10.1016/j.cpr.2021.102002 The direction of the odds ratio for duration of treatment switched so that having more days in treatment was associated with a lower likelihood of recovery when controlling for other variables (whereas longer duration was associated with a higher likelihood of recovery in the univariable model). Teamwork creates more moments where individual members can cross-train one another to create new skills and strengths in time. Although this paper refers to schools the information and advice herein are also applicable to graduate . The authors declare they have no competing interests. Several initiatives focused on improving staffs understanding and accuracy in the routine recording of presenting problems. However, this ignores patients receiving only one treatment session and those with less severe presentations to services, and there may be important changes in the number of patients receiving only one session or who were below caseness across time that might further influence changes in patient outcome, as suggested by Clark et al. Has data issue: true Peel, Alicia J. This was not considered in this analysis of treatment-delivery factors, as these patient-related factors cannot be influenced by clinical practice, and instead this analysis is concerned with changes to clinical practice that may be associated with outcomes. Tillage: Advantages and Disadvantages - CropWatch Proportion of patients with a diagnosis of MADD or without a diagnosis recorded, by financial year. advantages and disadvantages of outcome measures iapt Talking therapies can be helpful for lots of things, including: depression. These measures are used in a variety of ways, from monitoring patient progress in treatment, to service development and outcome monitoring. Bookshelf Close this message to accept cookies or find out how to manage your cookie settings. . Conclusions: The value of using IAPT data to inform service improvement evaluations is discussed. This is despite the number of referrals and numbers of treated patients also increasing year-on-year, suggesting that services have evolved local practices and treatment delivery to meet needs whilst improving performance. Hostname: page-component-7fc98996b9-rf4gk (PDF) Making decisions about patient progress: The - ResearchGate Routine Outcome Measurement in CAMHS - ACAMH Naqvi, Syed A. If the distribution of profiles has varied over time, with less complex profiles increasing in prevalence then it is possible that a change in patient profiles may be associated with improved performance. This is known as Routine Outcome Monitoring (ROM). gabriel slonina parents . View all Google Scholar citations When controlling for all of the other factors, having more treatment sessions, fewer weeks in treatment, fewer DNAs and cancellations, and not having a MADD problem descriptor were all associated with increased odds of recovery and reliable improvement. These measures are sometimes referred to as patient reported outcome measures (PROMs) and patient reported experience measures (PREMs). In addition, it is likely that this is something that varies between services quite considerably, whereby there may be local attendance or DNA policies which dictate practice in one service but not another. So, for example, services that increased the average number of appointments or decreased the average waiting time between referral and starting treatment, from 20142015 to 20152016, reported higher proportions of patients achieving reliable recovery and reliable improvement at the end of treatment in 20152016 than they did in 20142015. Major soil erosion. Huge progress has been made over the past decades in introducing patient reported outcomes (PROs) in medicine. Bauer-Staeb, Clarissa (PDF) Ecological studies: Advantages and disadvantages - ResearchGate -, Braun, V. , & Clarke, V. (2006). The survey was designed to look at how their use of and attitudes towards ROM changed over this 6 month period (quantitative data), and to find out more about what got in the way of using ROMs in practice (qualitative data). However, this does not reflect the variation in therapy type that may have occurred before the last sessions and therefore more detailed analysis would be required in order to use therapy type information. Outcome evaluation is the evaluation done by companies for calculation of the impact of the outcome or end result of an activity done in producing change. the implementation of outcome measures in child and adolescent mental health services (CAMHS) and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Shifting the perception of outcome measures as impersonal numbers to being process clinical tools ensures a personalised delivery of psychological interventions and has the potential to enhance engagement from practitioners and patients what may reduce drop-out rates and improve clinical outcomes. Depression symptom severity was measured using the Patient Health Questionnaire 9-item version (PHQ-9; Kroenke et al., Reference Kroenke, Spitzer and Williams2001), where scores of 10 or above indicate caseness for depression, and a reduction of 6 or more points on the scale indicates reliable improvement in depression symptoms (NHS Digital, 2016, 2017). Routledge. Approximately, 7 of every 10 people (67%) who have a course of treatment (two or more sessions) show reliable and substantial reductions in their anxiety/depression. they had symptoms of either depression or anxiety, suggestive of a probable diagnosis of some depressive or anxiety disorder; see Measures and outcomes section below for details) and completed pre- and post-treatment outcome measures. See Fig. (3) How analysing routinely collected data can be used to inform service improvement. There was a very small significant effect of a longer duration of treatment being associated with greater odds of recovery, and higher baseline severity scores on both the PHQ-9 and GAD-7 were associated with lower odds of recovery. advantages and disadvantages of outcome measures iapt 10.1002/cpp.1929 The first outcome, recovery, is defined in IAPT as moving from scoring above caseness for either depression or anxiety at the start of treatment to scoring below caseness on measures of both depression and anxiety symptoms at the end of treatment. The North and Central East London IAPT Service Improvement and Research Network (NCEL IAPT SIRN) was established in order to use routinely collected IAPT data from all individual patients that have been seen in the local services, for the purpose of sharing best practice and improving the care these services provide. Cirkovic, Mirko Naqvi, Syed A. Over half of our participants were Clinical Psychologists, who may have particular views of ROM due to their training, which arent necessarily consistent with the views of those with other professional backgrounds. The services also held regular training sessions with staff on working with interpreters, and anecdotally the staff in those services suggested this may have led to a reduction in the number of cancellations by the service. Establishing Presenting and Using Outcome Measures Outcome measures are important to accreditation and other forms of evaluation.Outcome measures are quantifiable indicators that gauge productivity in this case productivity of a school or graduate program of public health. A performance management process forces managers to discuss performance issues with employees. Dr Maria Loades is a Clinical Tutor for the Doctorate in Clinical Psychology programme, at the University of Bath. With 98.5% completion of pre- and post-treatment outcome measures (Clark, Reference Clark 2018 ), IAPT datasets have great potential to highlight potential areas of clinical practice . (1) Routinely collected information about how treatment is delivered can be used to highlight areas of improvement. advantages and disadvantages of outcome measures iapt. RP-PG-1016-20010/DH_/Department of Health/United Kingdom, Barkham, M. , MellorClark, J. , & Stiles, W. B. 1. is specialized diverge tubeless ready? St Saviour's House This study explores whether there have been changes in clinical practice with regard to: (1) the number of sessions and length of treatments; (2) the number of cancellations and non-attendance; and (3) the recording of problem descriptor information, and the association with treatment outcomes in IAPT. Two IAPT-defined patient outcomes were considered in the current study, both of which are used in national IAPT reporting (NHS Digital, 2019). It will allow top leadership to understand the strength and weaknesses of the organization. Excellent incorporation. Method: Average number of treatment sessions per episode and average duration of treatment, by financial year. Simons CL, Rivero-Arias O, Yu LM, Simon J. Qual Life Res. Taken together, the results indicate that the delivery of more sessions, provided at more frequent intervals, reduced cancellations and the correct identification of a patients presenting problem are associated with better outcomes in IAPT services, and that the year-by-year changes in these factors is associated with improving outcomes being reported nationally. Barnett, Phoebe sarah.smith@lshtm.ac.uk. 1 for the flow of patients into this study. The use of large individual patient data datasets such as the NCEL IAPT SIRN dataset can provide a means with which to feed back the impact of specific changes on clinical practice on patient outcomes, and provide a method of sharing best practice. The right-hand panel of Fig. 2018 Mar 2;18(1):59. doi: 10.1186/s12888-018-1639-5. Some involved improving relationships with GPs to improve the appropriateness of referrals, and seeing patients within GP surgeries to make attendance easier for the patients, thus reducing DNAs (Foustanos et al., Reference Foustanos, Morgan, Gray and Minton2018). IAPT services use the problem descriptor variable (an ICD-10 code) to help match patients to National Institute for Health and Care Excellence (NICE) evidence-based treatments, which for CBT interventions includes the use of the appropriate disorder-specific CBT protocol (Clark, Reference Clark2018). Data were extracted on all patients in the NCEL IAPT SIRN dataset who met inclusion criteria, and were initially split into financial years. Firstly, the dataset includes individual patient data from seven IAPT services, and although the trends in outcome seem to mirror those nationally, the treatment-delivery factors explored may operate differently in other IAPT services outside of the NCEL SIRN. Goldsmith, Kimberley A. ROMs which track specific symptoms and ROMS that capture functioning were used less often (20%). Using progress feedback to improve outcomes and reduce dropout, treatment duration, and deterioration: A multilevel metaanalysis. Our study took place in a network of CAMHS in an urban area, following a service-level mandate to use ROM. advantages and disadvantages of outcome measures iapt A metaregression analysis, How durable is the effect of low intensity CBT for depression and anxiety? Routine Outcome Monitoring in CAMHS: How Can We Enable Implementation in Practice? The NCEL IAPT SIRN dataset includes a number of measures related to the process of treatment that have been identified in previous analyses as having a potential impact on IAPT service performance and patient outcomes (Clark et al., Reference Clark, Canvin, Green, Layard, Pilling and Janecka2018; Green et al., Reference Green, Honeybourne, Chalkley, Poots, Woodcock, Price and Green2015). advantages and disadvantages of outcome measures iapt and advantages and disadvantages of outcome measures iapt Average number of treatment sessions per episode and average duration of treatment, by financial year. Advantages and disadvantages of Utilitarianism.docx The number of sessions and the duration of treatment were associated with outcomes here and have previously been found to be associated with psychological treatment outcomes both in IAPT (Green et al., Reference Green, Honeybourne, Chalkley, Poots, Woodcock, Price and Green2015) and other settings (Cuijpers et al., Reference Cuijpers, Huibers, Ebert, Koole and Andersson2013; Erekson et al., Reference Erekson, Lambert and Eggett2015). It helps the society place more value on actions that bring happiness. Having more sessions of treatment was associated with a higher likelihood of recovery in univariable models, whereas more DNAs and cancellations, as well as having a missing or MADD problem descriptor were all associated with a lower likelihood of recovery. Results are presented in Table1 and the top panel shows that each of the treatment-delivery factors was significantly associated with recovery in univariable models (left-hand columns). This advantage makes it easier to integrate more people into different roles as the scope of a project allows. This is because the multivariable models controlled for the effect of the number of sessions, and therefore when number of sessions was held constant results showed that increasing the duration in treatment was associated with poorer outcomes. Outcome evaluation is the assessment done to measure the final results of a program. Participants (11 patients and 11 practitioners) were recruited from four nationally funded IAPT services and one-third sector organisation commissioned to deliver Step 2 IAPT services, in England. Disclaimer. The use of aggregated datasets from IAPT services such as the one from the NCEL SIRN presented in the current analysis could be used to identify areas of clinical practice that are associated with improved patient outcomes and potentially identify aspects of service delivery that could be adjusted to optimise care. Away from IAPT, research evidence has shown that increasing the frequency of cognitive behavioural therapy (CBT) sessions (delivering sessions more frequently) rather than the total number of sessions is associated with better treatment outcomes (Cuijpers et al., Reference Cuijpers, Huibers, Ebert, Koole and Andersson2013; Herbert et al., Reference Herbert, Rheingold, Gaudiano and Myers2004). The factors highlighted in both the manual and the current analysis suggest that small changes to clinical practice can have positive benefits to outcomes in IAPT services. This field is for validation purposes and should be left unchanged. Search for other works by this author on: Copyright International Society for Quality in Health Care and Oxford University Press 2001, Reducing last-minute cancellations of elective urological surgery - effectiveness of specialist nurse pre-operative assessment, Community Pantries: A Health Service of Great Quality for the Most Affected Ones, Hospital accreditation: an umbrella review, Implementing a screening algorithm for early recognition of sepsis in hospitalized children: a quality improvement project, Is evidence of effectiveness a driver for clinical decision support selection? Advantages and disadvantages of being a low intensity worker For example, previous analyses have identified distinct profiles of patients attending IAPT services with significant differences in outcomes observed between these profiles (Saunders et al., Reference Saunders, Cape, Fearon and Pilling2016). England's national Improving Access to Psychological Therapies (IAPT) programme advocates stepped care as its organizational delivery of psychological therapies to common mental health problems. Your email address will not be published. The https:// ensures that you are connecting to the Eley, Thalia C. 2 But . 10.1191/1478088706qp063oa 1 We agree that PROMs could be an important component of healthcare decision making if used appropriately. As consumers, payers, and regulatory agencies require evidence regarding health care qualities the demand for process of care measures will grow. official website and that any information you provide is encrypted The association of treatment-delivery factors and baseline symptom severity with both recovery and reliable improvement in individual patients was then explored in the next set of analyses. Sign up for news, offers, and details of our online magazine The Bridge, ACAMH Routine Outcome Measures (ROMs) - Associate Development Solutions Ltd This study also took place in one geographical area and in one mental healthcare provider organisation (although across a number of CAMHS teams in this area). advantages and disadvantages of outcome measures iapt Published online by Cambridge University Press: In this essay, we discuss the advantages and . The Disadvantages of Performance Indicators. We would like to thank all clinicians and patients from NCEL IAPT services. Stott, Joshua (2) More treatment sessions, delivered in a more condensed period of time, was associated with better outcomes. The below charts show the number of people seen in IAPT services 2009 to . . anxiety. Timeliness considerations. Latest reports indicate that 52.1% of patients receiving a course of treatment recovered, up from 50.8% in the previous year (NHS Digital, 2019). Qualitative research using recordings of telephone-treatment sessions. The outcome-based education is among the overall strategies that try to reflect changes in the current edu. Patient reported outcome measurement: drawbacks of existing methods did not receive just one treatment session only), which were found to be associated with outcomes. This is probably due to the number of sessions already being controlled for, and indicates that delivering the same number of sessions more frequently improves the odds of recovery. However, qualitative research has identified some key challenges that warrant discussion to further understand how to maximise their potential use in routine clinical practice during treatment. advantages and disadvantages of outcome measures iapt This site needs JavaScript to work properly. summarising, categorising and comparing total scores); and (4) missed opportunities to use outcome measures therapeutically (e.g. Overall outcomes are good. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society. Changes in the number of sessions, frequency of sessions, and attempts at reducing cancellations or non-attendance at treatment sessions could therefore have important implications for patient outcomes at the end of treatment. Neely, Lizzie In order to meet the growing demand, training of increasing numbers of clinicians is required, with an aim of over 10,500 new therapists to be trained by 2021 (Clark, Reference Clark2018). advantages and disadvantages of outcome measures iapt. The benefits of ROM are that this regular feedback on progress makes it easier to spot when therapy is not having the desired effects, so that the therapist can adapt or change the intervention accordingly. The current analysis focused on patients who completed a course of treatment (2+ sessions) and were caseness at the start of treatment, as standard for national evaluations of IAPT services. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The ROMs that were most frequently used measured symptoms of anxiety and depression, the Revised Children's Anxiety and Depression Scale (RCADS). It will be useful if future studies establish whether these findings apply to other CAMHS, and more explicitly identify what facilitates using ROMs. J Psychiatr Ment Health Nurs. It reflects on the advantages and disadvantages of current approaches, all of which have their merits, and makes some suggestions for the future. All these factors were associated with recovery and reliable improvement in univariable models. Others involved removing arbitrary caps on the maximum numbers of clinical sessions offered, particularly at high intensity, and changing attendance policies so that there were differences in how patients were notified about expectations of attendance and the consequences of non-attendance. You will be responsible for the work you do not have to share the credit. Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Tookman A, Mannix K, Gola A, Davis S, Wood J, Jones L. Health Technol Assess. Treatment non-attendance is an inefficient use of health service resources (Wells et al., Reference Wells, Browne, Aguilar-Gaxiola, Al-Hamzawi, Alonso, Angermeyer and Kessler2013) and is associated with poorer outcomes from psychological interventions both in IAPT services and beyond (Schindler et al., Reference Schindler, Hiller and Witthft2013). Exploring the impact of these factors on change in performance in other services would be of value to assess the wider impact. But training KPIs don't show team transformations in a day. Cardoso, Ana Since performance measures tend to encourage somewhat rigid behavioral outcomes, they might result in a loss of creativity. The presented analysis of individual patient data provided by seven IAPT services from the last seven financial years has shown a number of potential treatment-delivery factors that are associated with the likelihood of patients achieving recovery and reliable improvement at the end of their IAPT treatment. Although this study benefits from a large sample of patients, with data spanning 7 years to assess change in both clinical practice and outcomes, there are a number of limitations to the current analysis. Many Child and Adolescent Mental Health Services (CAMHS) in the UK routinely evaluate change in a service users presenting difficulties, functioning and progress towards their goals over the course of treatment. Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT. However, the current findings suggest that treatment duration may be an additional treatment-delivery factor that could be considered in improving IAPT patient outcomes by clinicians, managers and commissioners. Any interruptions and extra meetings from others so you can focus on your work and get it done faster. (2) The link between clinical practice and potential service performance. Davies, Molly R. A qualitative descriptive study of senior hospital staff, About International Journal for Quality in Health Care, About the International Society for Quality in Health Care, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 International Society for Quality in Health Care and Oxford University Press.