Abstract
Background Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM).MethodIn a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18).ResultsEMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4–0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time.ConclusionThis study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment – as an index of health, obviating the need for an exclusive focus on traditional measures of ‘sickness’.
Highlights
Routine Outcome Monitoring (ROM) in mental health services may be used to continuously update and direct clinical decision making with objective data
This study supports the use of mHealth approach to ROM (mROM) as a means to involve the patient in the process of needs assessment and treatment
Ecological Momentary Assessment (EMA) data are meaningful to the patient, as they reflect daily life circumstances
Summary
Routine Outcome Monitoring (ROM) in mental health services may be used to continuously update and direct clinical decision making with objective data. If the patient is involved in the data collection and interpretation, it will facilitate shared decision making. While potentially useful as a local management information tool, a well-known pitfall of ROM data collection is a shift away from enrichment of the clinical process to an exclusive focus on management information, as described in some countries. Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM). EMA measures of activities, social interaction, stresssensitivity and negative mood states were sensitive to change over time
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