Outcomes Framework - Metric Types

Mirah supports three types of metrics. You can either select a fixed time point to measure and evaluate how many patients are successful, or you can set a fixed Success Criterion and measure how long it takes to achieve that goal.

  • Effectiveness Metric: Evaluate how many patients are successful at a time point in a treatment episode.
  • Efficiency Metric: Evaluate how long patients take to achieve an outcome.
  • Combined Metric: Combine several effectiveness or efficiency metrics into a single display.

Each is described in more detail below.


Effectiveness Metric

What is an Effectiveness Metric?

A Effectiveness Metric is a metric designed to evaluate outcomes at a certain point in treatment episode, as measured from treatment episode start.

Examples include:

  • % of patients who achieved remission at week 12 of treatment episode, as measured by the GAD-7.
  • Number of patients who saw treatment episode response after 3 months of treatment episode, as measured by the PHQ-9.
  • % of patients who were considered subclinical on the CSSRS at their last measurement.

Each of these examples has a final result of a single number - e.g. 56% or 34 patients.

In each case, the system evaluates the last measurement in the time period and compares it to the baseline.


What comprises an Effectiveness Metric?

A Effectiveness Metric comprises the following elements:

  • An "Aggregation" for the metric. The currently supported options are:
    • "Percentage (%) of patients" - measures the percentage of eligible patients who are successful.
    • "Number (#) of patients" - measures the number of eligible patients who are successful.
  • A "Time Period" for the analysis. Only one may be selected.
    • This defines at what point success must be met.
    • Detailed descriptions of each of the "Time Periods" can be found here.
  • One or more "Inclusion Criteria", which allow you to filter out patients who should not be included in the analysis.
    • For example, you may filter out patients who do not take a baseline measurement close enough to the Treatment Episode start.
    • All of the "Inclusion Criteria" must be met for a row to be included in the analysis.
    • Detailed descriptions of each of the "Inclusion Criterion" can be found here.
  • One or more "Success Criteria" corresponding to the outcomes you would like to see. You can select multiple. 
    • "Success Criteria" include options like "Remission" or "Treatment Episode Response".
    • ONLY ONE of the "Success Criteria" needs to be met for the Treatment Episode to be considered a success.
    • Detailed descriptions of each of the "Success Criteria" can be found here.

When should I use an Effectiveness Metric?

Effectiveness Metrics are the most common type. You should use an Effectiveness Metric when you want to get a sense of how many or what percentage of patients achieve success in a treatment episode, rather than how long success takes.

You will often want to blend an Effectiveness Metric with a Efficiency Metric (described below) to get a sense of both how many patients end up with a successful treatment episode and how quickly that success takes place. Both of which can be important for funding bodies, and this can be accomplished by creating a separate Effectiveness Metric and Efficiency Metric side-by-side.


Efficiency Metric

What is a Efficiency Metric?

An Efficiency Metric helps you answer questions such as ‘how long do patients take to get better’. When creating the metric, you set "Triggers" - e.g. "went into remission", or "a Treatment Episode Response", and the system will find the first time the event occurred and use that as a benchmark.

Examples include:

  • On average, how many days does it take to show response to treatment episodes as measured on the PHQ-9.
  • On average, how many days does it take for a patient as measured by the GAD-7 to move into remission.

What comprises an Efficiency Metric?

A Efficiency Metric comprises the following elements:

  • An "Aggregation" for the metric. The only currently supported option is:
    • "Average number of days since each treatment episode start". For the Treatment Episodes that meet the criteria, this averages the number of days it took for them to reach the criteria.
  • One or more "Inclusion Criteria", which allow you to filter out patients who should not be included in the analysis.
    • For example, you may filter out patients who do not take a baseline measurement close enough to treatment episode start.
    • ALL of the "Inclusion Criteria" must be met for a row to be included in the analysis.
    • Detailed descriptions of each of the "Inclusion Criterion" can be found here.
  • One or more "Triggers" corresponding to the outcomes you would like to see.
    • "Triggers" include options like "First time symptom went into remission" or First time patient saw "Treatment Episode Response".
    • ONLY ONE of the triggers needs to be met for the Treatment Episode to be considered in the analysis i.e. ‘Triggered’.
    • Detailed descriptions of each of the "Trigger Criteria" can be found here.

When should I use an Efficiency Metric?

In general, outcomes framework analyses attempt to answer one of two questions: ‘was treatment episode a success eventually’, or ‘how fast was treatment episode at achieving an objective’. Efficiency Metrics are designed to deal with the latter.

Insurance companies are very interested in Efficiency Metrics because they provide a proxy for questions such as ‘how many sessions does it take to achieve remission’.

Note that while Efficiency Metrics are important, they only include those treatment episodes that were successful, so usually a mix of Effectiveness and Efficiency Metrics are required to understand the full picture of treatment episodes.


Combined Metric

What is a Combined Metric?

A Combined Metric takes multiple Effectiveness or Efficiency metrics and bundles them together for easier display or comparison.

What comprises a Combined Metric?

A combined metric is composed of several Efficiency or Effectiveness metrics. In order to be displayed together, the individual metrics must have the same structure so that the numbers are directly comparable:

  • You cannot mix Effectiveness and Efficiency metrics in the same Combined Metric
  • Each metric must have the same Cohort Type
  • For Effectiveness metrics, each metric must use the same option for Time Period, but can have different values in that period.
  • Each metric must have the same Aggregation Type (Efficiency metrics can only aggregate by days since treatment start, Effectiveness metrics can aggregate by either percentage or number of patients).

The other elements of configuring a metric can vary between the metrics.


Each individual metric can be assigned a color to more easily distinguish them in the chart. The order they appear in the legend can be changed by reordering them in the list here.

When should I use a Combined Metric?

Use a combined metric when you want to see information from several metrics at the same time. Examples include:

  • Combine several Effectiveness metrics to measure treatment response at different time points - % of patients achieving remission at 12 weeks, at 24 weeks and at 36 weeks. You can combine these into a single metric that shows all the data at once, rather than having to read three separate charts.
  • Combine several Efficiency metrics to measure remission time between patients being treated with different measures