Routine Use Of Outcome Measures Research Articles

Mental health outcome measures in the Australian context: what is the problem represented to be?

BackgroundThere is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes.MethodsAn in-depth policy and document analysis was conducted using Carol Bacchi’s ‘What is the problem represented to be?’ approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves.ResultsTwo dominant representations of the ‘problem’ were identified: 1) the ‘problem’ of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the ‘problem’ of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the ‘problem’ of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision.ConclusionsThis critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

Use of Standardized Outcome Measures for People With Lower Limb Amputation: A Survey of Prosthetic Practitioners in the United States

ObjectiveTo assess the clinical resources available for the assessment of health outcomes in people with lower limb amputation and to understand barriers and facilitators associated with use of standardized outcome measures in clinical practice. DesignCross-sectional survey. SettingGeneral community (online). ParticipantsA volunteer sample of prosthetic practitioners was recruited through national professional organizations. Eligible participants were practitioners certified by a professional prosthetics organization and currently practicing as a prosthetist, prosthetist-orthotist, or prosthetic assistant. InterventionsNot applicable. Main Outcome MeasuresA custom-designed online survey on clinical use of patient-reported and performance-based standardized outcome measures to assess patients with lower limb amputation. ResultsA total of 375 participants completed the survey. Most participants (79%) reported that they are encouraged or required to administer standardized outcome measures in their clinic or facility. Most participants reported that use of patient-reported and performance-based outcome measures are within their scope of practice (88%) and that they have the knowledge required for outcomes measurement (84%). Few participants agreed that outcomes measurement is standardized across the profession (30%). Most participants had access to small spaces and equipment for outcomes measurement, such as short hallways (65%-94%), stairs (69%), and tablets with wireless internet connection (83%). Most participants reported that they would be willing to spend between 5 (36% of participants) and 10 (43% of participants) minutes on self-reported surveys, and between 10 (41% of participants) and 20 (28% of participants) minutes on performance-based tests. ConclusionsOutcomes measurement is encouraged or expected in contemporary prosthetic practice. Strategies to improve standardization and efficiency of administration are needed to facilitate routine use of outcome measures in clinical care.

Pilot evaluation of a group stabilisation intervention for refugees and asylum seekers with PTSD.

Post-traumatic stress disorder (PTSD) is commonly experienced by asylum seekers and refugees (ASR). Evidence supports the use of cognitive behavioural therapy-based treatments, but not in group format for this population. However, group-based treatments are frequently used as a first-line intervention in the UK. This study investigated the feasibility of delivering a group-based, manualised stabilisation course specifically developed for ASR. The second aim was to evaluate the use of routine outcome measures (ROMs) to capture psychological change in this population. Eighty-two participants from 22 countries attended the 8-session Moving On After Trauma (MOAT) group-based stabilisation treatment. PHQ-9, GAD-7, IES-R and idiosyncratic outcomes were administered pre- and post-intervention. Seventy-one per cent of participants (n = 58) attended five or more of the treatment sessions. While completion rates of the ROMs were poor - measures were completed at pre- and post-intervention for 46% participants (n = 38) - a repeated-measures MANOVA indicated significant improvements in depression (p = .001, ηp2 = .262), anxiety (p = .000, ηp2 = .390), PTSD (p = .001, ηp2 = .393) and idiosyncratic measures (p = .000, ηp2 = .593) following the intervention. Preliminary evidence indicates that ASR who attended a low-intensity, group-based stabilisation group for PTSD experienced lower mental health scores post-group, although the lack of a comparison group means these results should be interpreted with caution. There are significant challenges in administering ROMs to individuals who speak many different languages, in a group setting. Nonetheless, groups have benefits including efficiency of treatment delivery which should also be considered.

Utilisation of outcome measures by therapy teams in an NHS Trust

Background: Outcome measures need to be used by allied health professionals (AHPs) to measure clinical effectiveness, as well as communicate with patients and commissioners.
 Methods: A survey of current use of outcome measures was conducted across acute and community therapies departments (dietetics, occupational therapy, physiotherapy and speech & language therapy services) within University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT).
 Results: There was a 17% response rate with 51 respondents completing the survey. 25% of respondents used outcome measures with every patient, 24% at least once per day, 22% at least once per week, and 29% rarely or never. Most therapists felt confident that they are able to score outcome measures accurately (mode rating for confidence: 8/10). However, 1 in 5 therapists reported low (≤5/10) confidence in using outcome measures. There was wide variation in the outcome measures used by respondents. The most commonly used outcome measures were the Berg Balance Scale (n=13) and the Therapies Outcome Measure (TOMS) – Multifactorial Conditions (n= 9). However there were 35 outcome measure tools cited as being used by only 1 respondent each. Themes from comments included: ‘considering change’ and barriers to outcome measure use as ‘COVID-19 impact’, ‘staffing pressures’ or ‘brief-intervention services’.
 Conclusion: Whilst a wide variety of outcome measures are used by therapy staff at UHMBT, they are not used with sufficient frequency to allow routine monitoring of clinical effectiveness. Being able to measure the impact of different models of service delivery would be particularly beneficial where service changes are implemented rapidly in response to the COVID-19 pandemic. Next steps could draw on evidence from previous studies by identifying suitable outcome measures (including those suitable for use in remote consultations), and developing a training programme to encourage the routine use of outcome measures in practice.

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.

Impact of parental mental illness on children's HoNOSCA results in a regional child and adolescent mental health service

Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6-month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education-related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted.

Perspectives of patients, family caregivers and health professionals on the use of outcome measures in palliative care and lessons for implementation: a multi-method qualitative study.

Routine use of outcome measures in palliative care is recommended to demonstrate and improve quality of care. The use of outcome measures is relatively recent in UK specialist palliative care services and understanding their use in practice is key to successful implementation. We therefore aimed to explore how patient-centred outcome measures are used in specialist palliative care, and identify key considerations for implementation. Multi-method qualitative study (semi-structured interviews and non-participant observation). Patients, family caregivers and health professionals were purposively sampled from nine specialist palliative care services (hospice, hospital and community settings) in London, UK. Framework analysis, informed by the Consolidated Framework for Implementation Research (CFIR), was undertaken. Thirty eight interviews and nine observations were conducted. Findings are presented according to the five CFIR domains: (I) intervention: participants highlighted advantages, disadvantages and appropriateness of outcome measures in palliative care; (II) outer setting: policy and national drivers are necessary to encourage use of outcome measures; (III) inner setting: information technology infrastructure, organisational drive, and support from peers and leadership were institutional factors that shaped the use of outcome measures; (IV) individual: clear rationale for using outcome measures and skills to use them in practice were essential; (V) implementation: stepwise introduction of outcome measures, regular feedback sessions, and champions/facilitators were important to strengthen routine use. All CFIR domains need consideration for effective implementation. Outcome data needs to be fed back to and interpreted for professionals in order to improve and sustain outcome data collection, and drive meaningful improvements in palliative care.

Using symptom and interference questionnaires to identify recovery among children with anxiety disorders.

Questionnaires are widely used in routine clinical practice to assess treatment outcomes for children with anxiety disorders. This study was conducted to determine whether 2 widely used child and parent report questionnaires of child anxiety symptoms and interference (Spence Child Anxiety Scale [SCAS-C/P] and Child Anxiety Impact Scale [CAIS-C/P]) accurately identify recovery from common child anxiety disorder diagnoses as measured by a ‘gold-standard’ diagnostic interview. Three hundred thirty-seven children (7–12 years, 51% female) and their parents completed the ADIS-IV-C/P diagnostic interview and questionnaire measures (SCAS-C/P and CAIS-C/P) before (Time 1) and after (Time 2) treatment or wait-list. Time 2 parent reported interference (CAIS-P) was found to be a good predictor of absence of any diagnoses (area under the curve [AUC] = .81). In terms of specific diagnoses, Time 2 SCAS-C/P separation anxiety subscale (SCAS-C/P-SA) identified recovery from separation anxiety disorder well (SCAS-C-SA, AUC = .80; SCAS-P-SA, AUC = .82) as did the CAIS-P (AUC = .79). The CAIS-P also successfully identified recovery from social phobia (AUC = .78) and generalized anxiety disorder (AUC = .76). These AUC values were supported by moderate to good sensitivity (.70–.78) and specificity (.70–.73) at the best identified cut-off scores. None of the measures successfully identified recovery from specific phobia. The results suggest that questionnaire measures, particularly the CAIS-P, can be used to identify whether children have recovered from common anxiety disorders, with the exception of specific phobias. Cut-off scores have been identified that can guide the use of routine outcome measures in clinical practice.

Increasing podiatry referrals for patients with inflammatory arthritis at a tertiary hospital in Singapore: A quality improvement project

BackgroundFoot disease is highly prevalent in people with inflammatory arthritis and is often under-recognized. Podiatry intervention can significantly reduce foot pain and disability, with timely access being the key factor. The aim of this study was to plan and implement a quality improvement project to identify the barriers to, and improve, uptake of podiatry services among patients with inflammatory arthritis-related foot problems seen at a tertiary hospital in Singapore. MethodA 6-month quality improvement program was conducted by a team of key stakeholders using quality improvement tools to identify, implement and test several interventions designed to improve uptake of podiatry services. The number of patients referred for podiatry assessment was recorded on a weekly basis by an experienced podiatrist. The criterion for appropriate referral to podiatry was those patients with current or previous foot problems such as foot pain, swelling and deformity. ResultsInterventions included education initiatives, revised workflow, development of national guidelines for inflammatory arthritis, local podiatry guidelines for the management of foot and ankle problems, routine use of outcome measures, and introduction of a fully integrated rheumatology-podiatry service with reduced cost package. Referral rates increased from 8% to 11%, and were sustained beyond the study period. Complete incorporation of podiatry into the rheumatology consultation as part of the multidisciplinary team package further increased referrals to achieve the target of full uptake of the podiatry service. ConclusionThrough a structured quality improvement program, referrals to podiatry increased and improved the uptake and acceptance of rheumatology-podiatry services.

A scoping review of applications and outcomes of traction orthoses and constructs for the management of intra-articular fractures and fracture dislocations in the hand

IntroductionIntra-articular hand fractures can have devastating consequences for movement and function. The unique nature of the injury and diverse management strategies are a challenge for conducting trials. Purpose of the StudyTo conduct a scoping review of traction constructs for the management of intra-articular hand fractures. MethodsWe conducted a systematic search of the literature, extracting data on the scope and nature of the evidence for traction constructs. ResultsOur search yielded 87 articles addressing 3 traction constructs: (1) static traction (n = 17), (2) dynamic external fixation (n = 53), and (3) dynamic orthoses (n = 17). Active range of motion of the target joint was the most frequently reported outcome. Study designs included 36 cohorts, 21 case series, and 9 case studies: 24% contained only technical information. ConclusionsThe current literature addressing traction constructs consists primarily of small and low-quality studies. Evidence synthesis could improve the estimation of range of motion outcomes but would not be able to identify the best treatment. Consensus on classification of fracture patterns, routine use of outcome measures, and randomized trials are needed to compare different traction constructs and inform evidence-based care. Study designScoping review. Level of evidenceN/A.

Using Routine Outcome Measures to Provide Feedback at the Service Agency Level.

The use of routine outcome measurement (ROM) to assess service effectiveness has been on the rise in mental health settings. However, there is a scarcity of information on the use of ROM data to provide feedback to teams of service providers. In this paper we review the existing literature to identify the principles that can guide the use of ROM data as feedback with the aim to improve quality of service provision in mental health settings. We present a pilot trial of 12 agencies participating in group feedback sessions. The guiding principles and core processes, the procedure and implementation in a pilot trial, lessons learned and future directions are discussed. Based on this experience we conclude that using ROM to implement group feedback among mental health stakeholders is feasible and can generate discussions and directions for improvement.

Use and interpretation of routine outcome measures in forensic mental health.

The present study aimed to both pilot a method of monitoring mental health nurses' use of routine outcome measures (ROM) and to examine the precision of ratings made with these tools within a forensic mental health environment. The audit protocol used in the present study was found to be effective in evaluating both the accuracy with which nurses were able to interpret ROM items and their degree of adherence with local procedures for completing such instruments. Moreover, the results suggest that despite these ROM having been developed for use in general mental health settings, they could be interpreted and rated with an adequate degree of reliability by nurses in a forensic mental health context. However, difficulties were observed in the applicability of several components of these tools within a forensic environment. Recommendations for future research and implications for practice are discussed.

Getting the measure of outcomes in clinical practice

SummaryIt has been argued that the routine use of patient-reported outcome measures (PROMs) should be encouraged in order to improve the quality of services and even to determine payment. Clinician-rated outcome measures (CROMs), patient-reported experience measures (PREMs) and process measures also should be considered in evaluating healthcare quality. We discuss difficulties that the routine use of outcome measures might pose for psychiatric services. When outcome and experience measures are used to evaluate services they are difficult to interpret because of differences in case mix and regression to the mean. We conclude that PROMs and CROMs could be useful for monitoring the progress of individuals and that clinical audit still has an important role to play in improving the quality of services.LEARNING OBJECTIVESUnderstand the difference between process measurement and outcome measurement.Understand the limitation of using outcome measures to assess and promote quality of services.Understand the difficulties in assessing the psychometric properties and validity of outcome measures.

The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle.

BackgroundRoutine outcome measurement (ROM) is important for assessing the clinical effectiveness of health services and for monitoring patient outcomes. Within Child and Adolescent Mental Health Services (CAMHS) in the UK the adoption of ROM in CAMHS has been supported by both national and local initiatives (such as government strategies, local commissioning policy, and research).MethodsWith the aim of assessing how these policies and initiatives may have influenced the uptake of ROM within two different CAMHS we report the findings of two case-note audits: a baseline audit conducted in January 2011 and a re-audit conducted two years later in December 2012-February 2013.ResultsThe findings show an increase in both the single and repeated use of outcome measures from the time of the original audit, with repeated use (baseline and follow-up) of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) scale increasing from 10% to 50% of cases. Re-audited case-notes contained more combined use of different outcome measures, with greater consensus on which measures to use. Outcome measures that were applicable across a wide range of clinical conditions were more likely to be used than symptom-specific measures, and measures that were completed by the clinician were found more often than measures completed by the service user.ConclusionsThe findings show a substantial improvement in the use of outcome measures within CAMHS. These increases in use were found across different service organisations which were subject to different types of local service priorities and drivers.

Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: a critical perspective

The aim of this commentary is to provide an overview of clinical outcome measures that are currently recommended for use in UK Child and Adolescent Mental Health Services (CAMHS), focusing on measures that are applicable across a wide range of conditions with established validity and reliability, or innovative in their design. We also provide an overview of the barriers and drivers to the use of Routine Outcome Measurement (ROM) in clinical practice.

The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review.

BackgroundAllied Health Professionals today are required, more than ever before, to demonstrate their impact. However, despite at least 20 years of expectation, many services fail to deliver routine outcome measurement in practice. This systematic review investigates what helps and hinders routine outcome measurement of allied health professionals practice.MethodsA systematic review protocol was developed comprising: a defined search strategy for PsycINFO, MEDLINE and CINHAL databases and inclusion criteria and systematic procedures for data extraction and quality appraisal. Studies were included if they were published in English and investigated facilitators and/or barriers to routine outcome measurement by allied health professionals. No restrictions were placed on publication type, design, country, or year of publication. Reference lists of included publications were searched to identify additional papers. Descriptive methods were used to synthesise the findings.Results960 papers were retrieved; 15 met the inclusion criteria. Professional groups represented were Physiotherapy, Occupational Therapy, and Speech and Language Therapy. The included literature varied in quality and design. Facilitators and barriers to routine outcome measurement exist at individual, managerial and organisational levels. Key factors affecting professionals’ use of routine outcome measurement include: professionals’ level of knowledge and confidence about using outcome measures, and the degree of organisational and peer-support professionals received with a view to promoting their work in practice.ConclusionsWhilst the importance of routinely measuring outcomes within the allied health professions is well recognised, it has largely failed to be delivered in practice. Factors that influence clinicians’ ability and desire to undertake routine outcome measurement are bi-directional: they can act as either facilitators or barriers. Routine outcome measurement may only be deliverable if appropriate action is taken at individual therapist, team, and organisational levels of an organisation.

A framework for exploring the potential of routine outcome measurement to improve mental health care

To present a framework for exploring the potential applications of routine outcome measurement (ROM) to improve clinical practice. ROM is now commonplace in Australian mental health services, but it is fair to say that it has not yet achieved its potential in guiding service quality improvements. The framework described in this paper articulates the key components of ROM, noting that data from standardized outcome measures must be augmented by contextual information from other datasets. It considers the key users of ROM, and suggests the kind of questions that ROM might answer for each user group. It presents the use of ROM as a cycle of understanding the context, prioritization, brainstorming and planning, action and review. It is hoped that this framework might help to maximize the clinical utility of ROM at a number of levels.

Implementing routine outcome measures in child and adolescent mental health services: from present to future practice.

Routine outcome measurement (ROM) in CAMHS is supported by U.K. Government policy. However, little is known about how measures are used in practice. Data describing use of ROM, knowledge and attitudes regarding implementation were collected using a regional case-note audit, online survey and stakeholder workshop. While the principle of ROM was supported by stakeholders, baseline and follow-up outcome measurement occurred in less than a fifth of cases. Barriers to implementation included lack of training and resources, clinicians' perceptions of the limitations of existing measures and lack of regular feedback of outcome data. Implementation of ROM may be facilitated by session-by-session measures with immediate feedback to clinicians and patients.

The Effectiveness of Occupational Performance Outcome Measures within Mental Health Practice

Introduction: The routine use of outcome measures is essential to the maintained delivery of quality care and the continued commissioning of mental health occupational therapy services. Occupational therapists are required to demonstrate that intervention is successful in an evidence-based, valid and reliable way. Therefore, this critical review aims to address the issue of choosing an appropriate occupational performance outcome measure for use within mental health services. Method: Evidence was critically appraised for the effectiveness of the Assessment of Communication and Interaction Skills (ACIS), Occupational Therapy Task Observation Scale (OTTOS), Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS), all recommended for use by occupational therapists within mental health practice. Findings and discussion: The review identifies that there are a limited number of clinically based studies evidencing the validity and reliability of occupational performance outcome measures. It also identifies a paucity of literature concerning service user experience of outcome measures, bringing into question how client centred and meaningful these tools are.

Evidence-Based Practice Depends on the Routine Use of Outcome Measures

Evidence-Based Practice Depends on the Routine Use of Outcome Measures