Developing a system for automated monitoring of psychiatric outpatients: a first step to improve quality.
OBJECTIVE
To evaluate an automated system of quality monitoring for psychiatric outpatients.


METHODS
Cross-sectional study.


METHODS
Large outpatient psychiatry clinic in Kaiser Permanente--Northern California.


METHODS
Approximately 1500 new psychiatric patients and 20 clinicians.


METHODS
This system gave clinicians data on new patients from validated instruments before their intake interviews, measured outcomes for the depressed and panic-disordered patients, and monitored the clinic's case-mix.


METHODS
Clinic case-mix: Axis II disorders (Personality Disorder Questionnaire--Revised); emotional, social and physical functioning (Health Status Questionnaire 2.0); Axis I symptoms (Symptom Checklist-90); depression and panic disorder (Health Outcomes Institute Modules). Clinician reaction to system (telephone interview).


RESULTS
The study population was 62.4% female; 73.9% Caucasian; 70% employed; 15.9% had evidence of personality disorder; 63% reduced daily activities because of emotional problems; 18% had depression; 7% had panic disorder. Over 75% of clinicians used the data reports and found them helpful; criticism focused on questionnaire length, inadequate training, numerous false-positives, and insufficient administrative support.


CONCLUSIONS
An automated patient monitoring system can be implemented; clinician involvement needs to be significant; more research is needed to establish the usefulness of standardized data and outcomes management.
Hunkeler
E M
EM
Division of Research, Kaiser Permanente Medical Care Program, Northern California, Oakland, USA.
Westphal
J R
JR
Williams
M
M
D000328:Adult; D000555:Ambulatory Care Information Systems; D002140:California; D003953:Diagnosis-Related Groups; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008603:Mental Health; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D011570:Psychiatry / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*