Results Summary
What was the research about?
Therapy is a common treatment for many mental health concerns. Some therapists do better at treating certain concerns, such as depression or substance use, than others. But mental health centers don’t often consider how well therapists treat a certain concern when they assign patients to therapists. Instead, they may assign patients based on practical things like which therapist has an available appointment.
In this study, the research team tested a system called Match. Match pairs patients with therapists based on how well a therapist has treated patients with the same concerns in the past. The research team compared patients using Match with those assigned to a therapist using a clinic’s usual approach. Neither patients nor therapists were aware of how they were paired.
What were the results?
Across four months, compared with patients not paired with a therapist using Match, patients paired using Match
- Had greater reduction in general mental health symptoms, impaired functioning, and symptoms specific to their mental health concerns
- Had more consistent treatment results
- Felt less distressed or upset
Patients paired with a therapist using and not using Match didn’t differ in
- The quality of their relationship with their therapist
- How well they expected treatment to work
- Whether they stopped treatment early
- How satisfied they were with their therapist
Who was in the study?
The study included 218 patients who were referred to mental health care. Of these patients, 89 percent were White, 6 percent were Black, 3 percent were Latino, and 2 percent were another race. The average age was 34, and 67 percent were women. All received care at one of six mental health centers in Cleveland, Ohio.
What did the research team do?
The research team assigned patients by chance to one of two groups. In the first group, the mental health center used Match to pair patients with therapists. Match used information from at least 15 past patients to rate therapists as effective, neutral, or ineffective for each of 12 mental health concerns. Then the mental health center assigned each patient in the study to a therapist who had been rated as effective for their concerns. In the second group, the mental health center assigned patients to therapists in their usual way. All therapists treated patients as they would have if they weren’t in the study.
Patients filled out surveys before treatment started and multiple times during their four months of treatment.
Patients, therapists, referring doctors, and mental health center staff provided input during the study.
What were the limits of the study?
The research team tested Match in one health system in the Midwest; results might differ in other places. To rate therapists for certain concerns, the team looked at only one measure of their performance with past patients. Ratings might differ with other measures.
Future research could test Match in other places or use other measures to rate therapists’ past performance.
How can people use the results?
Mental health centers can use these results when considering how to pair patients with therapists to improve mental health care.
Professional Abstract
Objective
To compare the effectiveness of a case assignment system called Match with usual case assignment in reducing the general symptomatic and functional impairment of patients referred to mental health care
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 218 adults ages 18–70 who were referred to outpatient mental health care |
| Interventions/ Comparators |
|
| Outcomes |
Primary: general symptomatic and functional impairment according to the Treatment Outcome Package-Clinical Scales (TOP-CS) measure Secondary: global psychological distress, domain-specific symptomatic/functional impairment on most elevated presenting concern, outcome consistency across patients, therapeutic alliance quality, treatment outcome expectation, early treatment discontinuation, and patient satisfaction with therapist |
| Timeframe | Up to 16 weeks of usual treatment following baseline for outcomes |
This randomized controlled trial tested the effectiveness of Match, a system that assigns people who are referred to mental health care to therapists based on the therapists’ strengths in treating patients’ primary concerns, such as depression or substance use.
Researchers randomized patients to Match or usual case assignment. In Match, researchers paired patients with therapists based on therapists’ report card grades for treating the patient’s primary mental health concerns. To create the report card, researchers reviewed patient-reported outcomes from at least 15 of the participating therapists’ past patients in each of 12 outcome domains, such as depression, anxiety, substance use, and psychosis. For each domain, therapists received one of three grades depending on their patients’ average response over time: effective if patients improved more than expected, neutral if patients did not improve or decline beyond their expected change range, and ineffective if patients fell short of their expected change over treatment.
For usual case assignment, researchers paired each patient with a therapist based on practical considerations, such as availability or therapist-reported specialty.
After random assignment, patients received the mental health treatment they would have received if they were not in the study.
The study included 218 patients who were referred to mental health care at one of six participating community mental health clinics in Cleveland, Ohio. Of these patients, 89% were White, 6% were Black, 3% were Latino, and 2% were another race. The average age was 34, and 67% were female.
Patients completed surveys on outcomes at baseline and multiple times during 16 weeks of treatment.
Patients with lived mental health experience, psychotherapists, referring physicians, and community mental health center administrators provided input throughout the study.
Results
Across 16 weeks, compared with patients who received usual case assignment, patients in Match had greater reductions in general symptomatic and functional impairment, global psychological distress, and domain-specific impairment of primary mental health concerns (all p<0.05). At the end of treatment, general impairment improved more consistently for patients in Match than patients who received usual case assignment (p<0.05). Patients in Match and patients who received usual case assignment did not differ significantly in other study outcomes.
Limitations
The study included patients at one mental healthcare system in the Midwest; results may not be generalizable to other locations or populations. The study tested only one outcome measure to rate the therapists’ past performance; ratings based on other outcome measures might produce different results.
Conclusions and Relevance
In this study, personalized and measurement-based matching of patients and therapists improved patients’ general impairment, global psychological distress, and domain-specific impairment.
Future Research Needs
Future research could test the effectiveness of the Match system in other locations or use other outcome measures to rate therapists’ past performance.
Final Research Report
View this project's final research report.
More to Explore...
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Journal Citations
Article Highlight: Matching patients seeking mental health care with therapists who have a good track record of treating the patients' particular needs and concerns resulted in better outcomes than not matching patients, according to findings from this PCORI-funded study recently published in JAMA Psychiatry. Therapists tend to have areas of greatest experience and skill, the research team noted. Matched patients had larger reductions in both specific and general mental health symptoms and impaired functioning and reported feeling less distressed. The match system used in the study required minimal disruption within the mental health care system in which it was tested.
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
Reviewers asked whether the intervention effect that the researchers reported could have been due to patient characteristics rather than to the match system connecting patients to therapists with noted skill in treatment patients like them. The researchers admitted that their naturalistic study design meant that they had little control over therapists’ workloads and therefore over how many patients in each condition the therapists could take on. However, the researchers controlled for within-therapist factors to account for therapist effectiveness, and each participating therapist saw patients who were matched to them and patients who were not matched. With these controls, the researchers stated with confidence that a given therapist achieves better outcomes when treating a matched patient than a nonmatched patient.
To further test the reviewers’ concerns regarding the effect of therapist skill on achieving the stated results, the researchers conducted additional analyses to test whether the most effective therapists were more likely to treat matched patients than nonmatched patients. They found that in aggregate the top third most effective therapists saw about the same number of patients in each group. The researchers did acknowledge the possibility that therapist effectiveness contributed to the overall treatment effect in their report.
The reviewers questioned whether this study actually addressed mental illness because the patients in the study were not identified with mental health diagnoses. They asked the researchers to indicate how many patients would be identified as having behavioral health concerns rather than diagnosable mental illness. The researchers disagreed with this characterization of the study sample, saying that a mental illness diagnosis does not correlate with more severe problems. The researchers clarified in the report that the patients’ problem ratings were, on average, higher than 95 percent of the population, indicating significant mental health problems.