image: Michael Constantino is a professor of psychological and brain sciences at UMass Amherst. view more
Credit: UMass Amherst
A University of Massachusetts Amherst psychologist has received a $4.6 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to implement a program that matches mental health patients with psychotherapists based on the therapist’s previously established effectiveness strengths.
Michael Constantino, professor of psychological and brain sciences, led the first-of-its-kind randomized clinical trial – also funded by PCORI – that found patients intentionally matched with therapists who had a strong track record of treating the patients’ primary concerns had about double the improvement than patients who were case-assigned as usual, where matching occurred only by chance.
For the present award, Constantino and his team of academic, industry and clinical partners will implement in phase one the evidence-based match program with a large mental health care network in the Philadelphia area, Springfield Psychological. After that, in phase two, the protocol for patient-therapist matching – optimized based on dissemination science results from phase 1 – will be implemented across the Refresh Mental Health network at about 50 mental health care sites in more than 30 states.
This psychotherapy program is part of a portfolio of PCORI-funded projects that aim to improve the awareness, uptake and use of results from patient-centered comparative effectiveness research.
Chosen through a highly competitive review process, awardees’ proposals were assessed for the importance of the findings being shared and implemented and the potential for the project to lead to changes in practice and improvements in health care and health outcomes. PCORI’s Board has approved Constantino’s award pending completion of a business and programmatic review by PCORI staff and the issuance of a formal award contract.
“Even the most impactful findings from clinical research studies can take years to make it into widespread clinical practice,” PCORI states in announcing the award. “Cutting that lag time and smoothing the path to uptake is the focus of this PCORI-funded project.”
“The beauty of PCORI’s mechanism is that they want to fund good science and then they also want to fund the clinical translation of that science,” Constantino says.
In Constantino’s original research, the “match effect” was found to be even more beneficial and pronounced for patients who identified as racial or ethnic minorities.
“This will be one focus of our implementation project – addressing some of the disparities in mental health quality that we see in the field, meaning that underrepresented racial and ethnic minority patients often receive less-effective treatments,” Constantino says. “This is one means to try to address that.”
The matching relies on a multidimensional outcomes tool called the Treatment Outcome Package (TOP), which assesses 12 symptomatic or functional domains: depression, quality of life, mania, panic or somatic anxiety, psychosis, substance misuse, social conflict, sexual functioning, sleep, suicidality, violence, and work functioning.
Once a therapist has at least 15 patients complete a TOP before and after treatment, a “report card” is established showing that therapist’s strengths and weaknesses in treating the 12 domains. This information can then be used for prospective matching of new cases to the therapist’s measurement-determined areas of effectiveness.
“There are a lot of sites in Refresh Mental Health that aren’t using the TOP yet, so in phase two we will be able to truly demonstrate what it is like to go from A to Z if you if you are a mental health network that wants to start using our match system,” Constantino says.
PCORI is an independent, nonprofit organization authorized by Congress in 2010 to fund research that will provide patients, their caregivers and clinicians, and other healthcare decision makers with the evidence-based information needed to make better-informed healthcare choices.