Is It Time for Clinicians to Routinely Track Patient Outcome? A Meta-Analysis.

Lambert, Michael J.; Whipple, Jason L.; Hawkins, Eric J.; Vermeersch, David A.; Nielsen, Stevan L.; Smart, David W.

doi:10.1093/clipsy.bpg025

Cited by 390 publications

(346 citation statements)

References 47 publications

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“…There are 16 reviews of the quantitative/randomised controlled trial (RCT) literature on the feedback of individual-level PROMs data 24,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] and one review currently in progress. 57 There is also one review of qualitative studies 58 and four mixed-method reviews.…”

Section: Existing Evidencementioning

confidence: 99%

“…Of these reviews, one focused on screening for mental health problems 51 in primary and secondary care, and four others focused on the use of PROMs feedback in specialist mental health settings. 41,45,47,50 Four reviews focused on use of PROMs in…”

Section: Existing Evidencementioning

confidence: 99%

“…This programme theory underlies much of the research examining PROMs feedback within psychotherapy; for example, randomised trials have assessed the effects of providing feedback on patient progress to therapists, with a particular focus on highlighting patients who are not making the expected improvements. 41,50,310 In these trials, therapists use the PROMs as part of their own review of whether or not therapy is working, without necessarily discussing the feedback as part of the patient consultation. Furthermore, standardised outcome measures have also been used by multidisciplinary teams to inform clinical decision-making.…”

Section: Patient-reported Outcome Measures As a Tool To Support Clinimentioning

confidence: 99%

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Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

177

263

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BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Existing Evidencementioning

confidence: 99%

Section: Existing Evidencementioning

confidence: 99%

Section: Patient-reported Outcome Measures As a Tool To Support Clinimentioning

confidence: 99%

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Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

Greenhalgh

Dalkin

Gooding

et al. 2017

Health Serv Deliv Res

177

263

View full text Add to dashboard Cite

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“…Die Frage, ob The ra peu ten einen Nut zen da raus zie hen, wenn sie kon ti nu ier li che Rück meldung über den Er folg bzw. Zu stand ih rer Pa ti en ten er hal ten, ist mo men tan ei nes der am meis ten un ter such ten The men in nerhalb der Psy cho the ra pie for schung (s. beispiels wei se Lam bert et al 2003).…”

Section: Qua LI Täts Si Che Rung Und Qua Li Täts Ma Na Ge Ment In Derunclassified

Psychotherapie®

Strauß

2006

Psychotherapeut

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In sti tut für Me di zi ni sche Psy cho lo gie, Kli ni kum der Fried rich-Schil ler-Uni ver si tät, Jena Psy cho the ra pie ® Über den Wa ren cha rak ter von Psy cho the ra pie Psy cho the ra peut 2006 · 51:354-362 Eine psy cho the ra peu ti sche Kli nik be steht nur noch aus ei nem gro ßen Re chen zentrum, The ra pieräu men und ei ner Kan tine; ihre Mit ar bei ter aus Pro gram mie rern, Kü chen per so nal und ei nem Pfört ner: Dieser Pfört ner lei tet einen neu en Pa ti en ten zu nächst ei ner aus führ li chen Com pu terdia gno s tik zu, de ren Re sul tat eine spe zi fische "In ter na tio nal-Clas si fi ca ti on-of-Disea ses-(ICD-)Di ag no se" und die For mulie rung von The ra pie zie len ist. Je nach Di ag no se wird der Pa ti ent per Lauf band dann ent spre chend dem iden ti fi zier ten diag nos ti schen Al go rith mus in eine com puter ge stütz te Grup pe trans por tiert, z. B. in eine Bor der li ne-, Ess stö rungs-oder Trauma grup pe, in der die Per son so lan ge zu blei ben hat, bis sich et was ent schei dend an ih ren Sym ptom wer ten -die na tür lich konti nu ier lich com pu ter ge stützt re gis triert wer den -ge än dert hat. Die In ter ven tionen gibt aus schließ lich der Com pu ter auf der Ba sis ei ner Sprach ana ly se der Pa ti enten äu ße run gen, die wie de rum auf einen um fas sen den (aber na tur ge mäß recht begrenz ten) The sau rus von psy cho the ra peuti schen Äu ße run gen, Fra gen, Deu tun gen etc. be zo gen wer den, die dann dem Pa tien ten zu rück ge mel det wer den. Es han delt sich um die In ter ven tio nen, die sich in der For schung der ver gan ge nen Jah re als ef fektiv er wie sen ha ben. Eine neu er li che Di agnos tik wird dann da rü ber be fin den, ob der Pa ti ent wie der in sei ne Ar beits welt ver schickt wer den kann. Nach der Ent lassung steht ein elek tro ni scher On li ne-Kunden dienst zur Ver fü gung, der das bie tet, was man frü her in der Psy cho the ra pie als "boos ter ses si on" be zeich net hat. Je nach Be fin den des Pa ti en ten er hält er Bot schaften wie: "Wei ter so!", "Den ken Sie doch an das, was in ih rer Grup pe so oft be sprochen wur de", "Set zen sie ab so fort die se oder jene Stra te gie ein".Die ses Sze na rio wür de eine in dus triali sier te Psy cho the ra pie be schrei ben. Nun sind wir si cher noch weit da von ent fernt, Psy cho the ra pie aus schließ lich durch Maschi nen durch füh ren zu las sen, wenngleich ers te Schrit te in die se Rich tung (Stich wort: In ter net-und SMS-The ra pien) durch aus be reits ab seh bar sind. Eine voll stän di ge In dus tria li sie rung des Metiers wäre aber erst dann er reicht, wenn Pa ti en ten kei ner lei per sön li che Kon tak te mehr zu pro fes sio nel len Psy cho the ra peuten ha ben wür den.Die Wei ma rer Psy cho the ra pie wo che 2005 stand un ter dem Leit the ma "In dustria li sie rung der Psy cho the ra pie". Die ses The ma ent wi ckel te sich aus der Dis kus sion um eine neue Rol le psy cho the ra peuti scher Ver sor gung in un se rem Ge sundheits sys tem aber -und ins be son de re -in dem ak tu el len ...

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“…For example, the shift from facility-based to community-based services has been linked to increasing caseloads, increasingly complex presentations of clients, and increasing autonomy in service provision (Hoge et al, 2011). At the same time, research indicates that effective supervision can affect job retention and turnover, increase job satisfaction and promote quality of client care (Bogo et al, 2011;Lambert et al, 2003;Mor Barak, Travis, Pyun, & Xie, 2009;Shoenwald, Sheidow, & Chapman, 2009). In this context, some experts have suggested the development of an interprofessional clinical supervision model for mental health and addictions services, to face the challenges related to the contemporary work context by finding common elements to the practice of supervision within and across disciplines (Bogo et al, 2011;D'Amour, FerradaVidela, Rodriguez, & Beaulieu, 2005).…”

Section: Introductionmentioning

confidence: 99%