Routine clinical outcomes measurement in old age psychiatry

  title={Routine clinical outcomes measurement in old age psychiatry},
  author={Alastair J. D. Macdonald},
  journal={International Psychogeriatrics},
  pages={990 - 995}
  • A. Macdonald
  • Published 10 August 2009
  • Medicine, Political Science
  • International Psychogeriatrics
It is puzzling that major public health systems in the developed world do not engage in the routine clinical outcomes measurement (RCOM) of their interventions. For example, the budget of the U.K. National Health Service (NHS) for 2008/9 was £81 billion, with 15 million inpatient episodes, yet a Martian's question “How much better are these patients for all this expense?” cannot be answered for any but a tiny proportion of them, and then only by local enthusiasts. It is true that death rates of… 
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It is illustrated how problems inherent to design and analysis of ROM data prevent drawing conclusions about (comparative) treatment effectiveness, and how Subtle variations in analytic strategies influenced effect sizes substantially.
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Improving data input systems, sufficient training, regular feedback, measures to increase administrative and logistic support to improve implementation, acceptability, feasibility and sustainability, follow-up assessments and client attrition rate reduction efforts are only some measures needed to enhance PROM/ROM efficiency and efficacy.
Combining routine outcomes measurement and ‘Payment by Results’: will it work and is it worth it?
Summary The Department of Health in England has long encouraged the routine measurement of clinical outcomes in mental health services but has now decided to use outcome measures as part of a new


Routine outcome measurement by mental health-care providers: is it worth doing?
The usefulness of aggregate routine clinical outcomes data: The example of HoNOS65+
The development of methods of analysis of routine clinical outcomes data (using ICD10, HoNOS65+ and a developing intervention coding system) in an old age psychiatry service in South London are described.
Objections to routine clinical outcomes measurement in mental health services: any evidence so far?
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 found no evidence of gaming, selection, attrition or detection bias, and RCOM seems valid and practical in mental health services.
Do adults in contact with Australia's public sector mental health services get better?
The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type.
Quality of life routine outcomes measurement: lessons from experience in the USA and the UK
The general problems that affect QoL and all other routine measures are described and analysed using a framework devised by Peterson (1989).
Health of the Nation Outcome Scales (HoNOS)
The resulting 12-item HoNOS instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, and showed good reliability in independent trials.
Use of standardised outcome measures in adult mental health services
Routine use of outcome measures as implemented in this study did not improve subjective outcomes, but was associated with reduced psychiatric inpatient admissions.
Payment by results in mental health: the current state of play in England
The concept of payment by results is outlined, its use in other countries is briefly reported on, and the pilot study underway in England to define currencies to be used in a pay by results system planned for NHS mental healthcare throughout England and Wales is described.
Experience and application of HoNOS65
The implementation of the Health of the Nation Outcomes Scales for Old Age Psychiatry services (HoNOS65+) in a National Health Service trust is described and lessons learnt are identified.
Are the Health of the nation outcome scales (HoNOS) useful for measuring outcomes in older people'smental health services?
This review summarises how the Health of the Nation Outcome Scales was originally developed and validated and the question of whether the HoNOS orHoNOS65+ is suitable as an outcome measure in routine clinical practice in services for older people is addressed.