A Patient Progress Scale

Abstract

In evaluating effectiveness of treatment programs for psychiatric inpatients, it is often desirable to supplement symptom ratings with more global estimates of change. Psychiatrists in particular complain that the subtle, rare, and complexly integrated aspects of the clinical picture are not captured by discrete symptom or behavioral ratings. Overall clinical impression is often considered unsatisfactory for other reasons. During treatment, psychiatrists continually make decisions about individual patients, predicated upon a coral impression of the patient and knowledge of him as a person, his strengths as well as his weaknesses. Statements representing typical clinical decisions, such as type of ward placement, pass and privilege status, and the like were prepared and submitted to 55 psychiatrists to be judged on a nine-point scale along the continuum of of functional adjustment. Scale values of the items, obtained by the method of successive intervals, ranged from .246 (Has been placed on a suicide observation status) to 6.326 (Has resumed his customary social role in his community). Examples of intermediate items are: No-privilege scam (1.445), Limited ground privileges (2.907), Full ground privileges (3.869), Maximum security ward (.289), Closed ward 1.309), Supervised open ward (3.811), and Open ward (4.540). For our initial purposes, all 45 items were retained and psychiatrists are asked to check all items tha: pertain to a patient at a given time. The average scale value of the items checked (usually 4 to 8) is taken as an indication of the patient's status wichin the hospital at the time of rating and the difference between two such values as an indication of his progress. Although many subjective factors enter into a clinical decision, once made it is concrete and can be rated objectively without these judgments being involved. This should curtail the bias toward rating improvement that sometimes occurs when therapists rate their own patients. Data from 233 newly admitted schizophrenic patients showed a shift in the means from 1.742 to 2.485 after one month of hospitalization, a difference significant beyond the ,001 level (analysis of variance). Whether the scale will be successful in distinguishing berween differentially treated groups remains to be seen. As additional data are obtained some items may be discarded and alternative scoring procedures adopted but preliminary experience suggests that this may be a useful way to record a patient's progress wichin the hospital. The approach is similar to that of Gordon, et al. (1957), who scaled ward membership, but may have wider application because the clinical decisions are similar from hospital to hospital. REFERENCE GOWN, M. H., LINDLFI, S. B., & my, R. B. A criterion measure of within-hospita1 change in psychiatric illness. I. din. Psychol., 1957, 13, 145-147.