Routine Assessment of Patient-Reported Outcomes in Behavioral Health

Abstract

Outcomes assessment has become an important tool in assessing the quality of health care. To date, most quality initiatives have focused on adverse events, clinical processes, and/or cost variables. Considerably less attention has been paid to indices of clinical improvement, especially from a patient's perspective and in behavioral health settings. The relative inattention given to clinical improvement is attributable to a number of reasons, including (but not limited to) a lack of consensus regarding measures of improvement, few simple methods for data collection and analysis, and an inability to provide timely feedback. In this article, the authors describe a Web-based system designed to routinely collect quality-of-life ratings from patients in outpatient behavioral health clinics, allowing for real-time feedback at the patient levels regarding clinical improvement. The system also allows for administrative evaluation of overall clinic performance. The costs and benefits of this system are discussed.

Can Online Consumers Contribute to Drug Knowledge? A Mixed-Methods Comparison of Consumer-Generated and Professionally Controlled Psychotropic Medication Information on the Internet

“…In parallel, there is increasing momentum to gather patient-reported health and treatment outcomes [10,11], with the Internet identified as a major mechanism to accomplish this efficiently [12-14]. While much research has focused on developing and implementing new Internet-based technologies to collect patient-reported outcomes, studies on the practical uses of existing consumer-generated online health content remain limited in number and scope.…”

Clinicians’ Perspectives on a Web-Based System for Routine Outcome Monitoring in Old-Age Psychiatry in the Netherlands

“…Therefore, even when clinicians did not have the opportunity to fill out questionnaires on paper, the support of a research assistant was critical to the implementation of the routine outcome monitoring and is probably the reason that in our study only two comments on the increased workload were made. Previously reported barriers to routine outcome monitoring implementation from the clinician’s perspective included (1) the opinion that the expert knows best, (2) outcome measurement undermining clinical expertise and violating the privacy of the therapy dyad, (3) increased workload, and (4) fear of evaluation of their practice [6,7,10,26,27]. None of these reasons were mentioned in our survey.…”

“…Well-timed information on the severity and course of symptoms during treatment is an integral part of routine outcome monitoring [8,9]. Increased workload due to systematic data collection, such as filling out questionnaires multiple times, can easily lead to resistance by clinicians [10]. Therefore, the additional burden of data collection should balance the utility of these data from the clinician’s perspective.…”

“…Online delivery of questionnaires may facilitate routine outcome monitoring by (1) reducing the logistic burden, (2) being able to provide feedback directly to clinicians, which is an extension of the paper-and-pencil method, and (3) reducing the amount of missing data, because one may not proceed without answering all questions [6,10,11]. However, previous research has suggested that attention should be paid to cross-validation between electronic and paper-and-pencil versions of the questionnaires, as psychometric properties may change [12-14] and Internet-based surveys do not automatically translate into higher response rates than with paper-based versions [15-19].…”

Adolescents Are Less Satisfied with Inpatient Psychiatric Care than Their Parents

“…Formal assessment of symptoms and outcomes at admission, during hospitalization, and discharge is a unique characteristic of the Menninger Clinic. A number of barriers exist to incorporating such an extensive measurement system into clinical practice, and few have had the success that the Menninger Clinic has had (Madan et al, 2008(Madan et al, , 2010. The Baylor College of Medicine's and the University of Houston's Institutional Review Boards (IRBs) approved the use of these data.…”