Book: "Outcome Measurement in Mental Health" Cambridge University Press

Outcome Measurement in Mental Health
Theory and Practice
Edited by Tom Trauer
Hardback
Published June 2010

In order to operate in an evidence-based fashion, mental health services rely on accurate, relevant, and systematic information. One important type of information is the nature of the problems experienced by recipients of mental health care, and how these problems change over the course of time. Outcome measurement involves the systematic, repeated assessment of aspects of health and illness, either by service providers, service recipients, or both. From outcome measurement clinicians and service recipients achieve a common language whereby they can plan treatment and track progress, team leaders and managers secure a basis to compare their services with others and to promote quality, while policy makers and funders derive evidence of effectiveness. This book will be an essential and practical resource for all members of the mental health clinical team as well as those responsible for establishing or managing services, and directing policy.

• Presents a global perspective on outcome measurement enabling readers to compare and contrast practices around the world
• Enables readers to identify the specific challenges presented in different groups and settings, the instruments to use, and how to use the results
• Emphasizes the relevance and use of outcome data to clinicians, to help them improve their effectiveness

Contents

Preface; 1. Introduction Tom Trauer; Part I. Outcome Measurement Around the World: 2. Mental health outcome measurement in Australia Jane Pirkis and Tom Callaly; 3. Outcome measures in New Zealand Graham Mellsop and Mark Smith; 4. Outcome measurement in England Mike Slade; 5. Outcome measurement in Ohio and the United States James Healy and Dee Roth; 6. The outcome questionnaire system: a practical application for mental health care settings Michael J. Lambert; 7. Outcome measurement in Italy Mirella Ruggeri; 8. Outcome measurement in Germany Sylke Andreas, Thomas Becker, Holger Schulz and Bernd Puschner; 9. Outcome measurement in mental health services in Norway Torleif Ruud; 10. Outcome measurement in Canada: one province's experience with implementation in community mental health David Smith; Part II. Outcome Measurement in Specific Groups and Settings: 11. Routine outcome measurement in child and adolescent mental health Peter Brann; 12. Outcome measurement in adult mental health services Tom Trauer; 13. Outcome measurement in older persons Rod McKay and Regina McDonald; 14. Outcome measurement with indigenous consumers Tricia Nagel and Tom Trauer; 15. Routine measurement of outcomes by Australian private hospital-based psychiatric services Allen Morris-Yates and Andrew Page; 16. Mental health outcome measurement in Non-Governmental Organizations (NGOs) Glen Tobias; 17. Outcome measurement in drug and alcohol services Maree Teesson and Mark Deady; Part III. Current Issues in Outcome Measurement: 18. Outcome measurement - applications and utility Tom Trauer; 19. Stakeholder perspectives in outcome measurement Tom Trauer; 20. Assessment of change in outcome measurement Tom Trauer; 21. Routine outcome measurement: perspectives on skills and training Tom Trauer and Tim Coombs; 22. A review of instruments in outcome measurement Tom Trauer; 23. Some economic and policy considerations for outcome measurement Rowena Jacobs; 24. Future directions Tom Trauer; Index.

http://www.cambridge.org/uk/catalogue/catalogue.asp?isbn=9780521118347

My source:
UK Routine Clinical Outcomes Network Forum

EHR Software Market Share Analysis & UK residential care / nursing home sector musings

Last month (20th May 2010) Chris Thorman, who blogs about EMR systems at Software Advice, e-mailed me (copied below). Could I mention his recent EHR post on my blog?

Well thanks Chris! It is very encouraging to learn that W2tQ is seen by others as an infocare centre and valuable media avenue. It is very difficult for me to comment on this USA based analysis which is detailed at:

EHR Software Market Share Analysis

- but here are some thoughts. ... This is a great piece of work-in-progress which acknowledges the problem of being 100% comprehensive and coherent given the task, plus the market's spread and dynamics.

My perspective is UK and my full-time work as a nurse gives me a limited outlook on health IT markets as a whole. Nonetheless I value efforts to capture such data in order to better understand the health informatics industry and grasp the bigger picture. As Chris notes this project is challenging, the post is also an appeal for help. While a great proportion of surveys are commercial in motivation, the e-community and e-media can now add value by pointing out the gaps and other data sources. The comments that conclude Chris's post ably demonstrate this.

I would very much like to read something similar for the UK, including the use of information systems in the residential and nursing home sector (any suggestions welcome). It still amazes me how many care homes - including those that are part of large business groups - do not use a 'resident' information system.

Perhaps the new - post-election - health ICT market in England will see new opportunities?
(See post re. 1 July 2010 NW England BCS - British Computer Society meeting).

In ICT terms the care / nursing home sector to me seems passive; it is content to be waited-upon by primary care and the hospital based systems. If they are not engaged on this level can they (and others, e.g. commissioners) argue that they are integrated? I think not.

Care homes need to realize that a dedicated information system could pay dividends in terms of assessment; continuity of care (transfer of care); quality of care; client, family and staff engagement, reporting to inform commissioning, inspection and marketing. When we talk of a patient's viability, there is also the question of the future viability of this market sector amid competition, economics, standards and costs ... ?

Buyer sought for Loyd’s Nursing Homes Group’s 64 care homes
Catherine Boyle, Times Online, 21 May 2010.

Chris' focus is the EHR market, very much concentrated upon physician, medical and medical billing coding  applications. This is reflected in the search facility on the Software Advice website. The search is constrained and directed, driven of course by the underlying database of companies, their applications and reviews. Markets are, however, defined by their boundaries and the way they change over time. Anticipation of that change is a gift indeed.

The personal health record (PHR) lies outside the scope of this Software Advice post, since as per WikiPedia:

It is important to note that PHRs are not the same as EHRs (electronic health records). The latter are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate that compels a consumer or patient to store her personal health information in a PHR.

This work by Chris and respondents helps to establish and define the boundaries. The EHRs in question are not purely institutional (e.g. hospital-based), the vendors cater for varying numbers of users, in different care settings as you can see on the site's 3-stage search. So while I cannot add anything as such, I wonder if there could (should) be scope for residential care in there?

Or perhaps the EHR market is not viable when it comes to older adult* residential care?

Heaven forbid that the transatlantic (and global) EHR market is ageist!

Thanks again Chris.

*Residential care is also needed for younger adults too.

From: Chris Thorman
To: " Peter,"
Sent: Thu, 20 May, 2010 18:57:41
Subject: Blog post idea for your blog

Hello Peter,

I hope you've had a good week. I just finished a blog post about market share in the EMR industry and I wanted to give you a heads up about it. Here is the link:

http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/

In the article, I broke down:

• The size of the outpatient EMR market;
• What EMR vendors have the most physicians using their system; and,
• What EMR vendors have the most practices using their system.

As I'm sure you can imagine, it was a tough project to get accurate numbers on. I was hoping you could mention my article on your blog to get more eyes on it so we can clear up any discrepancies. Sort of a "crowd sourcing" project if you will. I'd also be interested to read your thoughts on our findings.

Would you mind mentioning my post?

------------------------------------------------------------
Chris Thorman
Senior Marketing Manager
Software Advice
www.softwareadvice.com
chris at softwareadvice.com

HoNOS, checklists and semi-structured interviews

Mental health services not routinely (and formally) using HoNOS (Health of the Nation Outcome Scales) are gearing up with a push to implement the scale across services by April. HoNOS has been around for a long time almost 20 years so it is time it earned its keep. Perhaps high quality tools take time to emerge from the noise and chatter of the care marketplace? ;-)

Although they are available, I've been putting a presentation together to help get to grips with HoNOS in the role of a trainer. The evidence for the validity and benefits of using HoNOS is well established, with the HoNOS family of scales boasting global usage and development:

• HoNOS for working age adults
• HoNOS65+ for older people
• HoNOSCA for children and adolescents
• HoNOS-Secure for use in health and social care settings secure psychiatric, prison health care and related forensic services, including those based in the community)
• HoNOS-LD for learning disabilities
• HoNOS-ABI for acquired brain injury (ref.)
  

The number of assessment, intervention and evaluation tools available to clinicians AND managers begs the question (ironically): is there 'space' in the toolkit for yet another tool? If HoNOS can help establish a coherent currency for mental health commissioning beyond the block contract then this is most welcome. Mental health services need to move forward on several fronts. There is a timeline running with completion of this difficult task in its sights.

One set of guidance for HoNOS points out that:

The scales are not used as a checklist or semi-structured interview, but form a brief record of severity.

There is some succor there then, since Hodges' model is a checklist and a quad-structured interview there is still a role for a global conceptual framework.

There's nothing like a full and tidy set of tools!

Ref. http://www.gpsa.org.au/media/docs/mentalhealth/honos_information.pdf

DoH: Honos health of the nation outcome scales report on research and development July 1993 - December 1995

Additional links:

The UK Routine Clinical Outcomes in Mental Health Group

The NHS Information Centre: Mental Health Minimum Dataset

RCP references

Memo to America's Right

Please do not treat the UK's NHS as a
political football and yes I mean 'football'
(there's enough of that o'er here without
you sticking your ten cents worth in!).

Do not underestimate the -
knowledge, skills, creativity and dedication -
of its staff, or how it is perceived, valued and loved by its People.

Yes, the NHS is not without its faults (it is also true we are not all Angels), but amid the signs of wear, the aged splinters -

we do not forget the middle,
the constant called change,
or the challenges that beckon in the 21st century.

Image source: Allproducts.com

Additional links:

BBC News Bloggers debate British healthcare

New York Times 2008 Paying Patients Test British Health Care System

NHS: Welcome to the world of churning?

In February (hey, give me chance - I am part-time!) in the HSJ was a news item about the NHS Constitution which warned of the huge bill that looms in the need to provide choice information for patients. Quoted figures c/o health economists at the Department of Health put "the best case scenario of a cost of £5.2m per year (£33,000 per PCT) 5.5 per cent of patients would need to switch providers".

We are all accustomed to switching providers when it comes to telephone, gas, electricity, TV, internet-broadband in various combinations. Some 'real' markets need their business models to recognise and take account of the fact that a proportion of the market switch service providers - in other word they churn.

You have to ask I suppose are the +ve and -ve qualities and impact of churners in these markets equivalent to those in health and social care? The future is a place and time of complex deals no doubt...

Crump, H. (2009). Huge bill looms for choice information, HSJ, February 5, p. 5.