Implementing Measurement-Based Care in Virtual Mental Health Services for Rural Veterans: Provider Insights from a Pre- Implementation Evaluation

Background: Measurement-Based Care (MBC) uses repeated standardized psychological assessments to monitor treatment progress and guide clinical decision-making. Although MBC improves outcomes when results are discussed collaboratively, adoption across the Veterans Health Administration (VHA) remains below 50%, particularly in virtual and rural settings. This pre-implementation evaluation explored provider perspectives to inform development of a digital MBC workflow for rural tele-mental health settings. Methods: Using the Alacrity Center’s Discover, Design, Build, and Test model and User Centered Design, we conducted a pre-implementation survey of mental health providers at a VHA Medical Center providing care to rural and highly rural Veterans in Southcentral United States. Providers represented disciplines of psychology and social work. The survey contained structured and open-ended questions assessing prior MBC use, perceived benefits and drawbacks, and educational needs. Qualitative data underwent inductive thematic analysis by two independent coders using consensus review to identify emergent themes. Results: Forty-six providers identified three key benefits of MBC: enhanced symptom awareness and monitoring, support for data-informed treatment planning, and facilitation of patient engagement and shared decision-making. Reported barriers included time constraints, inconsistent Veteran participation, functionality of digital tools, and challenges in interpreting and integrating results. Providers also expressed concern over the accuracy of self-report measures and potential negative psychological effects of repeated symptom tracking. Educational needs clustered around three domains: (1) psychometric understanding of measures, (2) effective communication of results with Veterans, and (3) practical guidance on integrating digital tools into workflow. Illustrative quotes are presented verbatim. Conclusions: Provider feedback underscores that successful MBC implementation in digital mental health requires not only technological infrastructure but also targeted provider education and psychoeducational tools. Training should emphasize interpretation of assessment data, patient-centered communication, and safe, ethical management of sensitive results. Embedding MBC within a structured digital workflow supported by provider-informed design can enhance engagement, streamline care, and align with VA’s goal to expand high-quality, data-driven mental health services for rural Veterans. Given the quality improvement context, findings should be interpreted as context-specific insights used to shape local implementation rather than generalizable evidence.