title: Benchmarking routine psychological services: a discussion of challenges and methods.
abstract: BACKGROUND
  Policy developments in recent years have led to important changes in the level of access to evidence-based psychological treatments. Several methods have been used to investigate the effectiveness of these treatments in routine care, with different approaches to outcome definition and data analysis.
  
  
  OBJECTIVE
  To present a review of challenges and methods for the evaluation of evidence-based treatments delivered in routine mental healthcare. This is followed by a case example of a benchmarking method applied in primary care.
  
  
  METHODS
  High, average and poor performance benchmarks were calculated through a meta-analysis of published data from services working under the Improving Access to Psychological Therapies (IAPT) Programme in England. Pre-post treatment effect sizes (ES) and confidence intervals were estimated to illustrate a benchmarking method enabling services to evaluate routine clinical outcomes.
  
  
  RESULTS
  High, average and poor performance ES for routine IAPT services were estimated to be 0.91, 0.73 and 0.46 for depression (using PHQ-9) and 1.02, 0.78 and 0.52 for anxiety (using GAD-7). Data from one specific IAPT service exemplify how to evaluate and contextualize routine clinical performance against these benchmarks.
  
  
  CONCLUSIONS
  The main contribution of this report is to summarize key recommendations for the selection of an adequate set of psychometric measures, the operational definition of outcomes, and the statistical evaluation of clinical performance. A benchmarking method is also presented, which may enable a robust evaluation of clinical performance against national benchmarks. Some limitations concerned significant heterogeneity among data sources, and wide variations in ES and data completeness.
authors.affiliation: Leeds Community Healthcare NHS Trust, UK.
authors.forename: Jaime
authors.initials: J
authors.lastname: Delgadillo
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
authors.forename: Chris
authors.initials: C
authors.lastname: Leach
authors.forename: Mike
authors.initials: M
authors.lastname: Lucock
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.forename: Nick
authors.initials: N
authors.lastname: Wood
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D019985:Benchmarking / Q000379:methods* / Q000592:standards*; D015928:Cognitive Behavioral Therapy / Q000592:standards* / Q000639:trends*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004739:England; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards / Q000639:trends; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000639:trends*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards / Q000639:trends; D011050:Policy Making; D011320:Primary Health Care / Q000592:standards / Q000639:trends; D011614:Psychotherapy, Brief / Q000379:methods / Q000592:standards / Q000639:trends; D012648:Self Care; D013813:Therapy, Computer-Assisted / Q000379:methods / Q000592:standards / Q000639:trends