized treatment approaches and providing opportunities to track clinical progress.
Some suggestions for meaningful ways to integrate measures into practice include:
- Talk with patients about the immense clinical value of taking measures early and frequently during treatment. Explaining how this self-reported data will be used to better understand their care needs aids in the transition from "How are YOU doing?" to "How are WE doing?"
- Use scores as a starting point to dialogue in session about symptoms. This could include reflecting and discussing increases in symptom severity, a slower rate of symptom improvement than expected, or an opportunity to celebrate clinical improvement and noted positive outcomes.
- Leverage scores to assess the effectiveness of current medication regimens, identifying any patterns or trends in symptom response over time.
- Discuss with patients how changes in their symptom scores may correlate with medication adherence or response, fostering a collaborative approach to medication management decisions.
- Incorporate patient-reported outcomes from MIC measures into shared decision-making processes regarding medication adjustments, emphasizing the importance of patient preferences and treatment goals.
- Include a brief sentence or two in each session note about using, reviewing, and integrating MIC as a highly valued, best clinical practice.
Measurement-Informed Care FAQ
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Does Rula have measures available for child patients ages 5-12? Outcome measures for children aged 5-12 years old have not yet been distributed but should be available in 2024.
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My adolescent patient is taking the measurements on their own, but should I also include their parents? The primary patient should be the only one to complete the surveys; however, for minor patients, we recommend that you include the parent or guardian in treatment (when clinically appropriate) to obtain their feedback on the patient's symptoms and care needs.
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When I treat couples/families, who fills out the survey? The primary patient will complete the measurement surveys by answering questions about themselves. Since there is always a primary patient in couples and family treatment, we are tracking the progress of this person.
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Are the surveys available in languages other than English? The surveys are not available in other languages at this time. However, patients may request translation services by contacting Support at support@rula.com or calling (323) 676-7425.
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My patient says they are not getting the measurement survey email, what should I do? All survey links are sent to the email address on file (the same address as appointment links). If they say they aren't receiving them, please ask your patient to check their spam folder for the words "check-in survey". If the patient is between the ages of 13 and 17, the link may be sent to a parent or guardian. Please discuss this with your patient's parent or guardian to ensure they have access to the survey link.
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Who has access to the patient’s MIC survey results? You (the patient’s provider), the Rula Quality team, and payers will have visibility of individual patient results as part of a chart review or audit.
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How is Rula using this data? Rula uses anonymous aggregate trends to evaluate treatment outcomes. We will share aggregate data with commercial insurance plans to provide transparency about the work that is being done. We will also discuss aggregate data with referral partners in order to increase the number of patients referred to Rula and, as a result, to get you more patients.
Our Quality Team is also tracking each provider's use of MIC, as evidenced by the percentage of time spent reviewing completed measurement scores with patients during sessions. This is an opportunity for us to look into how Rula can better support providers and patients in using MIC to improve care. Furthermore, outcome data over time is used in the Clinical Care Review process (only for specific patients in California) to assess the medical necessity of ongoing care, as required by some of our payer contracts.
- Is this mandatory? We expect all patients to complete these regular check-in surveys as a standard of care with Rula. However, not completing the survey does not prevent treatment from being provided. Technically, a patient can “opt-out” of the surveys by clicking “UNSUBSCRIBE” on the emails. However, this is discouraged as surveys are considered to be part of the standard of care and may be required by some payers.
For more information on the use of Measurement-Informed Care at Rula, reach out to our Clinical quality team at Quality@rula.com.
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