title: Defining multiple criteria for meaningful outcome in routine outcome measurement using the Health of the Nation Outcome Scales.
abstract: OBJECTIVE
  Using the reliable and clinically significant change approach, we aimed to identify meaningful outcome indicators for the Health of the Nation Outcome Scales (HoNOS) and to combine them in a single model. We applied these indicators to the 1-year outcome of two large samples of people attending community mental health services in Italy (cohort 1) and the Netherlands (cohort 2).
  
  
  METHODS
  Data were drawn from two studies on routine outcome assessment. The criteria for meaningful outcome were defined on both study cohorts and both language versions of the scale. The model combined (a) two criteria for adequate change (at least 4 or 8 points change), (b) two cut-offs for clinically significant change (a total score of 10 was the threshold between mild and moderate illness, 13 between moderate and severe illness), and (c) a method for classifying stable subjects in three degrees of severity (stable in mild, moderate or severe illness). Results were compared with those given by the effect size (ES) and analysis of variance and covariance (ANOVA and ANCOVA).
  
  
  RESULTS
  For the proposed approach the outcome of cohort 1 was better than cohort 2, with 65-67% of its subjects showing a positive outcome compared to only 45-46%. The other reference methods (ES and ANOVA), however, showed a greater improvement for cohort 2. ANCOVA indicated that the differences were due to regression to the mean (RTM) which showed opposite effects across the two cohorts.
  
  
  CONCLUSIONS
  The proposed approach proved valuable and generalizable for interpreting outcome on HoNOS, scarcely influenced by the RTM effect. Its introduction could benefit outcome evaluation and management.
authors.affiliation: Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via la Masa 19, 20156, Milan, Italy, parabiaghi@marionegri.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Parabiaghi
authors.forename: Hans E
authors.initials: HE
authors.lastname: Kortrijk
authors.forename: Cornelis L
authors.initials: CL
authors.lastname: Mulder
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000592:standards*; D005260:Female; D006801:Humans; D007558:Italy; D007802:Language; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
references.citation: J Consult Clin Psychol. 1984 Aug;52(4):497-504
references.pmid: 6470276
references.citation: J Clin Psychol. 2005 Feb;61(2):175-85
references.pmid: 15609355
references.citation: Qual Life Res. 1995 Aug;4(4):293-307
references.pmid: 7550178
references.citation: J Behav Health Serv Res. 2007 Jul;34(3):272-89
references.pmid: 17534718
references.citation: Acta Psychiatr Scand. 2000 Mar;101(3):235-42
references.pmid: 10721873
references.citation: Int J Epidemiol. 2005 Feb;34(1):215-20
references.pmid: 15333621
references.citation: Med Care. 1989 Mar;27(3 Suppl):S178-89
references.pmid: 2646488
references.citation: Behav Res Ther. 1999 Dec;37(12):1219-33
references.pmid: 10596468
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2010 Apr;45(4):475-85
references.pmid: 19572089
references.citation: Behav Res Ther. 1993 Sep;31(7):693-700
references.pmid: 8216170
references.citation: J Clin Epidemiol. 2003 May;56(5):395-407
references.pmid: 12812812
references.citation: Am J Epidemiol. 1976 Nov;104(5):493-8
references.pmid: 984023
references.citation: Behav Res Ther. 1999 Dec;37(12):1203-10; discussion 129-33
references.pmid: 10596466
references.citation: Health Qual Life Outcomes. 2005 Nov 28;3:76
references.pmid: 16313678
references.citation: J Consult Clin Psychol. 1991 Feb;59(1):12-9
references.pmid: 2002127
references.citation: Aust N Z J Psychiatry. 2011 Jul;45(7):558-68
references.pmid: 21561240
references.citation: Med Care. 2001 Oct;39(10):1039-47
references.pmid: 11567167
references.citation: Br J Psychiatry. 2001 Jun;178:561-6
references.pmid: 11388975
references.citation: Behav Res Ther. 1999 Dec;37(12):1195-202; discussion 1219-33
references.pmid: 10596465
references.citation: Aust N Z J Psychiatry. 2005 Aug;39(8):719-25
references.pmid: 16050926
references.citation: Aust N Z J Psychiatry. 2009 Jun;43(6):531-8
references.pmid: 19440885
references.citation: Qual Life Res. 1993 Jun;2(3):221-6
references.pmid: 8401458
references.citation: Mayo Clin Proc. 2002 Apr;77(4):384-92
references.pmid: 11936936
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2010 Feb;45(2):245-52
references.pmid: 19412561
references.citation: J Affect Disord. 2004 Mar;78(3):269-72
references.pmid: 15013253
references.citation: J Pers Assess. 2004 Feb;82(1):60-70
references.pmid: 14979835
references.citation: Aust N Z J Psychiatry. 2012 Mar;46(3):240-8
references.pmid: 22391281
references.citation: Nord J Psychiatry. 2011 Sep;65(4):251-8
references.pmid: 21062122
references.citation: Epidemiol Psichiatr Soc. 1999 Jul-Sep;8(3):198-208
references.pmid: 10638038
references.citation: J Consult Clin Psychol. 1992 Jun;60(3):402-8
references.pmid: 1619094
references.citation: Behav Res Ther. 1999 Dec;37(12):1169-93
references.pmid: 10596464
references.citation: Br J Psychiatry. 1998 Jan;172:11-8
references.pmid: 9534825