Standardised outcome measures reduce psychiatric in-patient admissions

Embargoed until Tuesday, October 03, 2006

Asking psychiatric patients and the staff treating them to complete regular questionnaires about the patients’ progress, with feedback, reduces in-patient admissions and saves the health service money.

There is international consensus that outcome for psychiatric patients should be routinely measured in clinical work. However, psychiatrists are not convinced about the effectiveness of such outcome measures, and so tend not to use them routinely.

This randomised controlled trial, published in the October issue of the British Journal of Psychiatry, was the first investigation of the use of standardised outcome measures over time in a representative adult mental health service.

160 adult mental health patients and paired community mental health staff in Croydon, South London, took part in the study. 101 patients were included in the intervention group, and the remaining 59 received treatment as usual.

The intervention involved asking staff and patients pairs to complete separately monthly postal questionnaires assessing needs, quality of life, mental health problem severity and therapeutic alliance. Both received identical 3-monthly feedback.

It was found that over 7 months of monthly assessment, the intervention did not improve primary outcomes of patients’ unmet needs, as rated by them, or their quality of life.

However, the intervention did reduce psychiatric in-patient days (average 3.5 for the intervention group v. 16.4 for the control group). As a result, service use costs were £2586 less for the intervention group, and further analysis indicated that the intervention was cost-effective.

Why were admissions reduced? Staff received regular clinical information about intervention patients, possibly triggering earlier support and so avoiding the need for admission.

Further, staff had more information about intervention-group than about control-group patients, which could have led to a marginal raising of the admission threshold for intervention patients. Further attention should be given to the influences that alter thresholds for in-patient admission.

This study demonstrates that it is feasible to undertake a carefully developed approach to routine outcome assessment in mental health services.

The staff response rate over the 7 months studied was 67%, and the patient response rate 79%. 92% of the intervention group received 2 rounds of feedback. Further, 84% of staff and patients received, read and understood the feedback.

The intervention cost was about £400 per person, which, for a primary care trust with a case-load of 3500 people, would equate to about £1.4 million. However, the results of this study suggest that the cost could be more than offset by savings in service use.