Routine Outcome Measure Research Articles

Patient-reported outcome measures (PROMs) use in post-stroke patient care and clinical practice: a realist synthesis protocol

BackgroundThere is growing interest in the use of routine patient-reported outcome measures (PROMs) to influence the care of individual patients with stroke. However, there are significant gaps in our understanding as to how PROMs influence post-stroke patient care and clinical practice. This is due to factors including the number of purported uses for PROMs and that PROMs are complex interventions, which attempt to stimulate varied actions or behaviours. Therefore, the objective of this realist synthesis is to offer theory-based explanations as to how PROMs influence post-stroke clinical practice and patient care.MethodsThis is a protocol for a realist synthesis, which involves three distinct phases: theory building (phase 1), theory testing and refinement (phase 2) and synthesis (phase 3). Phase 1 will develop initial rough programme theories (IRPTs), through literature searches (from January 2000 onwards) of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and the grey literature. Only secondary sources will be included that contribute to the development of IRPTs. Only two IRPTs, prioritised by the stakeholder group, will be taken forward to be tested and refined during phase 2. Further novel searches will be employed in phase 2, utilising the same criteria as phase 1; however, phase 2 searches will not utilise grey literature searches, and only primary research studies that contribute to the refinement of programme theories under investigation will be included. Two independent reviewers will screen and select all returned results. The reviewers will code and annotate relevant sources, resulting in ‘fragments’ to be extracted and graded based on the richness of their contribution to explanation and causal insight. Further, these fragments will be organised into ‘Context-Mechanism-Outcome’ configurations. Phase 3 of the review will involve the synthesis of context-mechanism-outcome configurations to form middle-range theory-based explanations and developed logic models for stakeholders to understand how PROMs in post-stroke clinical practice and patient care work for whom, how and under what circumstances.DiscussionThe resulting realist synthesis will provide guidance on the implementation of PROMs within routine post-stroke clinical practice and patient care and act as a touchstone for further testing and refinement of PROMs programmes.Systematic review registrationPROSPERO CRD42020138649.

Assessing recovery in treatment as usual provided by community child and adolescent mental health services.

Despite the importance of routinely assessing the outcomes of everyday practice, few studies have reported outcome metrics for child and adolescent mental health services (CAMHS). Our aim is to investigate reliable change and recovery rates for treatment as usual, provided by one community CAMHS over two time periods. We prospectively audited accepted consecutive referrals from November 2017 to January 2018, and April to September 2019. Cases with paired outcomes were identified, and reliable change and recovery rates were calculated. Baseline outcome data were obtained for 672 (78.2%) and 744 (77.5%) young people in 2018 and 2019, respectively. Of eligible participants, 174 (59.2%) and 155 (45.7%) completed at least one follow-up outcome measure in 2018 and 2019, respectively. Pre- and post-test scores on the Revised Child Anxiety and Depression Scale (RCADS) and Strengths and Difficulties Questionnaire (SDQ) showed a reduction in symptoms. Total RCADS scores showed 21-25% of participants reliably improved, with 44-49% showing reliable improvement on one or more subscale. On the SDQ, 11 (15.5%) and 19 (25.3%) participants reported reliable improvement on at least one subscale in 2018 and 2019, respectively. Reliable recovery rates ranged from 48 to 51% for youth-completed and 40 to 42% for parent-completed RCADS. Half of young people receiving treatment as usual from CAMHS reliably improved on at least one routine outcome measure subscale, improvement rates comparable with adult psychological therapies services. Our findings indicate that reliable change and recovery on subscale rather than total scores may be a better indication of outcomes.

The interrater reliability of a routine outcome measure for infants and pre-schoolers aged under 48 months: Health of the Nation Outcome Scales for Infants.

A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. The Child and Adolescent Mental Health Information Development Expert Advisory Panel Working Group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for use with those aged under 4 years. Prior psychometric testing showed that the HoNOSI was considered to show face validity, and that it met the standards for concurrent validity and internal consistency. We aimed to investigate the interrater reliability of the HoNOSI. Forty-five infant mental health clinicians completed HoNOSI ratings on a set of five case vignettes. Quadratic weighted kappa interrater reliability estimates showed the HoNOSI to have Almost Perfect interrater reliability for the HoNOSI total score. Of the 15 scales, one had Moderate, seven had Substantial and seven had Almost Perfect interrater reliability. Ten of the fifteen scales and the total score exceeded the COnsensus-based Standards for the Selection of Health Measurement INstruments criteria for interrater reliability (κw ≥ 0.7). There has been a clear need for a routine outcome measure for use with infants and pre-schoolers. This study provides evidence of interrater reliability. The current findings, combined with the face and concurrent validity studies, support further examination of HoNOSI in real-world settings.

Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS).

There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 (n = 1074) and April to September 2019 (n = 1172). Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.

Counselling in the third sector: to what extent are older adults accessing these services and how complete are the data third sector services collect measuring client psychological distress?

AbstractBackgroundA low number of older adults access Improving Access to Psychological Therapies (IAPT) services in England. Barriers include ageism and stigma. Routine outcome measures (ROMs) assess the effectiveness of counselling, although counsellor and service‐level barriers prevent uptake.AimsAccess rates of older adults to third sector (sometimes called voluntary or community sector) counselling and psychotherapy services were explored. The extent of ROM collection on psychological distress was assessed.MethodologyData collected between 2018 and 2019 were pooled across six third sector counselling services in England, Scotland and Northern Ireland (N = 2,757). Access based on age and gender was assessed, and the chi‐square analysis was used to compare gender distribution within the age groups. Availability of pre‐ and post‐therapy ROMs was assessed, and the chi‐square analysis was used to explore the age and gender differences in completion.FindingsLower access rates in people aged 65 and over (4.4%) were found compared with IAPT (7%). Access rates decreased further as age increased. Access of people aged 50 and over (24.5%) was below the 34.6% of the population in this age category. A third of people accessing counselling in all age groups were men. Only 28.6% completed a pre‐therapy ROM, and 29.5% of those clients subsequently completed a post‐therapy ROM.ImplicationsMental health promotion and adapting communication during counselling may help engage older adults and men in counselling. Training on working with older people and long‐term conditions is also beneficial. Support in using ROMs can improve uptake although organisational barriers may restrict implementation in the third sector.

A systematic review to examine the relationship between objective and patient-reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice.

BackgroundCommon sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient‐reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations.MethodsA search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis.ResultsIn total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin’ Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5).ConclusionOverall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin’ Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted.

A systematic review of patient-reported outcome measurement (PROM) and provider assessment in mental health: goals, implementation, setting, measurement characteristics and barriers.

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. Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science's Direct. Systemized review of literature (2000-2018) on implementation and sustainability of PROMs/ROMs in adult mental health settings (MHS). Systemized review of literature (2000-2018) on numerous aspects of PROM/ROM implementation and sustainability in adult MHS worldwide. 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. 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.

Patient-reported outcome measurements (PROMs) and provider assessment in mental health: a systematic review of the context of implementation.

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. Psych INFO and PubMed including Medline, Biomed Central, EMBASE Psychiatry and Elsevier Science's Direct. 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. 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. 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.

Measuring Change in Activity Participation of Mental Health Care Users Attending an Occupational Therapy Programme in Rural South Africa

ABSTRACT INTRODUCTION: Lack of evidence on the effect of interventions is one of the several ongoing challenges facing healthcare services in South Africa. The increasing emphasis on routine outcome measurement has urged occupational therapists to demonstrate the impact of their intervention in mental health. This study aimed to evaluate the change in activity participation of the mental health care users attending an occupational therapy programme METHODS: A one-group pre/post-test design was used. The Activity Participation Outcome Measure (APOM) was administered to measure activity participation of 64 mental health care users. Five measurements were done between admission and follow-up after discharge RESULTS: Majority of the participants were between the ages of 20 - 29 and mainly diagnosed with substance use disorders. The effect sizes, Cohen's d (&gt; 0.80) and Cohen's r (&gt;0.37) demonstrated a significant positive change (p=0.00) across all APOM domains during hospitalisation. An insignificant change (p&gt; 0.05) was noted in the effect sizes during the follow-up stages with a substantial decline in some of the APOM domains indicating that patients were not well-integrated into their communities CONCLUSION: This study revealed the importance of measuring change in participation for shaping clinical practice, to ensure meaningful intervention, and successful integration of MHCUs in their communities Keywords: routine outcome measurement, activity participation, occupational therapy, mental health, rural context.

Sociodemographic and clinical characteristics in child and youth mental health; comparison of routine outcome measurements of an Australian and Dutch outpatient cohort.

Although of great value to understand the treatment results for mental health problems obtained in clinical practice, studies using naturalistic data from children and adolescents seeking clinical care because of complex mental health problems are limited. Cross-national comparison of naturalistic outcomes in this population is seldomly done. Although careful consideration is needed, such comparisons are likely to contribute to an open dialogue about cross-national differences and may stimulate service improvement. The aim of this observational study is to investigate clinical characteristics and outcomes in naturalistic cohorts of specialized child and adolescent mental health outpatient care in two different countries. Routinely collected data from 2013 to 2018 of 2715 outpatients in the Greater Area of Brisbane, Australia (CYMHS) and 1158 outpatients in Leiden, the Netherlands (LUMC-Curium) were analysed. Demographics, clinical characteristics and severity of problems at start and end of treatment were described, using Children's Global Assessment Scale (CGAS), Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and the parental Strength and Difficulties Questionnaire (SDQ-P). Routine outcome measures (CGAS, HoNOSCA, SDQ-P) showed moderate to severe mental health problems at start of treatment, which improved significantly over time in both cohorts. Effect sizes ranged between 0.73-0.90 (CYMHS) and 0.57-0.76 (LUMC-Curium). While internalizing problems (mood disorder, anxiety disorder and stress-related disorder) were more prevalent at CYMHS, externalizing developmental problems (ADHD, autism) prevailed at LUMC-Curium. Comorbidity (>1 diagnosis on ICD10/DSM-IV) was relatively similar: 45% at CYMHS and 39 % at LUMC-Curium. In both countries, improvement of functioning was lowest for conduct disorder and highest for somatoform/conversion disorders and obsessive-compulsive disorders (OCD). Overall, 20-40% showed clinically significant improvement (shift from clinical-range at start to a non-clinical-range at the end of treatment), but nearly half of patients still experienced significant symptoms at discharge. This large-scale outcome study showed both cohorts from Australia and the Netherlands improve during the course of treatment on clinician- and parent-reported measures. Although samples were situated within different contexts and differed in patient profiles, they showed similar trends in improvement per diagnostic group. While 20-40% showed clinically significant change, many patients experienced residual symptoms reflecting increased risk for negative outcome into adulthood. We emphasize cross-national comparison of naturalistic outcomes faces challenges, although it can similarly reveal trends in treatment outcome providing direction for future research: what factors determine discharge from specialized services; and how to improve current treatments in this severely affected population.

A pilot practice-based outcomes evaluation of low-intensity cognitive behavioural interventions delivered by postgraduate trainees to children and young people with mild to moderate anxiety or low mood: an efficient way forward in mental health care?

AbstractAnxiety and depression affect a significant number of children and young people (CYP) and can have a far reaching and long-lasting impact. Cognitive behavioural (CB) interventions can be effective for treating anxiety and depression in CYP but are difficult to access. Recent government policy in England seeks to train a non-traditional graduate workforce to deliver a range of CB interventions for mild to moderate anxiety and depression to CYP, in community settings. This practice-based evaluation aimed to estimate the effectiveness of CB interventions delivered by postgraduate trainees undertaking training in a range of CB interventions for mild to moderate anxiety and depression whilst on placement in schools or community Child and Adolescent Mental Health Services (CAMHS). Self- and parent-reported routine outcome measures (ROMS) were completed pre- and post-intervention, including measures of symptom severity, symptom impact and goal achievement. Significant improvements were demonstrated across all self and parent-reported measures post-intervention, with mean scores falling firmly in the non-clinical range, a significant reduction in the proportion of CYP in the clinical range on measures, and predominantly medium to large effect sizes. Results are promising in terms of the capacity to train a graduate workforce to deliver a range of low-intensity CB interventions to CYP experiencing mild to moderate depression or anxiety-based difficulties in either CAMHS or school settings, increasing capacity across the system. The current practice-based evaluation also supports the potential effectiveness of current training models/programmes. Further research is needed in terms of long-term outcomes and to compare outcomes between settings, interventions, and demographic groups.Key learning aims(1)To understand the potential prevalence rates of mental health difficulties in children and young people in England, and their wider impact.(2)Critical awareness of the evidence base for cognitive and behavioural interventions for depression and anxiety in children and young people.(3)Awareness of gaps in access to evidence-based psychological interventions for children and young people in England.(4)Knowledge of emerging graduate-level low-intensity psychological practitioner roles in England.(5)Awareness of the emerging evidence base for the estimated effectiveness of low-intensity cognitive and behavioural interventions delivered to children and young people by graduate-level practitioners in schools and community mental health settings.

Evaluation of a Complex Intervention for Prisoners with Common Mental Health Problems, Near To and After Release: The Engager Randomised Controlled Trial

Background: Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with with homelessness and substance misuse. Only a minority receive specialist mental health care, including on release from prison. Few theoretically informed interventions have been developed to address these complex needs, and none formally evaluated. This study tests the hypothesis that the Engager intervention improves mental health outcomes following release. Methods: Two group parallel randomised superiority trial conducted in the North West and South West of England between in 2016-19. Men serving a prison sentence of two years or less were individually allocated 1:1 to either intervention (Engager plus usual care) or the control (usual care alone) group. Engager included psychological and practical support in prison, on release, and for three to five months in the community. Primary outcome: Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), six months after release. Primary analysis compared groups based on intention to treat (ITT). Outcomes: A total of 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in either the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1·1, 95% confidence interval -1·1 to 3·2, p= 0·325) or secondary analyses. There were no consistent clinically significant between group differences for secondary outcomes. Full implementation and delivery were not achieved with 18% receiving no post release intervention. Interpretation: Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not effective using standard outcome measures. Future research may benefit from improved delivery and more sensitive outcomes measures. Trial Registration: Engager was a two group parallel randomised superiority trial (ISRCTN11707331) Funding: Funding for the study was provided by the NIHR Programme Grants for Applied Research (grant number: RP-PG-1210-12011) Declaration of Interest: None to declare. Ethical Approval: The study was approved by the UK National Health Service, Wales Research Ethics Committee 3 (ref: 15/WA/0314), and the National Research Committee of Her Majesty’s Prison and Probation Service.

A brief session-by-session measure of eating disorder psychopathology for children and adolescents: Development and psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y).

Despite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y) scale, including its ability to detect short-term change in symptomatology. Youth (N = 203) ages 8-18 years completed self-report questionnaires and semi-structured diagnostic interviews upon initial presentation for an outpatient eating disorders assessment at an academic medical center. The ED-15-Y demonstrated excellent reliability (internal consistency, split-half reliability) and high sensitivity to change early in treatment (change from sessions 1 to 8, adjusting for baseline score). Further, these data demonstrate that the ED-15-Y has excellent convergent validity, being highly correlated with a well-tested, longer measure of eating disorders psychopathology-the Eating Disorders Examination-Questionnaire (EDE-Q). These data also support good discriminant and concurrent validity, differentiating between youth without an eating disorder or with ARFID and youth with eating disorders involving weight and shape concerns (e.g., anorexia nervosa, bulimia nervosa). The ED-15-Y may be a useful tool to briefly assess eating disorder psychopathology in youth as young as 8 years old. Its sensitivity to change very early in treatment suggests that it has the potential to be used as a routine outcome measure in the context of treatment.

Online counselling and goal achievement: Exploring meaningful change and the types of goals progressed by young people

AbstractBackgroundYoung people are increasingly looking towards the internet for mental health support. There has been little research on the impact of online counselling, as captured in routine outcome measures. This research aims to explore an online counselling service, using goal‐based data.Methods‘Meaningful change’ drawing on the principles of the Reliable Change Index, t tests and logistic regression were applied to administration data (n = 4,218) to assess goal progress, and associations between service contact, goal type and meaningful change.Results55.6% of young people reported meaningful goal improvement. Those who meaningfully improved spent significantly more time engaged than those who did not. Goal types most likely to meaningfully improve were ‘getting professional help’ and ‘self‐help–self‐care’.ConclusionsMost young people made significant movement towards their collaboratively agreed goals, which is a good indication that the service is helping to address important areas of change. The findings, linked to earlier research, may indicate that those who report improvements in goals may engage with services more. The high proportion of ‘getting help’ goals may be attributable to the online setting, which young people may use as a first point of contact for help seeking, to gather information to access further support. With the increased uptake of online support services associated with the current global pandemic, future research should consider the present findings as a baseline of goal progress and service utilisation.

Beyond morbidity and mortality: The practicality of measuring patient-reported outcomes in trauma

Background: The 2016 Zero Preventable Deaths report highlighted the need for comprehensive injury data to include long term outcomes such as societal and workforce re-entry. Currently, postinjury quality of life is poorly understood. We hypothesized that routine measurement of patient-reported outcomes is feasible as a part of post-discharge follow-up, and that trauma patients would report that their injury had a detrimental impact on health-related quality of life (HRQoL) after discharge.Methods: After instruction, patients self-administered the PROMIS-29 instrument in our outpatient office (11/2019-4/2020). We surveyed 7 domains: Participation in Social Roles/Activities, Anxiety, Depression, Fatigue, Pain Interference, Physical Function, and Sleep Disturbance. Results are reported as means (SD) and compared to the U.S population by t-score (mean score=50). Higher scores in negatively-worded domains (e.g. “Depression”) are worse; vice versa for positively-worded domains (e.g. “Physical Function”). Repeated scores among patients returning for a second visit were analyzed using paired t-tests.Results: 103 patients completed the PROMIS-29. Mean (SD) age was 42.3 (17.3) years, 75% were male, and 42% suffered a penetrating injury. Median length of stay was 3 days and median time from injury to clinic visit was 18 days. Mean scores were worse than population means in every domain. Pain Interference (mean 63.5, 95%CI [61.8-65.3]) and Physical Function (38.0 [36.2-39.8]) were particularly affected. Among patients returning for a second visit (n=10; median time between clinic visits: 17.5 days), there were no significant differences in domain scores over time.Conclusion: Trauma patients are at high risk for poor quality of life outcomes in the short term following injury. Our results highlight the need for early recognition and multidisciplinary treatment following injury.

Routine measurement of satisfaction with life and treatment aspects in mental health patients \u2013 the DIALOG scale in East London

AimsThe 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.MethodsVariables 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.ResultsOf 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).ConclusionsPatients 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.

Routine outcome measurement in specialist non-government alcohol and other drug treatment services: Establishing effectiveness indicators for the NADAbase.

The collection of routine outcome measurement (ROM) data provides an opportunity for service providers to conduct benchmarking to inform quality assurance practices. To conduct comparative benchmarking, it is important that services have access to comparative data. This paper aims to establish effectiveness indicators for ROM data collected within the alcohol and other drug (AOD) sector. ROM data were collected by specialist non-government AOD treatment services within the Network of Alcohol and other Drugs Agencies online database (i.e. NADAbase). All participants were attending treatment within New South Wales, Australia (N = 21 572). Effectiveness indicators were calculated by using effect sizes, standard error of measurement, and rates of reliable and clinically significant change. The study focused on quality of life (EUROHIS Quality of Life Scale), psychological distress (Kessler-10) and substance dependence (Substance Dependence Scale). Since 2010, 21 572 unique people have completed at least one NADAbase Client Outcome Measure. Amphetamines (36%) and alcohol (32%) were the most commonly reported primary substances of concern. Effectiveness indicators were established for the total sample, as well as for people attending residential rehabilitation (n = 8161) and community-based (n = 10 306) treatment services. Standard error of measurement was the least stringent effectiveness indicator (i.e. a higher proportion of people demonstrated improvement), while the clinically significant change was the most stringent approach. The study demonstrated the utility of the NADAbase to establish effectiveness indicators for benchmarking purposes. Recommendations are provided for the use of benchmarking to inform quality assurance activities in the sector.

Why do patients go off track? Examining potential influencing factors for being at risk of psychotherapy treatment failure

BackgroundRoutine outcome monitoring can support clinicians to detect patients who deteriorate [not-on-track (NOT)] early in psychotherapy. Implemented Clinical Support Tools can direct clinicians’ attention towards potential obstacles to a positive treatment outcome and provide suggestions for suitable interventions. However, few studies have compared NOT patients to patients showing expected progress [on-track (OT)] regarding such obstacles. This study aimed to identify domains that have predictive value for NOT trajectories and to compare OT and NOT patients regarding these domains and the items of the underlying scales.MethodsDuring treatment, 413 outpatients filled in the Hopkins-Symptom-Checklist-11 (depressive and anxious symptom distress) before every therapy session as a routine outcome measure. Further, the Assessment for Signal Clients, Affective Style Questionnaire, and Outcome Questionnaire-30 were applied every fifth session. These questionnaires measure the following domains, which were investigated as potential obstacles to treatment success: risk/suicidality, therapeutic alliance, motivation, social support and life events, as well as emotion regulation. Two groups (OT and NOT patients) were formed by defining a cut-off (failure boundary) as the 90% confidence interval (upper bound) of the respective patients’ expected recovery curves. In order to differentiate group membership based on the respective problem areas, multilevel logistic regression analyses were performed. Further, OT and NOT patients were compared with regard to the domains’ and items’ cut-offs by performing Pearson chi-square tests and independent samples t-tests.ResultsThe life events and motivation scale as well as the risk/suicidality scale proved to be significant predictors of being not-on-track. NOT patients also crossed the cut-off significantly more often on the domains risk/suicidality, social support, and life events. For both OT and NOT patients, the emotion regulation domain’s cut-off was most commonly exceeded.ConclusionLife events, motivation, and risk/suicidality seem to be directly linked to treatment failure and should be further investigated for the use in clinical support tools.

What Is the Impact of the COVID-19 Pandemic on Quality of Life and Other Patient-reported Outcomes? An Analysis of the Hand-Wrist Study Cohort.

The coronavirus disease 2019 (COVID-19) pandemic, and its associated lockdowns in many parts of the world, have changed our daily lives and may have a psychological impact on around the globe. However, it is unknown how this influences the patient-reported outcome measures (PROMs) of patients involved in ongoing clinical research and medical care. For both the current and potential future lockdowns, it is important to determine if PROMs collected during such a period can be interpreted with confidence. (1) Is there a difference in quality of life between patients in the COVID-19 period group (March 23, 2020 to May 4, 2020) and patients in a reference period group (from the same period in 2018 or 2019)? (2) Is there a difference in pain, hand function, anxiety, depression, and illness perception between patients in the COVID-19 period group and patients in the reference period group? This study was part of a large cohort study with routine outcome measures of patients with hand and wrist conditions. To answer our research questions, we analyzed two samples because not all PROMs were sent to participants at the same time points after treatment. The first sample consisted of all participants who completed PROMs on quality of life (QoL), pain, and hand function at their final follow-up time point, which was either 3, 6, or 12 months post-treatment. The second sample consisted of participants who completed PROMs 3 months post-treatment on anxiety, depression, and illness perception. Each sample consisted of two groups: a COVID-19 period group and a reference period group. We included 1613 participants in the first sample (COVID-19 period group: n = 616; reference period group: n = 997) and 535 participants in the second sample (COVID-19 period group: n = 313; reference period group: n = 222). The primary outcome was QoL, expressed in the EuroQol 5-Dimensions questionnaire (EQ-5D) index score. Secondary outcomes were the other domains on the EQ-5D, as well as pain, hand function, anxiety, depression, and illness perception. We found no between-group differences in the EQ-5D index score (standardized mean difference 0.035; p = 0.98). Furthermore, there were no between-group differences in PROM scores for hand function, anxiety, or depression. There were, however, a few small differences in subdomain items regarding pain and illness perception, but we believe in aggregate that these are unlikely to make a clinically important difference in our main finding. The COVID-19 pandemic and its associated lockdown had no influence on QoL and had little influence on secondary outcomes in participants who were part of the Hand-Wrist Study Cohort. This finding implies that PROMs data collected during this period can be used with confidence in clinical research. Our findings indicate that when a pandemic like this occurs again, we can continue to use PROMs for analysis in clinical research or routine outcome measures. Level III, therapeutic study.

Factors affecting the implementation of an outcome measurement feedback system in youth mental health settings

Objective: Measurement feedback systems provide clinicians with regular snapshots of a client’s mental health status, which can be used in treatment planning and client feedback. There are numerous barriers to clinicians using outcome measures routinely. This study aimed to investigate factors affecting the use of a measurement feedback system across youth mental health settings. Methods: The participants were 210 clinicians from headspace youth mental health services across Australia. They were surveyed on predictors and use of MyLifeTracker, a routine outcome measure. This was explored through three processes: looking at MyLifeTracker before session, using MyLifeTracker in treatment planning, and providing feedback of MyLifeTracker scores to clients. Results: Clinicians were more likely to look at MyLifeTracker before session, less likely to use it in treatment planning, and least likely to provide MyLifeTracker scores to clients. Each measurement feedback system process had a distinct group of predictors. Perceptions of MyLifeTracker’s practicality was the only significant predictor of all three processes. Conclusion: Practically, organisations and supervisors can increase the use of measurement feedback systems through targeted supports.