Sociodemographic factors associated with routine outcome monitoring: a historical cohort study of 28,382 young people accessing child and adolescent mental health services.

Alastair Macdonald,Johnny M Downs,Richard D Hayes,Anna C Morris,Argyris Stringaris,Tamsin Ford,Omer Moghraby,Emily Simonoff

doi:10.1111/camh.12396

Abstract

Patient-reported outcome measures (PROMs) are important tools to inform patients, clinicians and policy-makers about clinical need and the effectiveness of any given treatment. Consistent PROM use can promote early symptom detection, help identify unexpected treatment responses and improve therapeutic engagement. Very few studies have examined associations between patient characteristics and PROM data collection. We used the electronic mental health records for 28,382 children and young people (aged 4-17years) accessing Child and Adolescent Mental Health Services (CAMHS) across four South London boroughs between the 1st of January 2008 to the 1st of October 2017. We examined the completion rates of the caregiver Strengths and Difficulties Questionnaire (SDQ), a ubiquitous PROM for CAMHS at baseline and 6-month follow-up. SDQs were present for approximately 40% (n=11,212) of the sample at baseline, and from these, only 8% (n=928) had a follow-up SDQ. Patterns of unequal PROM collection by sociodemographic factors were identified: males were more likely (aOR 1.07, 95% CI 1.01-1.13), whilst older age (aOR 0.87, 95% CI 0.87-0.88), Black (aOR 0.79 95% CI 0.74-0.84) and Asian ethnicity (aOR 0.75 95% CI 0.66-0.86) relative to White ethnicity, and residence within the most deprived neighbourhood (aOR 0.87 95% CI 0.80-0.94) were less likely to have a record of baseline SDQ. Similar results were found in the sub-group (n=11,212) with follow-up SDQ collection. Our findings indicate systematic differences in the currently available PROMS data and highlights which groups require increased focus if we are to gain equitable PROM collection. We need to ensure representative PROM collection for all individuals accessing treatment, regardless of ethnic or socioeconomic background; biased data have adverse ramifications for policy and service level decision-making.

Highlights

In England, the government’s National Service Framework (Department of Health, 2004) and the National Health Service (NHS) Outcomes Framework policy (Department of Health, 2010) recommend that Child and Adolescent Mental Health Services (CAMHS) use patient-reported outcome measures (PROMs) to assess the impact of their interventions
Using electronic case register data for a very large community CAMHS cohort, we aimed to investigate current levels of PROM collection and whether sociodemographic or clinical factors are associated with differential rates of PROM completion
Our findings demonstrate that caregiver-reported Strengths and Difficulties Questionnaire (SDQ) were present in the health records for approximately 40% of young people who were accepted for CAMHS assessment and just 3% at 6month follow-up

Summary

Introduction

In England, the government’s National Service Framework (Department of Health, 2004) and the National Health Service (NHS) Outcomes Framework policy (Department of Health, 2010) recommend that Child and Adolescent Mental Health Services (CAMHS) use patient-reported outcome measures (PROMs) to assess the impact of their interventions These guidelines advise that PROMs, the Strengths and Difficulties Questionnaire (SDQ), are collected during a patient’s first appointment, to assist clinicians understanding of patients’ presenting problems, and again six months later or before depending on treatment closure. We need to ensure representative PROM collection for all individuals accessing treatment, regardless of ethnic or socioeconomic background; biased data have adverse ramifications for policy and service level decision-making

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