Interpreting the Enhanced Feedback Report

Mirah presents client-level clinical feedback in a comprehensive, interactive report. This report is the core of Mirah for clinicians using the platform and provides invaluable insight to guide care and clinical decision making. 

Understanding the Layout

Orienting to the Report Layout

Header

At the top of the screen, you’ll find basic information about the client. Initials presented in a dark gray circle indicate the client and their associated information and responses. Initials visualized in the light gray circle, if present, represents the caregiver. Throughout the report, you can always tell who the respondent for an item was by looking to the left of the measure for these identifiers. Other pertinent information includes client demographics, information about the active care episode, and the care team.

Risk Screening

Underneath the basic information in the header, there is a section for risk screening. This presents critical information related to risk screening and management. If more information is needed for any of the risks, clicking on the badge will bring up the most recent item responses in the right “Details” panel. From there, using the navigation at the top of the right hand panel, the user can view the entire risk history and item responses from past dates. See “Badge Details: Responses” below for more information.

There are three risk badges that may be present, based on the administered scales. They are:

• Suicidality
• Alliance
• Substance Use
• Medications

Two Panel Layout

The remainder of the report navigates between two panels. On the left “Overview” panel, the full overview or compare view will always be present. Within the right “Details” panel, the information will change based on what is selected from the left panel and how the navigation bar at the top of the right panel is utilized. At any time, the “Expand” button can be used to expand or minimize either panel, for more focused viewing. 

Compare

Clicking the “Compare” button allows you to choose any measures by any reporter to view. This is useful to understand patterns or limit the amount of information to focus attention on something in particular. Select the measures that you’d like to compare using the checkboxes. This shows the graph of past responses for those measures within the left panel. The data points on this view are clickable and selecting one will populate details in the right panel (see below “Badge Details: Responses” for additional information on item level responses).

Treatment Response

Treatment response shows information related to how the client is progressing in treatment, such as symptoms and goal attainment. Using the “Add” button opens editable fields in the right panel that allow the clinician to add different types of goals for either the client or the caregiver from within the report.

Goals/Problems

The Goals section allows for tracking of goals progress, over time. Any goals or problems that the patient (and/or caregiver) have been working towards are highlighted here. Selecting the “Add” button allows the user to add more goals from the report, as well. The drop down within the goal section allows for selecting a “Top Problem”, “7 point Likert Goal”, or “Goal Attainment Scaling” to automatically add to the report.

Other Scales

The bottom section of the left panel presents the information related to the rest of the scales from the respondents. Scales are grouped by domains that organize scales measuring similar psychometric constructs. The names shown in the report are typically the construct names. However, when selecting a scale to view the details, the scale name is also displayed.

Deeplinking

The enhanced feedback report supports deeplinking.

Interpreting the Enhanced Clinical Feedback Report

Overview Panel

The “Overview” Panel has common elements for all scales administered. This includes who responded, what is being measured, trend over time, a heatmap indicating the change over time, the current/most recent score, and any acute changes in the scale since the last session. Each section below explains one of these common elements and how to use them to interpret the report.

Trend

The trend over time icon appears for any measure that has three or more completed sessions. It indicates that the patient has been “Improving”, “Stable”, or “Worsening” over time since the measure was first completed. Hovering over the icon gives a text explanation of its meaning, for additional clarification. If there is no trend icon, the measure does not support trends and additional exploration can provide further details.

In the examples below, the client report of “Life Satisfaction” is stable, which means there has been no change since the first time the measure was completed. In other words, there might be some small differences in the responses to the measure at each time, but those differences were not significant. “Therapy Alliance”, however, shows an improving trend icon. This may mean that the symptoms are getting better or perhaps there is less awareness of the symptoms (and therefore less endorsement of symptoms) since the first administration of the measure.

Heatmap: Change Over Time

The heatmap for a measure appears inline following the indication of the respondent and what is being measured. Each heatmap is made up of colored chips that show all of the past responses for that respondent on the measure over the course of time. This is a useful guide to see the past scores on that measure all at once and the change over the course of time. The image to the right shows the heatmap with responses at every session, with gaps in administration (i.e. specific sessions were not scheduled to administer this measure), and with gaps in patient response (i.e. the measure was administered but the respondent did not answer at all or with enough responses to be clinically significant). 

The heatmap noting responses at every session shows a worsening trend over the course of treatment, where a client started out in the low range and then over the course of a few sessions worsened and is now reporting scores in the moderate range. 

Badge: Current Score

The most recent score for a measure appears as a badge inline following the heatmap. The badge color and the text both carry meaning. 

Color

The color of the current score badge and throughout the report correspond to a stoplight, where green represents “Doing well, check it out”, yellow represents the need to pause and “Pay attention”, and red indicates the clinician should “Stop, there might be a problem). 

If the badge is gray, it indicates that the measure was not administered at the most recent session, based on how often it is scheduled to be administered. In this case, the text color and the heatmap provide insight into the measure’s responses the last time it was administered and responses were collected.

The full color palette through the report corresponds to shades of these 4 colors, based on the level of severity that is represented. This is seen both on the badges and also in the heatmaps, based on the measure and the responses that are available. 

Text

The text within the badge corresponds to the measure itself. A low score on some measures is in the positive range while on others, it may be in the negative range or indicate higher severity. If the text is just a number or date, it means that the measure does not have clinical cutoffs or carry a score, respectively. In this case, going directly to the item responses can offer additional clinical insight.

Interpretation

Combining all of the information in a sentence can be helpful for interpreting the current score. In Example #1 below, low therapy alliance means there might be a risk or rupture to your working relationship with a client, which is something to stop and explore. In Example #2, low symptoms mean that symptoms are minimal compared to other clients receiving similar treatment. 

Acute Change

Acute change compares the most recent score on a measure to the previous administration, to help the clinician understand whether a change in score is significant or not. When there has been an acute change since the previous administration, an acute change icon will be present. This icon represents that the change was large enough to reach a specified threshold (which varies by scale). 

Reaching this threshold may be clinically meaningful and indicate recent improvement or worsening over and above any natural variations that may occur. Perhaps there was a recent event in the client’s life, or something else to be explored further in session. Hovering over the icon gives a text explanation of its meaning, for additional clarification. If there is no acute change icon, no acute change for that measure was indicated since the last administration.

In the examples below, the client report of “Symptoms'' was “Moderate” and orange, as an item to pay attention to. However, symptoms have worsened since the last session, as noted by the thundercloud icon.

Details Panel

If there are points in the overview that require further understanding and exploration, all of the heatmaps and badges are clickable. Once an overview item has been clicked, an outline appears around the line item to orient the clinician to what they are viewing in the “Details” panel.

Scale Name and Heatmap Details

Selecting the scale name or the heatmap from the “Overview” panel opens a graphical representation of all administered scale scores in the “Details” panel.  At the top of the right “Details” panel, there is a navigation trail to indicate this is the “Measure History”. It includes the name of the measure, a brief description of the measure, each past response presented in a line graph, a reminder of the respondent for the measure that is being viewed, and the latest score on the measure. 

Hovering over the latest score gives additional details on the score including the date it was recorded, the exact score, and the severity that score corresponds to. As a reminder, this information is also available within the badge for the measure, in the “Overview” panel. 

Within “Measure History” data points on the graph as well as the latest score can both be selected to show the individual item responses for the corresponding scale administration (see below).

Badge Details: Responses

Selecting the current score badge from the “Overview” panel opens the detailed, item level responses for the most recent administration of that measure. At the top of the “Details” panel, the navigation trail indicates this is the “Responses” view. 

This view confirms the name of the respondent, the response date, and then outlines the first score that was ever recorded for the measure, any trend that exists for the measure, and the score that is currently being viewed. Additionally, the pencil icon allows the user to navigate and edit any of the responses that are documented. Following these details, each item on the scale is written with the correlating responses.

If applicable based on the scale, item alerts will be shown for each response with a red dot. This means that the answer given was in the top 25th percentile of negative responses in comparison to the psychometric sample. 

Navigating back to the “Measure History”, other item level responses from different scale administrations may be viewed by selecting a data point on the graph or clicking on the latest score. 

Additionally, the detailed item responses are populated when any of the risks in the top section are selected. 

Navigating to Different Scales

At any time, details for a different scale can be viewed in the “Details” panel by selecting it from the “Overview” panel. Navigating among the scales will change the indicator box in the “Overview” panel, so the user is always oriented to the scale for which they are viewing the details.

Generate a Clinical Note

Within the Enhanced Feedback Report, users have the ability to view a clinical note with a summary of the report's findings.

1. Click on the menu in the top right corner and select "Generate Clinical Report".

2. The note will appear on the screen, detailing important information about the session and measurement responses. By selecting "Copy", this summary will be copied to your clipboard.

Reporting Dates in the Enhanced Feedback Report

When a measurement invitation is created for a patient, the corresponding report date is set based on that creation date of that invitation.

1. The invitation creation date is reflected on the patient's measure in the enhanced feedback report.

2. The completed date may be different from the invitation creation date displayed on the report.