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VISN 4 Mental Illness Research, Education and Clinical Center


The goal of the VISN 4 MIRECC is to enhance the overall mental health of Veterans throughout the nation. We have chosen for our MIRECC an overall theme of “Measurement Based Mental Health Care.” Measurement-based care refers to the use of biomarkers, self-assessment, or other measures of disease/problems as a way to influence treatment planning and program management. Measurement-based care has many components. Within those components, we focus on two major elements. First, we work to enhance the initial evaluation of patients by systematically eliciting and integrating their treatment preferences in the care process and implement specific kinds of symptom and disorder measurement, including biomarkers, to tailor the choice of existing treatments to be deployed. Second, we use measurement-based care to adapt treatment over time, understand implementation barriers to measurement-based care and build a platform to incorporate patient preference. We extend our work on the development of information technology as a means to improve the assessment process, particularly that involving self-reported information. We accomplish these broad goals through services research; education and training programs; clinical programs built on research findings; involvement of the VA Medical Centers within VISN 4, and the VA more broadly, and the University of Pennsylvania and the University of Pittsburgh.


  • Develop tools to implement measurement-based care in clinical practice as a means to systematically drive precision medicine
  • Validate and incorporate new measures of care such as biomarkers, including genetic variants (as identified to date in addiction care) to select the most efficacious and least risky treatments
  • Develop methods that systematically incorporate patient preference in treatment decision making to improve the acceptability of treatments
  • Develop treatment algorithms and decision aids for clinicians practicing in integrated and specialty care settings, principally focusing on affective and addictive disorders

Our MIRECC's role in promoting measurement based care

The VISN 4 MIRECC's theme of measurement based care is a broad-based approach to scientific discovery and the development of new clinical procedures. This includes genetic and other biomarkers and treatment decisions, patient preferences, the development of treatment algorithms and patient reported outcome measures (PROM) used in clinical care. A forum including VA's Mental Health Services office and the Office of Mental Health Operations has begun an implementation initiative to promote the use of PROM, specifically, throughout the VA's health care system. It could be argued that measurement-based care should already be a routine part of clinical practice in behavioral health as indicated by a recent Institute of Medicine’s report on PTSD and the Inspector General’s report on depression care. There is a general lack of implementation in clinical practice, however. The VISN 4 MIRECC works in support of VA's Measurement Based Care clinical implementation; click here for more information.


David W. Oslin, M.D.
CPL Michael J Crescenz VA Medical Center