Decisional Informatics for Psychosocial Rehabilitation

Abstract

This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional treatment planning using similar behavioral therapies in 52 adults with severe mental illness attending community-based day treatment. At post and follow-up, group differences and moderate to large effect sizes favoring FORT were detected in social function, work readiness, self-esteem, working memory, processing speed, and mental flexibility. Of participants who identified obtaining a GED as their primary goal, 73% in FORT passed the exam compared to 18% in traditional treatment planning. FORT was also associated with higher agency cost-effectiveness and a better average benefit-cost ratio, even when considering diagnosis, baseline symptoms, and education. While the comparison groups were not completely equivalent, the findings suggest computerized decision support systems that collaborate with human decision-makers to personalize psychiatric rehabilitation and address critical decisions may have a role in improving treatment effectiveness and efficiency.

Guidelines improve patient outcomes in specialised mental health care: A systematic review and meta‐analysis

“…The studies had a duration of 12 to 156 weeks, with a median of 24 weeks. Five studies pertained to a total of 1073 patients with schizophrenia, 16 , 31 , 34 , 39 , 40 another two studies included 573 patients with a bipolar disorder, 41 , 42 seven studies included 1900 patients with a depressive disorder, 33 , 43 , 44 , 45 , 46 , 47 , 48 one study focused on 537 patients with an alcohol use disorder 49 and three studies included mixed patient samples (n = 767). 50 , 51 , 52 Table S2 presents the main study characteristics.…”

“… 50 , 51 , 52 Table S2 presents the main study characteristics. In 16 studies, the intervention condition was compared with TAU, 16 , 31 , 33 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 while four studies evaluated head‐to‐head comparisons of an active with a passive implementation strategy. 31 , 33 , 34 , 50 Because two studies 31 , 33 presented two head‐to‐head comparisons (by comparing an active strategy vs TAU as well as an active strategy vs a passive strategy), the total number of comparisons is 20.…”

“… 16 , 31 , 33 , 34 , 44 , 49 , 50 , 52 Furthermore, the other 10 included studies investigated evidence‐based treatment algorithms developed with a structured methodology, using tailored strategies, based on expertise from national consensus groups and expert panels and written according to the latest scientific evidence. 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 51 The content of the guidelines and algorithms evaluated in the included studies is presented in Table S3 . As shown in Table S3 , the majority of evidence‐based guidelines were medication‐focused.…”

“… 40 , 42 , 43 , 45 , 46 , 47 , 48 , 51 One guideline, investigated in the study by Bauer et al, 41 included a psychotherapy algorithm in addition to a medication algorithm. Furthermore, a study by Choi et al 39 investigated the effects of a computerised decisional tool with algorithms using psychosocial strategies in addition to medication management. All included studies implemented the guidelines at a professional and a patient level, such as by training clinical staff; providing educational meetings and visits; distribution of educational material via computer or in printed form; patient and family education; educational packages; information cards and booklets; and providing reminders, audits and written feedback to providers.…”

“…Effect sizes for all included studies on outcomes at the patient level are presented in the harvest plot in Figure 2 . Of 20 effect sizes Cohen's d on rating scales measuring severity of psychopathology, 17 were positive, 16 , 33 , 34 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 with nine small, 33 , 34 , 39 , 42 , 43 , 44 , 45 , 49 , 51 seven moderate 16 , 33 , 40 , 41 , 46 , 48 , 50 and one large effect size. 47 Since the 95% CI crossed the null‐line in 11 cases, eight effect sizes could be considered significantly positive in favour of the guideline.…”