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Uptake of mandatory outcome measures in mental health services

  • Rowena Jacobs (a1) and Valerie Moran (a2)
Abstract
Aims and method

The collection of results of a specific outcome measure, the Health of the Nation Outcome Scales (HoNOS), is mandatory for mental healthcare providers in the National Health Service in England. Not all providers collect HoNOS data and coverage varies widely. This paper explores, by means of interviews with clinicians and policy makers and econometric analysis of HoNOS data, the barriers and incentives to the uptake of HoNOS and outcomes more generally, and the key characteristics associated with providers who do undertake HoNOS.

Results

The main barriers to the collection of outcomes involve a lack of adequate feedback mechanisms, a lack of perceived clinical relevance and poor information technology infrastructure. Econometric results show HoNOS collection is associated with providers who produce high-quality data.

Clinical implications

Initiatives should focus on putting systems in place to encourage feedback mechanisms for clinicians.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Rowena Jacobs (rj3@york.ac.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Department of Health. Guidance on the Routine Collection of Patient Reported Outcome Measures (PROMs). Department of Health, 2009 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_092647).
2 Jacobs, R. Investigating Patient Outcome Measures in Mental Health. Research Paper 48. Centre for Health Economics, University of York, 2009 (http://www.york.ac.uk/inst/che/pdf/rp48.pdf).
3 Office of Health Economics. Report of the Office of Health Economics Commission on NHS Outcomes, Performance and Productivity. OHE, 2008 (http://www.ohe.org/page/Commissionreport.cfm).
4 Gilbody, SM, House, AO, Sheldon, TA. Routinely administered questionnaires for depression and anxiety: systematic review. BMJ 2001; 322: 406–9.
5 Gilbody, SM, House, AO, Sheldon, T. Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome – a systematic review. Psychol Med 2002; 32: 1345–56.
6 Gilbody, SM, House, AO, Sheldon, T. Outcome measures and needs assessment tools for schizophrenia and related disorders. Cochrane Database Syst Rev 2003; 1: CD003081.
7 Ashaye, O, Livingston, G, Orrell, M. Does standardized needs assessment improve the outcome of psychiatric day hospital care for older people? A randomized controlled trial. Aging Ment Health 2003; 7: 195–9.
8 Priebe, S, McCabe, R, Bullenkamp, J, Hansson, L, Rossler, W, Torres-Gonzales, F, et al. The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study. Epidemiol Psichiatr Soc 2002; 11: 198205.
9 Slade, M, McCrone, P, Kuipers, E, Leese, M, Cahill, S, Parabiaghi, A, et al. Use of standardised outcome measures in adult mental health services. Randomised controlled trial. Br J Psychiatry 2006; 189: 330–6.
10 Fonagy, P, Matthews, R, Pilling, S. The Mental Health Outcomes Measurement Initiative: Report from the Chair of the Outcomes Reference Group. National Collaborating Centre for Mental Health, Department of Health, 2004.
11 Jones, A. Applied Econometrics for Health Economists: A Practical Guide (2nd edn). Radcliffe, 2007.
12 Department of Health. Mental Health Services: Project on Implementation of Outcomes Measurement. Department of Health, 2006.
13 Selbie, D, Department of Health. Mental Health Services: Project on Implementation of Outcomes Measurement (letter). Gateway reference 7279. Department of Health, 2006.
14 Persaud, A, Pearson, S, Department of Health. Mental Health Services: Project on Implementation of Outcomes Measurement (letter). Gateway reference 7280. Department of Health, 2006.
15 National Institute for Mental Health in England, Barts and the London School of Medicine, Department of Health. Outcomes Compendium: Helping You Select the Right Tools for Best Mental Health Care Practice in Your Field. Gateway reference 10934. Department of Health, 2009 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093316).
16 Audit Commission. Managing Finances in Mental Health: A Review to Support Improvement and Best Practice. Audit Commission, 2006.
17 Appleby, L. The National Service Framework for Mental Health – Five Years On. Department of Health, 2004.
18 Heller, J, Jamrozik, K, Weller, DP. Modernisation or reform? The NHS approach. Med J Austr 2004; 180: 441–2.
19 Degeling, P, Maxwell, S, Kennedy, J, Coyle, B. Medicine, management, and modernization: a ‘danse macabre’? BMJ 2003; 326: 649–52.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
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Uptake of mandatory outcome measures in mental health services

  • Rowena Jacobs (a1) and Valerie Moran (a2)
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eLetters

Routine outcome measures in liaison psychiatry

Gopinath Ranjith, Consultant Liaison Psychiatrist
23 August 2010

Jacobs and Moran, in their article enthusiastically supportive of theuse of HoNOS as a routine outcome measure, recommend ‘mild coercion’ by Trust managers to improve completion rates 1. They acknowledge the bluntness of the instrument and its inappropriateness in some specialist services but fail to consider that it may be totally inapplicable in some psychiatric specialities one of which is liaison psychiatry.

The authors state the truism that for HoNOS to be considered an outcome measure there needs to be paired ratings. Liaison psychiatry services see patients mainly in the Emergency departments (ED) and inpatient medical units. The ED assessments are mainly one off assessmentswhere paired assessments are inapplicable. The average stay for acute carein the UK is about 6 days 2; thus there are few patients on medical wards where paired ratings with a space of at least two weeks between them are possible.

Another problem in using HoNOS as an outcome measure, even in the fewcases it may be possible, is the nature of consultation-liaison work. The consultations are often directed at the referring medical team, examples including clarifying a complex capacity situation or advising on change inpsychopharmacology in patients with organ impairment. Even when the consultation is patient-focused the interventions are not necessarily aimed at bringing about symptomatic change in a short period of time. ThusHoNOS would at best fail to capture relevant outcomes and at worst seriously misrepresent the effectiveness of liaison psychiatry teams.

This is not to say that outcome measures are not important in liaisonpsychiatry but they need to be smarter. Operational definitions for consultation outcomes that focus on the effectiveness of individual consultations should be agreed- such an approach has been recently studiedby a Brazilian group 3. Quality of liaison psychiatry services should be judged by looking at consultation outcomes and performance standards such as those recently published by the Psychiatric Liaison Accreditation Network (PLAN) 4.

Declaration of interest: None

References

1.Jacobs R, Moran V. Uptake of mandatory outcome measures in mental health services. The Psychiatrist 2010; 34: 338-43.

2.Organisation for Economic Co-operation and Development (OECD). Health at a Glance: OECD indicators. OECD, 2007.

3.de Albuquerque Citero V, de Araujo Andreoli PB, Nogueira-Martins LA, Andreoli SB. New potential clinical indictors of consultation-liaison psychiatry’s effectiveness in Brazilian general hospitals. Psychosomatics 2008; 49: 29-38.

4.Palmer L, Dupin M, Hinchcliffe G, McGeorge M. Quality standards for liaison psychiatry services. Royal College of Psychiatrists, 2009.
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Conflict of interest: None Declared

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