Abstract
ObjectiveUsing outcome data collected routinely over a continuous two-year treatment period, we wished to distinguish homogeneous subgroups of patients with a severe mental illness whose psychosocial problems followed a similar pattern over time. By identifying the effectiveness of health services for different patient groups, this approach allowed us to identify patients at risk of deterioration and those recovering from their symptoms.MethodsIn total we included 2,660 patients who were in two-year continuous contact with a Flexible Assertive Community Treatment team (FACT). We collected outcome data on psychosocial functioning, needs for care and quality of life. We performed a latent class growth analysis (LCGA).ResultsThe LCGA identified six homogenous patient subgroups using trajectories of HoNOS scores. On the basis of the patterns of patients’ psychosocial problems over time, we labelled these as follows: 1) stable at a low problem-severity level (N = 709; 27%); 2) stable at a low medium problem-severity level (N = 1,208; 45%); 3) stable at a high medium problem-severity level (N = 528; 20%); 4) stable at a high problem-severity level (N = 116; 4%); 5) amelioration of problems (N = 42; 2%); and 6) deterioration of problems (N = 57; 2%). Patients with stable and a high severity of psychosocial problems had more practical and somatic unmet needs than those in other subgroups, and also had the fewest decrease in the number of unmet needs.DiscussionAfter linking patient subgroups with clinical features such as the need for care, we found that, over two years, most patients remained relatively stable in terms of psychosocial functioning, but that their unmet needs decreased over time. However, in terms of needs for treatment during two years of contact with a FACT team, patients in the subgroup with a stable and high problem-severity level tended to derive little or no benefit.
Highlights
The routine measurement of health outcomes has gained momentum over the past decade
We found a trend that more patients in the subgroup with the stable low medium Health of the Nation Outcome Scales (HoNOS) trajectory reported problems with psychotic symptoms (20% vs. 10%, Chi2(1) = 2.764, p = 0.096), not significantly
One solution may be to establish Flexible Assertive Community Treatment team (FACT) teams specialized in the treatment of personality disorders and substance-use disorders
Summary
The routine measurement of health outcomes has gained momentum over the past decade. in 2018, Routine Outcome Monitoring (ROM) is a widely recognized standard around the world [1,2]. Most studies present patient outcomes in group summaries, using mean total scores or change scores over time. While this approach is appealing, as it is both easy to calculate and to understand, experience with SMI patients has shown that the plotted average outcomes usually result in a ‘flat line’ over time [7]. This stable average outcome, some patients improve, while others deteriorate or suffer chronically from severe psychiatric problems. This ‘group as a whole’ approach obscures the variations in outcomes, making it difficult to extract clinically relevant results from which we can learn and improve treatment
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