July 13, 2012
In the acute medical world an outcomes-driven model of delivering care has been very successful. I believe the same will hold true for the behavioral healthcare world. In a behavioral health setting a diagnosis is likely more of a categorization of groups, and outcomes will be generally measured along one or more of three dimensions: symptomology, functionality and satisfaction. So outcomes reporting might look like, “For depressed patients, 87% showed improved mood when seen by Dr. Jones” or “ at one year post treatment, 67% of people with a serious mental illness who attended program Y were still employed”.
For specific symptoms, there was good outcomes in treating people with panic disorder, a very common anxiety disorder.
Functionality improvements are typically the measurements of choice for more long term, chronic conditions like schizophrenia. In this case, we want to know whether they are able to go to work, go to school, avoid being arrested and similar things that indicate their level of functionality is improving. By the way, when employers think about their employees, this is what they are concerned about. They want to know when somebody can come back to work, not whether they are less depressed.
Some are surprised to see “satisfaction” listed as an outcomes measure. The reason I like to include it is because satisfaction is the only thing that consistently correlates with adherence to treatment. If it’s not measured or more importantly, if it’s not addressed, patients drop out of treatment prematurely which, in and of itself is a poor treatment outcome. If they aren’t in treatment, their clinical goals are not met and their outcomes suffer. So, satisfaction may not be a direct clinical outcomes indicator, it is a strong mediator to successful outcomes. This is a fascinating subject that I will address in more detail in a subsequent blog.