Objections to routine clinical outcomes measurement in mental health services: any evidence so far?
BACKGROUND
Routine clinical outcomes measurement (RCOM) is gaining importance in mental health services.


OBJECTIVE
To examine whether criticisms published in advance of the development of RCOM have been borne out by data now available from such a programme.


METHODS
This was an observational study of routine ratings using HoNOS65+ at inception/admission and again at discharge in an old age psychiatry service from 1997 to 2008. Testable hypotheses were generated from each criticism amenable to empirical examination. Inter-rater reliability estimates were applied to observed differences between scores between community and ward patients using resampling.


RESULTS
Five thousand one hundred eighty community inceptions and 862 admissions had HoNOS65+ ratings at referral/admission and discharge. We could find no evidence of gaming (artificially worse scores at inception and better at discharge), selection, attrition or detection bias, and ratings were consistent with diagnosis and level of service. Anticipated low levels of inter-rater reliability did not vitiate differences between levels of service.


CONCLUSIONS
Although only hypotheses testable from within RCOM data were examined, and only 46% of eligible episodes had complete outcomes data, no evidence of the alleged biases were found. RCOM seems valid and practical in mental health services.
Institute of Psychiatry, King's College, London, UK. alastair.macdonald@iop.kcl.ac.uk
Alastair J D
AJ
MacDonald
Tom
T
Trauer
D000368:Aged; D001291:Attitude of Health Personnel; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D006113:United Kingdom