Measurement-Based Care: What's Your Number Today?
Earlier this year, the DBSA staff was lucky enough to spend some serious time with Dr. John Rush, the primary investigator for the STAR*D research. If you need a refresher on what STAR*D is all about, there's a reasonable overview on the NIMH website. And one of the best sources of conversation about research and bipolar disorder and depression is McMan's Depression and Bipolar Web.
What caught my interest in our talk with Dr. Rush was his emphasis on the need for measurement-based care. How often do we find ourselves in our psychiatrists' office for a 12-minute check-up telling them "I'm fine" or "I'm not doing well" when we have no way to measure or rate that feeling? It's one of the reasons mood charting is so popular, of course. With a glance, our doctor can see how we've been doing over a span of time. Then, we can base our conversation on that, instead of on how we're feeling as we take the elevator up to his/her office that particular day.
If we begin tracking how we're doing using a reliable tool, we might be able to have a practical interaction with our doctor, based on something more than just guesswork. John proposes that we use one of two measurement-based care tools: the Quick Inventory of Depressive Symptomatology (QIDS) and/or the Altman Self-Rating Mania Scale (ASRM).
One of the reasons I'm so very interested in measurement-based care is that many of us are stuck in the "good but not great" mode. That is, we feel like we can't complain too much because, after all, we're not in the low lows or the high highs ... but we aren't fully well either. We still deal with symptoms that get in the way of living a full life.
Many of us also aren't able to communicate very well how we are really doing. After all, if I'm sunk down on the depressed side, perhaps living with the depression feels normal. Or when I'm "up," I may say I'm wonderful, but I'm actually not doing well at all.
Furthermore, studies show that, time after time, almost all of us accept poor quality care. When you think about it, it makes sense—what do we have to compare it to?
With measurement-based care, my doctor and I together are tracking how I'm doing on an established scale like QIDS or ASRM, and doing this (especially if reported to an insurance company) could actually change this poor quality care statistic. My doctor can't claim to be giving great care if my scores on the scales remain flat. Together, my doctor and I can make better decisions about how to adjust my treatment if my scores indicate that, for example, over the past 90 days my "score" has been all over the map. My doctor can see that I have a ways to go, if my scores indicate that I'm "good but not great."
Now, some consumer communities could see measurement-based tools as somewhat problematic: Why would I be simply measuring symptoms? Isn't the point of recovery to build on our strengths and focus on what we're trying to create in our life and not what is holding us back (our symptoms)?
Agreed, but the cold, hard reality is that psychiatrists currently do focus on symptoms in the 10 to 12 minutes we have with them. And if that's the case, then wouldn't you want that conversation to at least be meaningful?
What are your thoughts on measurement-based care and using tools like QIDS and ASRM?