Importance of this research

Mental health treatment is anything but straightforward. Different professionals may offer a variety of different, and sometimes conflicting, opinions about a single patient’s problem and the correct way to treat it. The problem of different and conflicting ideas is present due to the nature of mental health problems. They are complex. Biology, the social environment, cultural norms and expectations, personal ways of thinking and behaving, among other factors, all interact in how a patient experiences and describes any of the conditions that qualify for a formal mental health diagnosis.

This research was conducted to evaluate how a digital screening process designed at the Rochester Center for Behavioral Medicine (RCBM) impacted the patient experience, and to identify the factors which make for a successful screening program. The primary goal was to enable practitioners (beyond RCBM) who implement comprehensive assessment, screening, or other measurement-based care methods of improving patient outcomes to have a basis for effective and impactful development of such program.

A secondary goal of this research was to inform new product development of MindMetrix, a comprehensive screening and evaluation tool designed for use by individuals. The team at RCBM had intrinsically seen the value in having data to support such complex mental health decision-making, and this research confirmed and shed light on the reasons it was also viewed as beneficial to patients.

Specific screening factors linked to patient experience.

We are happy to present you with the results of our report, Comprehensive Screening & Patient Experience.

The team of psychiatrists, psychologists, dietitians, counselors, nurse practitioners and clinical social workers at RCBM found that the more thoroughly we understand the different parts of a patient’s experience, the more effective we are at choosing methods of helping patients overcome mental health problems. When beginning treatment at the Rochester Center for Behavioral Medicine (RCBM), most patients are referred to undergo a comprehensive psychological screening assessment. The comprehensive assessment collects information using a large selection of questionnaires that have been scientifically designed to measure dozens of different mental health conditions. The questionnaires a patient completes are initially selected based on a clinician’s hypothesized diagnosis for the patient. Plus, additional tests are added as the patient completes the initial set of questionnaires if their answers indicate a certain condition or diagnosis could be present. A clinician will then review the responses and results, working to identify patterns that are consistent with the patients’ and loved ones’ verbal reports of experiences and symptoms. 

To understand whether (and why) RCBM patients find the comprehensive testing beneficial, we conducted a survey to capture their experiences and evaluations of the screening experience and its effects on their treatment.

Who we surveyed

146 RCBM patients who had been through RCBM's comprehensive screening completed our survey. All survey participants had undergone the screening within the 18 months prior to the survey being sent out.  Our goal was to include participants who had an up-to-date experience of RCBM's screening process, and who also would have had time to review results and assess their impact on treatment outcomes.

We asked questions to understand the level of investment clients had made in improving their mental health before coming to RCBM. Their responses confirmed an enormous amount of effort and investment in improving mental health prior to seeking care from RCBM.

Patients reported significant investments in treatment prior to coming to RCBM:

-74.6% reported having sought out mental health treatment elsewhere

-53.8% reported spending 6-8 years or more searching for answers to their mental health problems.

-33.3% reported spending more than $3,000 on mental health treatment prior to coming to RCBM. 16.7% spent more than $10,0000.

-79.8% reported having tried psychiatric medication prior to RCBM screening with an average of over 6 different psychiatric medications tried prior to undergoing RCBM screening.

Methodology

Based on these qualitative reviews and reports from patients, we constructed a patient experience questionnaire that presented a wide variety of questions to respondents, who were asked to rate those about their experience with screening on a 10-point scale.

An analysis using structural equation modeling was performed to evaluate the measurement model and assess which questionnaire items best “fit together” to define predictors of patient satisfaction with screening, or more specifically the extent to which screening factors impact a patient's feelings of having an experience at RCBM that was better than they'd received in the past, better than they'd expected, and one that improved their mental health outcomes. We also analyzed descriptive statistics of our sample's personal characteristics.

Once groupings or themes were established, we labeled them to describe the concept. In this case, four significant predictors of patient satisfaction were identified, and multiple data-points were established to better understand the problems faced by those seeking answers to complex mental health questions. In doing this analysis, we not only establish causal relationships between how comprehensive screening supports feelings of improved mental health, but also how these drivers impact a patient's perceived feeling that the comprehensive screening, alone, was worthwhile.

Findings

The survey results suggested that patients are very satisfied with their experience at RCBM, and that it is due to several factors related to their comprehensive screening & assessment process.

Patients reported:

-78.5% reported trying 2 or fewer new psychiatric medication total since screening.

"I finally found the answer to a lifetime of mental health struggles."

-77.9% reported that RCBM screening did not miss anything relevant to their healthcare.

"I received a new diagnosis that I had not before that helped explain a lot of what I was experiencing."

Patients reported that the results were highly accurate. On a scale of 1-10 ( 1 = not accurate, 10 = Extremely accurate), the patients averaged an answer of 8.

"I realized that I do not have ADHD and it made me more aware of my anxiety diagnosis."

Patients reported that the results improved their self awareness. On a scale of 1-10 ( 1 = no self awareness gained, 10 = complete awareness gained), the patients averaged an answer of 8.

"I knew I was ADHD and had anxiety but I didn’t know how bad they were both impacting me. And I didn’t realize how severe one was impacting the other."

Patients reported that the results were highly beneficial to treatment. On a scale of 1-10 ( 1 = not beneficial, 10 = Extremely beneficial), the patients averaged an answer of 8.

"... insight into correct treatment (both coping mechanisms/behavior and medication)"

The more the screening experience was easy to access & use, increased their self awareness or insight, provided accurate results, and impacted changes to treatment, the more likely a patient reported a high level of overall satisfaction with the comprehensive screening process. R (147) = .898. 

Takeaways

Undergoing RCBM’s comprehensive screening was seen by patients as beneficial, improving both treatment and self awareness. A very high percentage of patients reported a new more targeted treatment following screening. A large percentage of patients also affirmed that the comprehensive screening resulted in a complete and accurate assessment of their experiences in terms of mental health conditions and concerns. 

These results bolstered RCBM’s commitment to having treatment be informed by a complete clinical picture created by a wide range of differing information gathering tools and sources. Given these results, we recommend that other psychiatric professionals adopt similar strategies.