Examining Real-World Implementation of Measurement-Based Care and its Influence on Emergency Department Visit Risk Among Outpatients With Mood and Anxiety Disorders

07/05/2026

AI Summary

Real-world MBC implementation was associated with a 34% lower emergency department visit rate (IRR 0.66, 95% CI 0.54-0.80).
No significant difference in time to first ED visit between groups, but higher MBC exposure reduced ED visit hazard (HR 0.61 for ≥15%).
Completion of measures at 15% or more of visits yielded dose-dependent reductions in ED visits, indicating modest MBC uptake confers benefit.

Adm Policy Ment Health. 2026 May 7. doi: 10.1007/s10488-026-01508-8. Online ahead of print.

ABSTRACT

The practice of using validated rating scales to guide treatment-measurement-based care (MBC) remains underutilized in behavioral health. This study examined the association between real-world MBC implementation, ascertained by measure completion, and emergency department (ED) visits. A retrospective cohort design made use of medical insurance claims data (2015-2023) to examine adult psychiatric outpatients exposed to real-world MBC (“MBC” sample; n = 524); 482 were propensity score-matched to patients who received care as usual (“CAU” sample; n = 964). The index visit was the date of registry enrollment for the MBC sample and the first psychiatric encounter while enrolled for the CAU sample. Time-to-event and negative binomial models were used to estimate hazard ratios (HRs) and incidence rate ratios (IRRs) for ED visits. The overall sample included 1,488 patients (63% female and 44 years old, on average). Among the MBC sample, 171 (33%) experienced at least 1 ED visit in one year of follow-up versus 299 (31%) in the CAU sample. There was no significant group difference in time to the first ED visit. However, the MBC sample had a 34% lower ED visit rate (IRR = 0.66; 95% CI: [0.54, 0.80]). Compared to patients who received MBC at less than 6% of their visits, those who received MBC at 15% or more had lower ED visit risk (HR = 0.61 [0.40, 0.94]; median time to ED visit 123 days vs. 101, among those who visited). Completion of measures at as little as 15% of behavioral healthcare visits was associated with significantly fewer ED visits in a dose-dependent manner.

PMID:42096017 | DOI:10.1007/s10488-026-01508-8

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