FIT: Improving Treatment and Outcomes with Feedback Informed Treatment

It’s All About Measuring Outcomes.

Basic and fundamental change is coming. FIT (Feedback Informed Treatment), also known as “Measurement-Based Care,” is an evidence-based program for measuring progress and outcomes in SUD (Substance Use Disorder) and BH (Behavioral Health) treatment. With FIT, outcomes improve by 70% – 350% in SUD/BH treatment when progress measurement is used to monitor progress, adjust treatment, and measure post-treatment outcomes. Beginning on January 1, 2018, Progress and Outcome Measurement will be required by The Joint Commission and is already recommended by dozens of experts, including The Kennedy Forum. Are you ready? Are you sure?

How FIT Evolved: How We Got Here.

The FIT (Feedback Informed Treatment) concept was originally developed in 1996, yet has only become more useful with the evolution of cloud computing, along with faster, easier technology which allows FIT to be implemented on a broad scale. FIT began with a noble goal: to create a method of obtaining feedback from patients to measure progress in treatment and outcomes of MH and SUD treatment. FIT addresses the importance of assessing whether a given treatment is working for a specific individual, not just whether it tends to work for a large group of people. It also suggests that comparing an individual’s progress as measured throughout treatment with expectation of progress can help treatment decisions. This, experts agree, will lead to quality improvement. After more than 20 years, FIT’s time has come.

Measuring Progress and Outcomes With FIT…

  • Outcomes improve 70% – 350% in BH/SUD treatment when progress measurement is used to monitor progress, adjust treatment, and thereafter measure post-treatment outcomes
  • Reduce dropout rates by 50%
  • Reduce deterioration rates in treatment by 30%
  • Required by The Joint Commission, effective January 1, 2018
  • Expected requirement by other accreditation bodies in 2018
  • Expected requirement by CMS and insurance payors by 2019
  • Financial results improve as outcomes improve

How and Why FIT is Effective.

Research clearly indicates that “Client Factors” play an overwhelming role in positive treatment outcomes. These factors (which are independant of treatment), include (1) A patient’s readiness for change, and (2) A patient’s strength and resources, the severity of the addiction and a patient’s social support environment. These Client Factors determine 87% of outcomes. All other factors account for a small percentage of coutcomes, the exception being the patient/therapist alliance, which typically accounts for just 5% – 8%, and therapist effects which amount to just 4% – 9%. The research concludes: After the Client’s Factors, alliance with a therapist and therapist effects are the most important elements in determining a positive treatment outcome.

That’s where FIT comes in. FIT dictates that a standardized measurement of the treatment progress, its outcomes, and the theraputic alliance between patient and therapist are carefully evaluated and tracked. To answer the call, in 2009 the BAM (Brief Addiction Monitor) is implemented by the U.S. Dept. of Veterans Affairs, for use in SUD treatment, comprised of 17 questions that assesses substance, risk and protective factors.

BEST PRACTICE: FIT on Smartphones and Tablets.

While FIT systems were developed in the early 2000s, the advent of cloud computing, tablets and smartphones make FIT systems easy to implement with mobile technology. Why is this an important breakthrough?

Studies show conclusively that patients will “tell” a smartphone or tablet device more than they often reveal to their therapist — especially when it comes to treatment progress. Patients often seek approval and friendship from their therapist, so they will tell their therapist what he or she wants to hear. However, given the opportunity to answer a survey on an iPad or smartphone, the answers are often more truthful. No matter what we say or do, patients with substance use disorders feel burdened with shame and find it difficult to fully and honestly open up to another person.

Patients find it easier to provide greater and more honest communication electronically. It feels more anonymous, even when it is not, which enables to give honest answers. This was confirmed by studies cited in the U.S. Surgeon general’s report on addiction, as well as results reported by recent brain scan studies in the U.K.

The FIT survey will generate immediate results, and help improve treatment progress and outcomes. FIT breaks the silence of patients with the use of electronic surveys, assessments and other form-filled measurement and diagnostic tools designed to solicit information from patients.

KIPU and BAM. Answering The Joint Commission.

The Brief Addiction Monitor (BAM) supports the individualized, measurement-based care for substance disorders (SUD). The BAM monitors a patient’s progress in SUD care and yields reliable data that is both easy to collect and readily integrated into SUD treatment planning. The BAM is a 17-item, multidimensional questionnaire administered electronically from the Kipu EMR to patients seeking or enrolled in SUD treatment. It retorspectively assesses three SUD-related domains: Risk Factors for substance abuse, Protective Factors that support and encourage sobriety, and drug and alcohol use. BAM scores have proven highly reliable; BAM scores collected at intake also may predict treatment completion vs. dropout.

Some Brief Historical Context.

Between 2012 and the present, FIT has become the required standard. In 2016, The Kennedy Forum announced that progress measurement (or lack thereof) is the most important factor in contributing to successful outcomes in MH/SUD treatment. And in 2017, The Joint Commission announced their requirement that accredited SUD treatment facilities must use a standardized tool for progress and outcomes measurement along with internal procedures for reacting to the data.

Today, The Brief Addiction Monitor (BAM), a FIT tool, is implemented nationally in the VA Health System’s 46 hospitals that treat SUD. It is also used by The Group for the Advancement of Psychiatry, endorsing the use of standardized syptom rating scales to supplement clinical interviews. The National Council for Behavioral Health endorces the use of research-backed outcomes measurement tools to help clinicians address functional deficits of individualized care plans. And the United States Army routinely uses a tablet-based symptom rating scale system in its specialty mental health clinics.

Likewise in 2015, Anthem Blue Cross Blue Shield,® United Healthcare® and CMS (the Centers for Medicine and Medical Services) have all announced value-based payment programs which incentivize measurement-based care. The time has come. We’re working in the era of FIT and measurement-based care. That why we’ve assembled a FREE E-Deck download. Everything you’ll need to know is in this single, concise volume.

Fit Comes Full Circle.

We’ve assembled a detailed E-deck, describing how FIT and the concept of Progress and Outcome Measurement began; how it’s evolved and where it’s headed.

Produced by Jeffrey Fiorentino and the editors at Kipu EMR, this volume answers many questions regarding January 18, 2018 requirements and standardized measurement tools.

THE FINAL WORD: U.S. Surgeon General:

Recommended by the U.S. Surgeon General in his landmark report: “Technology can play a key role in supporting these integrated care models. Electronic health records (EHRs), telehealth, health information exchanges (HIE), patient registries, mobile applications, Web-based tools, and other innovative technologies have the potential to extend the reach of the workforce; support quality measurement and improvement initiatives to drive a learning health care system; electronically deliver prevention, treatment, and recovery interventions; efficiently monitor patients; identify population health trends and threats; and engage patients who are hesitant to participate in formal care…Performance measurement has the dual purpose of accountability and quality improvement.”


Are You “Joint Commission Ready?”

Are you ready for the new requirement that dictates patients must regularly report how they’re feeling and that feedback is used by clinicians to inform clinical care? Kipu is ready.

How will you select a symptom rating scale? How will your patients complete surveys, and how will the results made available to clinicians so they can react to changes or alerts? Kipu has the answers.

How will you prove to The Joint Commission that progress and outcome data is actually being used to inform clinical care? And perhaps most importantly, who will gather all the appropriate data needed to assess your programs effectiveness then adjust treatment and continue measurement? Kipu streamlines the process.

Measuring progress and outcomes using a standardized tool is is now required. Measuring progress and outcomes is already required by many large providers, including the VA Health System, the U.S. Army and others. Progress and outcome measurement will soon be required by CMS, insurance payors and other accreditation agencies.

The good news? If you’re a Kipu client, you’re already compliant with the new TJC requirements. If you’re not using Kipu, perhaps we should talk. We’ll make sure you’re compliant, efficient and profitable.

Kipu has all the tools to enable Feedback
Informed Treatment. We’ll get you compliant.
Call us now 561-349-5901

KIPU is Ready. Are You?

Kipu has all the tools to enable Feedback Informed Treatment.
We’ll get you compliant. Give us a call.