Toto, we're not in Kansas anymore: Measuring and using outcomes in behavioral health care

Patient health outcomes in psychiatric mental health nursing

This integrative literature review examined evidence concerning the relationship between psychiatric mental health nursing interventions and patient-focused outcomes. Empirical studies, published between 1997 and 2007, were identified and gathered by searching relevant databases and specific data sources. Although 156 articles were critically appraised, only 25 of them met the inclusion criteria. Findings from this review showed that the most frequently used outcome instruments assessed psychiatric symptom severity. Most of the instruments targeted two symptom categories: altered thoughts/perceptions and altered mood. Other outcome instruments were categorized in the following domains: self-care, functioning, quality of life and satisfaction. The most important finding of this review is the lack of consistently strong evidence to support decisions concerning which outcome instrument or combination of instruments to recommend for routine use in practice. Based on this review, additional research to conceptualize, measure and examine the feasibility of outcome instruments sensitive to psychiatric mental health nursing interventions is recommended.

A practical system for monitoring the outcomes of substance use disorder patients

Outcomes monitoring and management are receiving mounting attention because of increased emphasis on health care accountability and cost containment. Efficient, practical outcomes monitoring systems (OMSs) are crucial if health care system performance is to be determined and effective/cost-effective treatments are to be identified, but such practical monitoring systems generally are lacking. This article describes the features of such a system for monitoring the care received by, and the substance use and psychosocial outcomes of, patients treated for substance use disorders (SUDs) in the Department of Veterans Affairs (VA). In contrast to a 15-21% follow-up rate achieved by VA SUD program staff under a previously mandated system-wide monitoring system, the monitoring system used in this project achieved a 67% follow-up rate without paying patients for their participation. We provide data on patient characteristics and treatment outcomes, estimate the cost of implementing this type of monitoring system on a broad scale, and provide recommendations for OMSs in other large health care organizations.

New subscales for an anchored version of the Brief Psychiatric Rating Scale: construction, reliability, and validity in acute psychiatric admissions

Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed.

Use of BPRS-A percent change scores to identify significant clinical improvement: accuracy of treatment response classification in acute psychiatric inpatients

Use of Brief Psychiatric Rating Scale [Overall J.E., Gorham D.R., 1988. The Brief Psychiatric Rating Scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacology Bulletin 24, 97-99] percent change scores (PCSs) to measure treatment effects may be problematic because two different item-weighting systems (0-6 and 1-7) have been employed to represent the seven rating options and PCSs have demonstrated sensitivity to the item-weighting system used. This study compared the ability of a range of BPRS total scale PCS categories generated by both item-weighting procedures to predict estimates of clinical improvement in a large (N = 1415) heterogeneous acute sample of adult psychiatric inpatients. Results revealed significant differences between the two scaling systems in the proportion of patients classified into categories of PCS symptom improvement. Additional analysis suggested different optimal predictive PCS classifications for each item-weighting system: > 19% for 1-7 and > 39% for 0-6. Guidelines for BPRS publications are presented to facilitate study interpretation and replication. In light of their demonstrated limitations, it is suggested that the use of BPRS PCSs to measure treatment effects be reconsidered.