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Feasibility, usefulness, limitations and perspectives of routine outcome assessment: the South Verona Outcome Project

Published online by Cambridge University Press:  11 October 2011

Mirella Ruggeri
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Summary

Closing the gap between research and clinical practice is nowadays considered a priority in outcome studies. Survey studies in community settings having as their main aim the multidimensional measure of outcome of mental health care interventions, including the use of standardised instruments administered as part of the routine clinical activities in mental health services, have recently started to be planned in various countries, but have encountered several difficulties. A naturalistic, longitudinal study aimed to assess the outcome of care provided by a community-based mental health service, the South Verona Outcome Project, has been conducted in Italy starting from the beginning of the 90's and is running since then. This paper: a) describes a series of methodological aspects of the South Verona Outcome Project, such as instruments, study design, inclusion and exclusion criteria, training of the staff, and focuses on strategies used so to ensure feasibility of the assessment and good quality of the data; b) summarises some results of the study, characteristics of feed-back provided, and outputs; c) discusses the problems faced, the impact of this approach on service provision, its limitations and future perspectives.

Keywords

treatment outcomescommunity mental health servicesquality of care
Type
Research Article
Information
Epidemiology and Psychiatric Sciences , Volume 11 , Issue 3 , September 2002 , pp. 177 - 185
Copyright
Copyright © Cambridge University Press 2002

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References

REFERENCES

American Psychiatric Association (1994). DSM-IV Diagnostic and Statistical Manual of Mental Disorders (5th Edition). American Psychiatric Association: Washington DC.Google Scholar
Andrews, G. & Wittchen, H.U. (1995). Clinical practice, measurement, and information technology. Psychological Medicine 25, 443–446.CrossRefGoogle ScholarPubMed
Attkinsson, C., Cook, J., Karno, M., Lehman, A, McGlashan, T.H., Meltzer, H.Y., ÒConnor, M., Richardson, D., Rosenblatt, A., Wells, K., Williams, J. & Hohman, A.A. (1992). Clinical services research. Schizophrenia Bulletin 18, 561–627.CrossRefGoogle Scholar
Bero, L.A., Grilli, R., Grimshaw, J.M., Harvey, E., Oxman, A.D. & Thomson, M.A. (1998). Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. British Medical Journal 317, 465–468.CrossRefGoogle Scholar
Bonizzato, P., Bisoffi, G., Amaddeo, F., Chisholm, D. & Tansella, M. (2000). Community-based mental health care: to what extent a services costs associated with clinical, social and service history variables? Psychological Medicine 30,1205–1215.CrossRefGoogle ScholarPubMed
Carulla, L.S. (1999). Routine outcome assessment in mental health research. Current opinion in Psychiatry 12, 207–210.CrossRefGoogle Scholar
Dawson, S. (1997). Inhabitating different worlds: how can research relate to practice? Quality of Health Care 6, 177–178.CrossRefGoogle ScholarPubMed
Dickerson, F.B. (1997). Assessing clinical outcomes: the community functioning of persons with serious mental illness. Psychiatric Services 48, 897–901.Google ScholarPubMed
Dunn, G. (1996). Statistical methods for measuring outcomes. In Mental Health Outcomes (ed. Thornicroft, G. and Tansella, M.), pp.3–13. Springer-Verlag: Berlin.CrossRefGoogle Scholar
Eisen, S.V. & Dickey, B. (1996). Mental health outcome assessment: the new agenda. Psychotherapy 33, 181–189.CrossRefGoogle Scholar
Ellwood, P. (1998). A technology of patient experience. New English Journal of Medicine 318, 1549–1556.CrossRefGoogle Scholar
Endicott, J., Spitzer, R.L., Fleiss, J.L. & Cohen, J. (1976). The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766–771.CrossRefGoogle Scholar
Gallagher, J. & Teesson, M. (2000). Measuring disability, need and outcome in Australian community mental health services. Australian and New Zealand Journal of Psychiatry 34, 850–855.CrossRefGoogle ScholarPubMed
Galletta, M., Lasalvia, A. & Ruggeri, M. (1999). Ibisogni di cura dei pazienti psichiatrici in relazione alle loro caratteristiche demografiche, cliniche, sociali e di interazione con i servizi. Rivista Sperimentale di Freniatria 4, 237–268.Google Scholar
Gilbody, S., House, A.O., Sheldon, T. (2001). Routinely administered questionnaires for depression and anxiety: systematic review. British Medical Journal 322,406–409.CrossRefGoogle ScholarPubMed
Harrison, G. & Eaton, W.W. (1999). From research world to real world: routine outcome measures are the key. Current Opinion in Psychiatry 12, 187–189.CrossRefGoogle Scholar
Jenkins, R. (1996). England's policy on severe mental illness. Epidemiologia e Psichiatria Sociale 5, 31–37.CrossRefGoogle Scholar
Kissingl, W. (2001). Who is interested in the quality of everyday psychiatry care? International Clinical Psychopharmacology 16, Suppl. 3, S1–S4.Google Scholar
Lasalvia, A., Ruggeri, M., Mazzi, M. & Dall'Agnola, R. (2000). The perception of needs for care in staff and patients in community-based mental health services. Acta Psychiatrica Scandinavica 102, 366–375.CrossRefGoogle ScholarPubMed
Lasalvia, A., Ruggeri, M. & Santolini, N. (2002) Subjective quality of life: its relationship with clinician-rated and patient-rated psychopathology. Psychotherapy and Psychosomatics 11, 275–284.CrossRefGoogle Scholar
Lukoff, D., Nuechterlein, K. & Ventura, J. (1986). Manual for expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin 4, 594–602.Google Scholar
Mechanic, D. (1996). Emerging issues in international mental health service research. Psychiatric Services 47, 371–375.Google Scholar
Mirin, S.M. & Namerow, M.J. (1991). Why study treatment outcome? Hospital and Community Psychiatry 42, 1007–1013.Google ScholarPubMed
Oliver, J.P. (1991). The social care directive: development of a quality of life profile for use in community services for the mentally ill. Social Work & Social Science Review 3,4–45.Google Scholar
Phelan, M., Slade, M., Thornicrotf, G., Dunn, G., Hollway, F., Wykes, T., Strathdee, G., Loftus, L., McCrone, P. & Hayward, P. (1995). The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry 167, 589–595.CrossRefGoogle ScholarPubMed
Priebe, S. & Gruyters, T. (1995). Patients' assessment of treatment predicting outcome. Schizophrenia Bulletin 21, 87–94.CrossRefGoogle ScholarPubMed
Priebe, S., Bullenkamp, J., Mccabe, R., Hansson, L., Rossler, W., Torres-Gonzales, F. & Wiersma, D. (2002). The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study. Epidemiologia e Psichiatria Sociale 11, 198–205.CrossRefGoogle ScholarPubMed
Rosenblatt, A. & Attkinsson, C.C. (1993). Assessing outcomes for sufferers for severe mental disorder: a conceptual framework and review. Evaluation and Program Planning 16, 347–363.CrossRefGoogle Scholar
Rossi, A., Amaddeo, F., Bisoffi, G., Ruggeri, M., Thornicroft, G. & Tansella, M. (in press). What predicts dropping out of treatment from community-based psychiatric services? British Journal of Psychiatry.Google Scholar
Ruggeri, M. (1996). Gli obiettivi, i modelli e i metodi per la valutazione dei servizi psichiatrici. Un'esperienza italiana. Epidemiologia e Psichiatria Sociale 5, 19–27.CrossRefGoogle Scholar
Ruggeri, M. & Dall'Agnola, R. (1993). The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psyclwlogical Medicine 23, 511–523.CrossRefGoogle ScholarPubMed
Ruggeri, M. & Dall'Agnola, R. (2000). Come Valutare I'Esito nei Dipartimenti di Salute Mentale. Il Pensiero Scientifico Editore: Roma.Google Scholar
Ruggeri, M. & Tansella, M. (1995). Evaluating outcome in mental healthcare. Current Opinion in Psychiatry 8, 116–121.CrossRefGoogle Scholar
Ruggeri, M. & Tansella, M. (1996). Individual patient outcomes. In Mental Health Service Evaluation (ed. Knudsen, H.C. and Thornicroft, G.), pp. 281–295. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Ruggeri, M. & Tansella, M. (2002). To what extent do mental health services meet patients' needs and provide satisfactory care? Current Opinion in Psychiatry 15, 193–199.CrossRefGoogle Scholar
Ruggeri, M., Dall'Agnola, R., Agostini, C., & Bisoffi, G. (1994). Acceptability, sensitivity and content validity of VECS and VSSS in measuring expectations and satisfaction in psychiatric patients and their relatives. Social Psychiatry and Psychiatric Epidemiology 29, 265–276.CrossRefGoogle ScholarPubMed
Ruggeri, M., Dall'Agnola, R., Greenfield, T. & Bisoffi, G. (1996). Factor analysis of the Verona Service Satisfaction Scale-82 and development of reduced versions. International Journal of Methods in Psychiatric Research 6, 23–38.3.3.CO;2-D>CrossRefGoogle Scholar
Ruggeri, M., Biggeri, A., Rucci, P. & Tansella, M. (1998a). Multivariate analysis of outcome of mental health care using graphical chain models. The South Verona Outcome Project 1. Psychological Medicine 28, 1421–1431.CrossRefGoogle ScholarPubMed
Ruggeri, M., Riani, M., Rucci, P., Biggeri, A. & Tansella, M. (1998b). Multidimensional assessment of outcome in psychiatry: the use of graphical displays. The South Verona Outcome Project 2. International Journal of Methods in Psychiatric Research 7, 186–198.CrossRefGoogle Scholar
Ruggeri, M., Warner, R., Bisoffi, G. & Fontecedro, L. (2001). Subjective and objective dimensions of quality of life in psychiatric patients: a factor-analytic approach. British Journal of Psychiatry 178, 268–275CrossRefGoogle Scholar
Ruggeri, M., Gater, R., Bisoffi, G., Barbui, C. & Tansella, M. (2002). Determinants of Subjective Quality of Life in Patients Attending Community-based Mental Health Services. Ada Psychiatrica Scandinavica 105, 131–140.CrossRefGoogle ScholarPubMed
Ruggeri, M., Pacati, P. & Goldberg, D. (submitted for publication). life, Neurotics are dissatisfied with their, but not with services.Google Scholar
Shuldberg, H.C. & Bromet, E. (1981). Strategies for evaluating the outcome of community services for the chronically mental ill. American Journal of Psychiatry 138, 930–935.Google Scholar
Slade, M. (2002). The use of patient-level outcomes to inform treatment. Epidemiologia e Psichiatria Sociale 11, 20–27.CrossRefGoogle ScholarPubMed
Slade, M., Thornicroft, G. & Glover, G. (1999). The feasibility of routine outcome measures in mental health. Social Psychiatry and Psychiatric Epidemiology 34, 243–249.CrossRefGoogle ScholarPubMed
Slade, M., Thornicroft, G., Loftus, L., Phelan, M. & Wykes, T. (2000). CAN: Camberwell Assessment of Needs. Edizione italiana (a cura di Ruggeri, M. e Tansella, M.), pp. 37–41. CIC: Roma.Google Scholar
Slade, M., Leese, M., Ruggeri, M., Kuipers, E., Tansella, M. & Thornicroft, G. (submitted for publication). Needs-focussed instead of symptom-focussed mental health services for improving quality of life?Google Scholar
Srebnik, D., Hendryx, M., Stevenson, J., Caverly, S., Dyck, D.G. & Cauce, A.M. (1997). Development of outcome indicators for monitoring the quality of public mental health care. Psychiatric Services 48, 903–909.Google ScholarPubMed
Stedman, T., Yellowlees, P., Drake, S., Chant, D., Clarke, R., & Chappie, B.(2000). The perceived utility of six selected measures of consumer outcomes proposed for routine use in Australian mental health services. Australian and New Zealand Journal of Psychiatry 34, 842–849.CrossRefGoogle ScholarPubMed
Tansella, M. (Ed.) (1991). Community-Based Psychiatry. Long-Term Patterns of Care in South Verona, Psychological Medicine Monograph Supplement 19, pp. 1–54. Cambridge University Press: Cambridge.Google Scholar
Tansella, M. (1999). Dalla ricerca scientifica all'assistenza psichiatrica: un flusso irregolare e discontinuo. Rivista Sperimentale di Frenatria 123, 159–164.Google Scholar
Thornicroft, G. & Tansella, M. (1999). The Mental Health Matrix. A Manual to Improve Services. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Ventura, J., Green, M., Shaner, A. & Lieberman, R. (1993). Training and quality assurance with the Brief Psychiatric Rating Scale: “the drift busters”. International Journal of Methods in Psychiatric Research 3, 221–224.Google Scholar
World Health Organization (1988). Disability Assessment Schedule (DAS-II). WHO: Geneva.Google Scholar
Wright, R.G., Heiman, J.R., Shupe, J. & Olvera, G. (1989). Defining and measuring stabilisation of patients during 4 years of intensive community support. American Journal of Psychiatry 146, 1293–1298.Google ScholarPubMed