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Lehmann I, Zielasek J, Blumenröder T, Engemann S, Vrinssen J, Gaebel W, Banger M, Grümmer M, Janssen B, Marggraf R, Muysers J, Rinckens S, Scherbaum N, Supprian T, Tönnesen-Schlack A, Mennicken R, Wenzel-Jankowski M, Gouzoulis-Mayfrank E. Development and implementation of quality indicators in a group of nine psychiatric hospitals. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:8-16. [PMID: 37884419 DOI: 10.1016/j.zefq.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/26/2023] [Accepted: 09/16/2023] [Indexed: 10/28/2023]
Abstract
Quality indicators (QI) are becoming increasingly important in mental healthcare in Germany. QI can be used for various purposes, such as for creating transparency as well as for benchmarking between hospitals. QI themselves are subject to high quality standards. The aim of this report is to describe the development and implementation of QI in a group of psychiatric hospitals. Since 2015, the LVR hospital group has developed and gradually implemented QI for the purposes of quality measurement, quality assurance and internal benchmarking in its nine psychiatric hospitals in a comprehensive, multidisciplinary, scientifically accompanied process. The full LVR-QI set, consisting of eight structure-, twelve process- and four outcome indicators as well as one patient satisfaction questionnaire, was implemented by 2019. In order to create high documentation quality and acceptance by clinicians, various implementation and dissemination strategies were used, such as written documentation manuals, staff training as well as regular face-to-face communication between the LVR hospitals, the LVR Institute for Health Services Research as the central coordinating body and the headquarters of the LVR hospital group. The QI led to a quality-oriented dialogue within and between the LVR hospitals.
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Affiliation(s)
- Isabell Lehmann
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Jürgen Zielasek
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany; Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tilman Blumenröder
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Sandra Engemann
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Jürgen Vrinssen
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany
| | - Wolfgang Gaebel
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany; Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; WHO Collaborating Center DEU-131, LVR-Hospital Düsseldorf - Clinics of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | | | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Tillmann Supprian
- LVR-Hospital Düsseldorf - Clinics of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Roman Mennicken
- LVR-Hospital Group, Cologne, Germany; FOM University of Applied Sciences for Economics and Management, Essen, Germany
| | | | - Euphrosyne Gouzoulis-Mayfrank
- LVR-Institute for Education and Research, LVR-Institute for Health Services Research, Cologne, Germany; LVR-Hospital Cologne, Academic Hospital of the University of Cologne, Cologne, Germany.
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2
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Oster C, Dawson S, Kernot J, Lawn S. Mental health outcome measures in the Australian context: what is the problem represented to be? BMC Psychiatry 2023; 23:24. [PMID: 36627588 PMCID: PMC9832818 DOI: 10.1186/s12888-022-04459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes. METHODS An in-depth policy and document analysis was conducted using Carol Bacchi's 'What is the problem represented to be?' approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves. RESULTS Two dominant representations of the 'problem' were identified: 1) the 'problem' of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the 'problem' of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the 'problem' of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision. CONCLUSIONS This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.
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Affiliation(s)
- Candice Oster
- Present Address: Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Bedford Park, Adelaide, 5001, South Australia.
| | - Suzanne Dawson
- Present Address: Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Bedford Park, Adelaide, 5001, South Australia
- School of Allied health and Practice, University of Adelaide, Adelaide, 5005, South Australia
- Central Adelaide Local Health Network, Adelaide, South Australia
| | - Jocelyn Kernot
- Allied Health & Human Performance, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia
| | - Sharon Lawn
- Lived Experience Australia Ltd, PO Box 12, Oaklands Park, 5046, South Australia
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Bedford Park, Adelaide, 5001, South Australia
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3
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Katz IR, Liebmann EP, Resnick SG, Hoff RA, Schmidt EM. Progress toward a performance measure for mental health based on a generic patient- reported outcome measure: Findings from the Veterans Outcome Assessment survey. Psychiatry Res 2022; 317:114797. [PMID: 36030700 DOI: 10.1016/j.psychres.2022.114797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
Abstract
We report on studies conducted to develop outcome-based performance measures (PROM-PMs) based on generic patient-reported outcome measures (PROMs) that could support strategies for quality improvement applicable to all patients in a mental health system. Data were from the Veterans Outcome Assessment Survey at baseline and three months for the Mental Component Score (MCS-12), a widely used measure of mental health-related quality of life, for 15,540 outpatients beginning treatment in General Mental Health clinics in 140 Veterans Affairs (VA) facilities. Mental health diagnoses from medical records were coded using hierarchical categories. Mental health staffing levels and quality measures were from administrative data. Changes in MCS-12 scores were associated with demographics, baseline scores, and diagnostic categories; in fully adjusted models, differences between facilities accounted for only 0.5% of the total variance between patients. There were small but significant associations of both baseline and changes in MCS-12 scores with staffing levels and administrative measures of the quality of care that support the potential value of adjusted measures of changes in MCS-12 as a PROM-PM. Remaining issues include the low proportion of variability that can be attributed to differences between facilities and the associations of staffing and quality with possible case-mix adjustment variables.
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Affiliation(s)
- Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Philadelphia, PA 19104, United States.
| | - Edward P Liebmann
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Rani A Hoff
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Eric M Schmidt
- VA Office of Performance Measurement, Analytics and Performance Integration, Quality and Patient Safety, Veterans Health Administration, Menlo Park, CA 94025, United States; Center for Innovation to Implementation (Ci2i), VA Medical Center, Menlo Park, CA 94025, United States
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4
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Harris MG, Tapp C, Arnautovska U, Coombs T, Dickson R, James M, Painter J, Smith M, Jury A, Lai J, Burgess PM. Assessing the Content Validity of the Revised Health of the Nation Outcome Scales (HoNOS 2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9895. [PMID: 36011532 PMCID: PMC9408525 DOI: 10.3390/ijerph19169895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
The Health of the Nation Outcome Scales (HoNOS) comprises 12 scales that cover the kinds of problems that may be experienced by working-age adults in contact with specialised mental health services. Drawing on 20 years' experience in clinical practice, a collaborative, international review of the HoNOS was undertaken and a revised measure (known as the HoNOS 2018) was published. In this study, 32 experts from Australia, England and New Zealand completed an anonymous web-based survey to assess the relevance, comprehensiveness and comprehensibility (aspects of content validity) of the HoNOS 2018. The experts rated 11 of the 12 HoNOS 2018 scales as 'important' or 'very important' for determining the overall clinical severity (item-level content validity index or I-CVI ≥ 0.75). Evaluations of the scales' ability to capture change, comprehensiveness and comprehensibility were more variable, but generally positive. Experts' comments provided further insights into this variability; for example, they noted that some scales combine multiple phenomena, which can result in ambiguity in item wording and assessment challenges. Results from this study suggest that the revisions have not altered the importance of the scales. Given the measure's breadth of content, training remains important for ensuring rating fidelity. Inter-rater reliability and utility testing are indicated.
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Affiliation(s)
- Meredith G. Harris
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
| | - Caley Tapp
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
| | - Urska Arnautovska
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
| | - Tim Coombs
- Australian Mental Health Outcomes Classification Network (AMHOCN), c/- HETI, Locked Bag 2030, St Leonards, NSW 1590, Australia
| | - Rosemary Dickson
- Australian Mental Health Outcomes Classification Network (AMHOCN), c/- HETI, Locked Bag 2030, St Leonards, NSW 1590, Australia
| | - Mick James
- Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, UK
| | - Jon Painter
- Department of Nursing and Midwifery, Collegiate Crescent, Sheffield Hallam University, Sheffield S10 2BP, UK
| | - Mark Smith
- Te Pou, Kakariki House, Waikato Mail Centre, 293 Grey St, Hamilton East P.O. Box 307, Hamilton 3240, New Zealand
| | - Angela Jury
- Te Pou, Millennium Centre, Phase II, Building B, Ground Floor, 600 Great South Road, Ellerslie, Auckland 1051, New Zealand
| | - Jennifer Lai
- Te Pou, Millennium Centre, Phase II, Building B, Ground Floor, 600 Great South Road, Ellerslie, Auckland 1051, New Zealand
| | - Philip M. Burgess
- School of Public Health, The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
- Australian Mental Health Outcomes Classification Network (AMHOCN), The University of Queensland, Public Health Building, Herston, QLD 4006, Australia
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5
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Timman R, Arrindell WA. A very short Symptom Checklist-90-R version for routine outcome monitoring in psychotherapy; The SCL-3/7. Acta Psychiatr Scand 2022; 145:397-411. [PMID: 35075633 PMCID: PMC9303250 DOI: 10.1111/acps.13396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/17/2021] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Routine outcome monitoring (ROM) is applied in many physical and mental health treatments. The treatment course is monitored with patient reported outcome measures (PROMs). A potential problem with PROM is response burden. This can be decreased by presenting such measures with less and better selected items. The SCL-90-R is an often used PROM for psychotherapies and a number of very short forms have been developed; the SCL-5, SCL-8, SCL-9 and SCL-10. This study aims to develop a new very short form, the symptom checklist 3 out of 7 (SCL-3/7) and to evaluate the effectiveness of these PROM with the precision relative to the complete SCL-90-R score. METHODS Item Response Theory analysis was applied to select the 7 best discriminating items, evenly distributed over the latent trait. A routing serves that patients only need to administer 3 items. RESULTS In a sample of 15,055 cases, the relative precisions of the SCL-3/7 were best for outpatients (122.7%), day care patients (111.8%) and inpatients (108.3). The SCL-5 was best for juvenile patients (110.0%), and the SCL-9 was best for addicted patients (107.2%). CONCLUSION The SCL-3/7 decreases patient burden in ROM and has a better precision in adult therapies than other SCL-90 short forms.
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Affiliation(s)
- Reinier Timman
- Section of Medical Psychology and PsychotherapyDepartment of PsychiatryErasmus Medical CentreRotterdamThe Netherlands
| | - Willem A. Arrindell
- University of Social Sciences and HumanitiesVietnam National UniversityHo Chi Minh CityVietnam
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6
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Gaebel W, Lehmann I, Chisholm D, Hinkov H, Höschl C, Kapócs G, Kurimay T, Tosevski DL, Milosavljevic M, Nakov V, Winkler P, Zielasek J. Quality indicators for mental healthcare in the Danube region: results from a pilot feasibility study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1017-1025. [PMID: 32270290 DOI: 10.1007/s00406-020-01124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
Quality indicators are vital for monitoring the transformation of institution-based mental health services towards the provision of person-centered mental healthcare. While several mental healthcare quality indicators have been identified as relevant and valid, their actual usability and utility for routine monitoring healthcare quality over time is significantly determined by the availability and trustworthiness of the underlying data. In this feasibility study, quality indicators that have been systematically identified for use in the Danube region countries of Bulgaria, the Czech Republic, Hungary, and Serbia were measured on the basis of existing mental healthcare data in the four countries. Data were collected retrospectively by means of the best available, most standardized, trustworthy, and up-to-date data in each country. Out of 21 proposed quality indicators, 18 could be measured in Hungary, 17 could be measured in Bulgaria and in the Czech Republic, and 8 could be measured in Serbia. The results demonstrate that a majority of quality indicators can be measured in most of the countries by means of already existing data, thereby demonstrating the feasibility of quality measurement and regular quality monitoring. However, data availability and usability are scattered across countries and care sectors, which leads to variations in the quality of the quality indicators themselves. Making the planning and outputs of national mental healthcare reforms more transparent and evidence-based requires (trans-)national standardization of healthcare quality data, their routine availability and standardized assessment, and the regular reporting of quality indicators.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Bergische Landstraße 2, 40629, Düsseldorf, Germany. .,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - I Lehmann
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - D Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - H Hinkov
- NCPHA-National Center of Public Health and Analyses, Sofia, Bulgaria
| | - C Höschl
- National Institute of Mental Health, Klecany, Czech Republic
| | - G Kapócs
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Institute for Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - T Kurimay
- Department of Psychiatry and Psychiatric Rehabilitation, Buda Family Centred Mental Health Centre, Teaching Department of Semmelweis University, Saint John Hospital, Budapest, Hungary.,Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - M Milosavljevic
- Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - V Nakov
- Mental Health, National Center of Mental Health and Analyses, Sofia, Bulgaria
| | - P Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
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7
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Gelkopf M, Mazor Y, Roe D. A systematic review of patient-reported outcome measurement (PROM) and provider assessment in mental health: goals, implementation, setting, measurement characteristics and barriers. Int J Qual Health Care 2021; 34:ii13–ii27. [PMID: 32159763 DOI: 10.1093/intqhc/mzz133] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 11/08/2019] [Accepted: 12/03/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To review and integrate the literature on mental-health-related patient-reported outcome measures (PROMs) and routine outcome measures (ROMs), namely in the domains of goals, characteristics, implementation, settings, measurements and barriers. PROM/ROM aims mainly to ascertain treatment impact in routine clinical practice through systematic service users' health assessment using standardized self-report, caretaker and/or provider assessment. DATA SOURCES Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science's Direct. STUDY SELECTION Systemized review of literature (2000-2018) on implementation and sustainability of PROMs/ROMs in adult mental health settings (MHS). DATA EXTRACTION AND SYNTHESIS Systemized review of literature (2000-2018) on numerous aspects of PROM/ROM implementation and sustainability in adult MHS worldwide. RESULTS Based on 103 articles, PROMs/ROMs were implemented mostly in outpatient settings for people with assorted mental health disorders receiving a diversity of services. Frequency of assessments and completion rates varied: one-third of projects had provider assessments; about half had both provider and self-assessments. Barriers to implementation: perceptions that PROM/ROM is intrusive to clinical practice, lack of infrastructure, fear that results may be used for cost containment and service eligibility instead of service quality improvement, difficulties with measures, ethical and confidentiality regulations and web security data management regulations. CONCLUSION Improving data input systems, sufficient training, regular feedback, measures to increase administrative and logistic support to improve implementation, acceptability, feasibility and sustainability, follow-up assessments and client attrition rate reduction efforts are only some measures needed to enhance PROM/ROM efficiency and efficacy.
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Affiliation(s)
- Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.,Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Yael Mazor
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.,Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.,Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.,Department of Clinical Medicine, Psychiatry, Aalborg University, Denmark
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8
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Hong RH, Murphy JK, Michalak EE, Chakrabarty T, Wang Z, Parikh SV, Culpepper L, Yatham LN, Lam RW, Chen J. Implementing Measurement-Based Care for Depression: Practical Solutions for Psychiatrists and Primary Care Physicians. Neuropsychiatr Dis Treat 2021; 17:79-90. [PMID: 33469295 PMCID: PMC7813452 DOI: 10.2147/ndt.s283731] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022] Open
Abstract
Measurement-based care (MBC) can be defined as the clinical practice in which care providers collect patient data through validated outcome scales and use the results to guide their decision-making processes. Despite growing evidence supporting the effectiveness of MBC for depression and other mental health conditions, many physicians and mental health clinicians have yet to adopt MBC practice. In part, this is due to individual and organizational barriers to implementing MBC in busy clinical settings. In this paper, we briefly review the evidence for the efficacy of MBC focusing on pharmacological management of depression and provide example clinical scenarios to illustrate its potential clinical utility in psychiatric settings. We discuss the barriers and challenges for MBC adoption and then address these by suggesting simple solutions to implement MBC for depression care, including recommended outcome scales, monitoring tools, and technology solutions such as cloud-based MBC services and mobile health apps for mood tracking. The availability of MBC tools, ranging from paper-pencil questionnaires to mobile health technology, can allow psychiatrists and clinicians in all types of practice settings to easily incorporate MBC into their practices and improve outcomes for their patients with depression.
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Affiliation(s)
- Ran Ha Hong
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jill K Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zuowei Wang
- Hongkou Mental Health Center, Shanghai, People’s Republic of China
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Larry Culpepper
- Department of Family Medicine, Boston University, Boston, MA, USA
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jun Chen
- Shanghai Mental Health Center, Shanghai, People’s Republic of China
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9
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Austin A, Potterton R, Flynn M, Richards K, Allen K, Grant N, Glennon D, Mountford VA, Franklin‐Smith M, Schelhase M, Jones WR, Serpell L, Mahoney K, Brady G, Nunes N, Kali K, Connan F, Schmidt U. Exploring the use of individualised patient‐reported outcome measures in eating disorders: Validation of the Psychological Outcome Profiles. EUROPEAN EATING DISORDERS REVIEW 2021; 29:281-291. [DOI: 10.1002/erv.2819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 11/09/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Amelia Austin
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Rachel Potterton
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Michaela Flynn
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Katie Richards
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Karina Allen
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
- South London and Maudsley NHS Foundation Trust London UK
- School of Psychological Sciences The University of Western Australia Western Australia Australia
| | - Nina Grant
- South London and Maudsley NHS Foundation Trust London UK
| | | | - Victoria A. Mountford
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
- South London and Maudsley NHS Foundation Trust London UK
- Maudsley Health Abu Dhabi United Arab Emirates
| | | | | | | | - Lucy Serpell
- North East London NHS Foundation Trust London UK
- Division of Psychology and Language Sciences University College London London UK
| | - Kate Mahoney
- North East London NHS Foundation Trust London UK
| | - Gaby Brady
- Central and North West London NHS Foundation Trust London UK
| | - Nicole Nunes
- Central and North West London NHS Foundation Trust London UK
| | - Kuda Kali
- Central and North West London NHS Foundation Trust London UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust London UK
| | - Ulrike Schmidt
- King's College London Institute of Psychiatry, Psychology and Neuroscience London UK
- South London and Maudsley NHS Foundation Trust London UK
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10
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Palman J, McDonagh JE. Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology. Open Access Rheumatol 2020; 12:309-321. [PMID: 33324121 PMCID: PMC7732171 DOI: 10.2147/oarrr.s228083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
Consideration of the mental health and emotional wellbeing is an important component of health care for all young people, irrespective of setting. Mental health disorders are common during adolescence and young adulthood and young people with rheumatic musculoskeletal diseases (RMD) are not exempt. For such young people, risks of poor outcomes are related to both mental health as well as their RMD. Times of change during adolescence and young adulthood-transitions-are potentially vulnerable life stages for young people with RMD and warrant specific attention in health care provision. Such transitions include those occurring at puberty, during education, training, and employment, socially with moves away from the parental home, as well as from child to adult-centered health services. There is great potential for rheumatology professionals to support young people with RMD at these transitions in view of their frequent encounters and ongoing therapeutic relationships. In this review, we aim to assess the impact of mental health on RMD during adolescence and young adulthood with particular reference to transitional care provision and how rheumatology professionals can be involved in addressing mental health issues during this time of change.
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Affiliation(s)
- Jason Palman
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Manchester, UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
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11
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Mosler F, Priebe S, Bird V. Routine measurement of satisfaction with life and treatment aspects in mental health patients - the DIALOG scale in East London. BMC Health Serv Res 2020; 20:1020. [PMID: 33167986 PMCID: PMC7654159 DOI: 10.1186/s12913-020-05840-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
AIMS The DIALOG scale has been implemented as a routine patient outcome and experience measure (PROM/PREM) in a mental health trust in East London since 2017. The resulting healthcare dataset was used to estimate satisfaction with life and treatment aspects over time and factors associated with it. METHODS Variables available from the Trust were DIALOG items, service level, clinical and basic demographic data. Data was extracted in February 2019. Data is described using a range of descriptive statistics and looking at the subgroups: treatment stage, diagnosis, service type. Predictors for average DIALOG scores across patients was explored with clustered linear regression models. A fixed effect model was chosen to estimate the impact of clinical and service related variables on patient's average DIALOG scores over time. Sensitivity analyses with the whole data set and complete cases were carried out. RESULTS Of the original 18,481 DIALOG records 12, 592 were kept after data cleaning (5646 patients). The average DIALOG score was 4.8 (SD 1.0) on the 7-point scale. Average satisfaction with life aspects (PROM) was 4.65 (SD 1.1) and with treatment aspects (PREM) was 5.25 (SD 1.17). Across all 11 items, "job situation" scored lowest (mean 4.05) and "meetings with professionals" highest (mean 5.5). Satisfaction for all items increased over time (average increase 0.47). The largest increase was in "mental health" (0.94) and the smallest in "family relationships" (0.34). CONCLUSIONS Patients in mental healthcare services were "fairly satisfied" in both life and treatment aspects with improvements seen over time. These results will act as a benchmark for clinical services currently implementing DIALOG across the UK and inform local service developments.
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Affiliation(s)
- Franziska Mosler
- Unit for Social and Community Psychiatry, Institute of Population Health Sciences, Queen Mary University of London, London, UK.
- East London NHS Foundation Trust, London, UK.
- Present address: Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London, E13 8SP, UK.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Institute of Population Health Sciences, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Victoria Bird
- Unit for Social and Community Psychiatry, Institute of Population Health Sciences, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
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Abstract
Abstract Objectives: Measurement feedback systems (MFS) are a class of health information technologies developed to facilitate measurement-based care. The individual clinical decision support features within MFS are diverse and their influence on clinicians is largely unknown. This study tested the impact of MFS features on clinicians' progress assessments and treatment decisions in different scenarios. Method: Clinicians (n = 299) were randomly assigned to view one of six combinations of the following MFS features: graph, expected change trajectory line, alert, and treatment suggestions. The assigned feature combination was paired with three vignettes and clinical data representing three clinical scenarios: patient deterioration, no progress, and approaching remission. Clinicians answered questions after each vignette, and at the conclusion. Results: MFS features differentially impacted clinicians' progress assessment accuracy, their likelihood of making a treatment change, and their treatment choices. Which feature was most impactful varied depending on the clinical scenario. Clinicians reported graphs influenced their assessments and choices significantly more than the other features, and the majority stated they would prefer to use all of the features. Conclusions: Specific MFS features impact clinicians' assessments and choices to greater degrees, and the impact of those features can be influenced by the clinical state of the patient.
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Affiliation(s)
- A Paige Peterson
- Department of Psychology, University of Washington, Seattle, USA
| | - Corey Fagan
- Department of Psychology, University of Washington, Seattle, USA
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Abstract
SUMMARYIn value-based healthcare (VBHC) value is defined as outcomes that matter to patients divided by the cost of achieving these outcomes. Value is measured for discrete medical conditions across the whole cycle of care. Data on the value achieved by different providers is openly shared. Providers increase value using quality improvement (QI) techniques to improve outcomes, reduce costs or both. Patients or commissioners choose the provider achieving the greatest value. Units should compete regionally or nationally. There are challenges to implementing such ideas in the mental health services in the UK. However, measuring outcomes, understanding costs and using QI to drive up value may be possible without adopting the complete model that has developed in the context of a North American and acute hospital healthcare system.
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Gray RM, Kelly PJ, Beck AK, Baker AL, Deane FP, Neale J, Treloar C, Hides L, Manning V, Shakeshaft A, Kelly J, Argent A, McGlaughlin R. A qualitative exploration of SMART Recovery meetings in Australia and the role of a digital platform to support routine outcome monitoring. Addict Behav 2020; 101:106144. [PMID: 31648139 DOI: 10.1016/j.addbeh.2019.106144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/22/2019] [Accepted: 09/20/2019] [Indexed: 11/24/2022]
Abstract
Previous research has reported on the benefits of mutual support groups. However, such groups do not routinely collect data on participant outcomes. Moreover, the effect of collecting outcomes measures on these groups is unknown. The objective of this mixed methods study was to elicit participant views on using a novel, purpose built digital platform for routine outcome monitoring (ROM) as a standard component of a mutual support group. SMART Recovery, or the Self-Management and Recovery Training program, is group-based and uses professional clinicians to facilitate discussion and foster mutual support for a range of addictive behaviours, alongside Cognitive Behavioural Therapy and Motivational Interviewing techniques. This paper reports on the qualitative component of this study and how participants perceive ROMs, and the potential shift to technological resources. Twenty semi-structured telephone interviews were conducted with participants from SMART Recovery groups across New South Wales, Australia. Participants discussed their use of mutual support within group meetings to manage their recovery, including: naming their goals in front of peers; learning from clinicians and group discussion; and developing reciprocal and caring relationships. They also described any previous experience with routine outcomes measures and how digital technologies might enhance or hinder group function. Participants valued mutual support groups and reported that digital technologies could be complementary to physical, weekly group meetings. They were also concerned that the introduction of technological resources might pose a threat to physical meetings, thereby risking their access to mutual support. Findings have implications for the implementation of ROM when delivered via digital mechanisms, and indicate threats and opportunities that warrant consideration for future initiatives.
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Roe D, Mazor Y, Gelkopf M. Patient-reported outcome measurements (PROMs) and provider assessment in mental health: a systematic review of the context of implementation. Int J Qual Health Care 2019; 34:ii28–ii39. [DOI: 10.1093/intqhc/mzz084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Purpose
To review and integrate the vast amount of literature yielded by recent growing interest in patient-reported outcome measurement and routine outcome measures (PROMs/ROMs), in order to suggest options and improvements for implementation. PROMs are the systematic assessment of service users’ health using standardized self-report measures. Specifically, for ROMs, it includes routine provider or caretaker assessment measures. Both are administered to ascertain routinely, the impact of treatment in mental health settings and to improve care. A review is needed because of the large differences in setting, conceptualization, practice and implementation. Here, we examine the different major projects worldwide.
Data sources
Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science’s Direct.
Study selection
We conducted a systematized review of the literature published from 2000 to 2018 on the implementation and sustainability of PROMs and ROMs in mental health services for adults.
Data extraction, synthesis and Results
We described and characterized the programs in different countries worldwide. We identified 103 articles that met the inclusion criteria, representing over 80 PROMs/ROMs initiatives in 15 countries. National policy and structure of mental health services were found to be major factors in implementation. We discuss the great variability in PROMs/ROMs models in different countries, making suggestions for their streamlining and improvement.
Conclusion
We extracted valuable information on the different characteristics of the numerous PROMs/ROMs initiatives worldwide. However, in the absence of a strong nationwide policy effort and support, implementation seems scattered and irregular. Thus, development of the implementation of PROMs/ROMs is left to groups of enthusiastic clinicians and researchers, making sustainability problematic.
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Affiliation(s)
- David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
- Department of Clinical Medicine, Psychiatry, Aalborg University, Denmark
| | - Yael Mazor
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, Haifa, 3498838 Israe
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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Sweeney J, Adamis D, Helmi L, Macdonald AJD. Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service. Ir J Med Sci 2019; 188:1329-1335. [PMID: 30980222 DOI: 10.1007/s11845-019-02015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/26/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Routine clinical outcome monitoring (RCOM) is the standardised gathering of measures of clinical outcomes in everyday practice. HoNOS (Health of the Nation Outcome Scales) is a tool used in RCOM. AIMS To examine (a) agreement between HoNOS and Global Assessment of Functioning (GAF), (b) HoNOS changes over time/attendance and (c) clinical parameters affecting HoNOS scores. METHODS Data from outpatient clinics were collected at each contact over 2 years until June 2016 including: gender, age, diagnosis (ICD-10) and HoNOS scores. In a subsample, the GAF also were completed by community psychiatric nurses blind to HoNOS scores. RESULTS A number of 470 outpatients have undergone 1125 HoNOS assessments during the study period. Mean age of the attendants was 43.12; SD 14.6. Male = 220 (46.8%). Longitudinal analysis demonstrated that lower HoNOS scores are independently significantly associated to number of assessments and diagnosis in ICD-10 categories of F20-F29 (Schizophrenia, schizotypal and delusional disorders) F30-F39 (mood disorders) F40-F48 (neurotic, stress-related and somatoform disorders) and F50-F59 (behavioural disorders associated with physiological disturbances). Gender and age were not significantly associated with decline of HoNOS scores. Neither were other diagnostic categories. Agreement between HoNOS and GAF was excellent (N = 261, rho = - 0.919, p < 0.001). CONCLUSIONS This study shows that HoNOS is a feasible instrument which can be potentially used in ROCM in mental health services in Ireland and supports further the need for implementation of routine measurements in Mental Health Services. It adds longitudinal data which is lacking in similar previous studies.
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Affiliation(s)
- James Sweeney
- Sligo Leitrim Mental Health Service, Clarion Road, Sligo, Co. Sligo, Ireland.
| | - Dimitrios Adamis
- Sligo Leitrim Mental Health Service, Clarion Road, Sligo, Co. Sligo, Ireland
| | - Luqman Helmi
- Sligo Leitrim Mental Health Service, Clarion Road, Sligo, Co. Sligo, Ireland
| | - Alastair J D Macdonald
- Clinical Outcomes Research, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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