Impact of consumer-rated measures on outcomes, use and costs of specialised public sector mental health services: a propensitymatched

Transcription

1 Impact of consumer-rated measures on outcomes, use and costs of specialised public sector mental health services: a propensitymatched study Meredith Harris, Philip Burgess, Claudia Sparti, Jane Pirkis & Tim Coombs 6th Australasian Mental Health Outcomes and Information Conference June 2017 Australian Mental Health Outcomes and Classification Network Sharing Information to Improve Outcomes

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3 Overview Aim: To report on work-in-progress by AMHOCN to explore whether consumer-rated measure completion predicts later clinical and functional outcomes, service utilisation and costs Context Summary of the evidence base Initial findings Where to from here?

4 Guidelines for offering consumer-rated measures Clinician presents consumer self assessment as positive experience and a genuine attempt to engage the consumer in treatment planning Clinician assesses for potential difficulties the consumer may have in completing the self assessment and makes efforts to compensate for these difficulties. Degree of distress Language barriers Literacy issues Physical disability 4

5 Guidelines for offering consumer-rated measures Clinician presents rationale for completion of the consumer self assessment measure including: Genuine effort to understand consumer perspective Genuine effort to involve consumer in assessment and care planning Tool for clinician to monitor progress Tool for consumer to monitor progress Information can be used for service development and quality improvement processes. Temporary contraindication or general exclusion criteria 5

6 Potential benefits and a problem Potential benefits of consumer-rated outcomes include: improved detection of clinically significant problems ;and facilitation of consumer-clinician communication which may translate into improved quality of care. However consumer-rated measures are offered and completed less frequently than the clinician-rated measures.

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10 Patterns over time Clinician-rated outcomes assessments occur approximately 80+% where expected by the NOCC Protocol; Consumer-rated outcome assessments occur < 20% where expected; Rates of clinician- and consumer-rated outcome reporting have not changed over the past nine years

11 Does it make a difference? It is currently unknown whether either the offer and/or completion of these measures influences actual outcomes for consumers.

12 What does the evidence say? 8 systematic reviews have synthesised evidence on the impact of consumer-rated measures on outcomes in mental health care These suggest: modest positive effects on treatment outcomes greater for consumers who are not on-track greater when feedback is provided to both clinicians and patients, and is given frequently

13 What does the evidence say? But few studies in specialised mental health care settings most are conducted under experimental conditions most test the effect of offer and completion with feedback compared to something else

14 Our question In real-world specialised mental health care settings. Does the offer and completion of a consumer-rated measure predict later clinical outcomes, functional outcomes, service utilisation and costs?

15 Methods

16 Data source: NOCC Protocol: Age Group x Setting x Collection Occasion x Measures: Admission Review Discharge Clinician-rated: LSP-16 Clinician-rated: HoNOS Consumer-rated measure* Age Sex Focus of care Diagnosis Mental health legal status 3 age groups focus on adults 3 settings focus on ambulatory 3 collection occasion types (A/R/D) Consumer-rated measures vary by jurisdiction

17 Study design Uses propensity-score matching methodology Mimics the design of randomised clinical trials by reducing systematic biases between cases and controls (those who did and did not complete a consumer-rated measure) Will allow for a robust test of whether consumer-rated measures affect clinical outcomes for consumers Makes use of real-world observational datasets

18 Steps in the analysis SAMPLING FRAME Ambulatory care Adult setting years 2007/ /16 (9 years of data) Admitted in annual reporting period DEFINE THE COHORT HoNOS rating at end of period (review or discharge) Not brief episode or discharged to another setting CONDUCT ANALYSIS Match cases to controls with similar propensity but who did not complete the measure Test the effect of completing measure on change in HoNOS score (outcome)

19 Preliminary results

20 The cohort Offered and completed a consumer-rated outcome measure N % No 68, Yes 25, Total: 93,098

21 Reporting period

22 Jurisdiction K BASIS-32/MHI-38 --

23 Age and sex

24 Diagnosis and legal status

25 Ongoing vs. completed episodes Episode type N % Ongoing (A > R) 43, Completed (A > D) Offered and completed a consumerrated outcome measure Time in treatment (mean) No Yes Ongoing (A > R) Completed (A > D)

26 Admission HoNOS (10 item) scores HoNOS score at admission normalised percentile, M (SD) Offered and completed a consumerrated outcome measure Ongoing (A > R) 47.2 (29.5) 46.5 (28.2) Completed (A > D) 51.3 (28.7) 47.0 (27.6) No Yes

27 Change in HoNOS (10 item) scores HoNOS change score normalised percentile, M (SD) Offered and completed a consumerrated outcome measure Ongoing (A > R) 8.6 (29.5) 11.3 (27.2) Completed (A > D) 21.5 (29.1) 23.1 (26.4) No Yes

28 Effect on outcome HoNOS change score normalised percentile, M (SD) Offered and completed a consumerrated outcome measure Coeff (95% CI P-value Ongoing (A > R) 2.8 ( ) <0.001 Completed (A > D) 1.7 ( ) <0.001

29 Where to from here?

30 Early observations There are some systematic differences between people who do and do not complete consumer-rated outcome measures Controlling for these, we found a small but significant positive on clinical outcomes due to the offer and completion of a consumer-rated measure These modest effects are consistent with existing reviews

31 But what about? For this analysis, the outcome was the clinician's rating not the consumer s ; And it was the total score not scales / subscales; There are other important outcomes to consider: Functioning; Social; Service use, costs The consumer-rated measures have somewhat different foci (K10 = distress; MHI38 = well being; BASIS-32 = symptoms/functioning) so could be analysed separately There s more work to do!