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Table 4 Summary of design considerations for MBC systems

From: What do clinicians want? Understanding frontline addiction treatment clinicians’ preferences and priorities to improve the design of measurement-based care technology

Potential benefits Design considerations
Improved patient-clinician communication Design with patient-provider interaction in mind. Features could include open-ended questions that allow patients to provide additional information and context to clinicians. Design results dashboard so patients and clinicians can easily co-review and discuss MBC results and reasons for clinical changes (or barriers to change) during sessions
Empowering to patient Ensure that displays of MBC results clearly illustrate changes in outcomes and goals over time
When introducing MBC to patients, encourage them to “own” it as their own recovery-related tool, as opposed to something mandated by clinicians or clinics
Support patients in accessing their own MBC data outside of clinical sessions
Improved communication between clinicians Make MBC results accessible and understandable and relevant to clinicians from multiple disciplines who offer various types of treatments (e.g., pharmacotherapy, psychotherapy, case management, psychiatric care). Also make results understandable to clinicians who may have infrequent contact with patients and who provide non-SUD-related services. Avoid using SUD-specific jargo
Potential drawbacks Design considerations
Patient self-reports are subjective Emphasize to clinicians that MBC is just one additional data source, not meant to replace clinical judgment or objective measures
Recognize that incentives for dishonest reporting may vary between patients and over time
Emphasize that some non-substance use outcome may be less subject to bias even if there are concerns about under-reporting of substance use (e.g., coping skills, self-efficacy, depression)
Consider incentivizing MBC engagement (e.g., rewards or privileges for completing assessments) and avoid punitive consequences based on responses to MBC assessments (e.g., self-reporting substance use on MBC assessments should not trigger punishment or loss of privileges)
Lack of personalization Measure patients’ goals as part of MBC to contextualize the meaning of MBC results
Measure domains that are potentially valuable across a range of patients – e.g., engagement in valued activities
Burden of time Send MBC questionnaires automatically to patients’ mobile devices to reduce the need for clinicians to administer, score, enter, and save data from measures
Make MBC results available using devices that are already available to clinicians (e.g., desktop computers) and patients (e.g., mobile devices and/or patient-facing computers in clinics, when available)
Utilize existing software that does not require patients and clinicians to install and learn new software—e.g., questionnaire links that can be sent to patients via text message and completed via web browser; questionnaire results that can be viewed via web browser or electronic health record software
Clinician anxiety or difficulty with using new technology Utilize existing devices and software to support MBC, when possible
Ensure MBC data collection and storage has adequate security protections in place
Communicate data security protections and limitations to patients and clinicians
Preferences and ideas for MBC Design considerations
Minimize clinician burden Utilize devices and software that are already used by clinicians (e.g., desktop computers, electronic health record systems, internet browsers) and patients (e.g., mobile phones, text messaging software, internet browsers)
Quantify results over time Provide easy to read graphical summaries to summarize multiple data points
Highlight or flag patients that appear to be “at risk” and in need of intervention based on historical trends in score
Easy for patients Utilize short MBC questionnaires and collect passive data to understand how long clients spend completing measures
Emphasize personalization Measure patient goals in addition to progress
Allow SUD-specific MBC to potentially be augmented with measures for other clinical targets (e.g., depression, anxiety, insomnia) as needed