Would you be happy with your medical care if doctors never measured anything?

At the beginning of 2018, behavioral health agencies under JC accreditation will be required to measure outcomes through the use of a standardized tool or instrument. Why?

Nearly twenty years of behavioral health care research has demonstrated the value of measurement-based care as a tool for improving the outcomes of care, treatment, or services. The findings are robust and extend across modalities, populations, and settings.
— The Joint Commission

Yet, according to an issue brief published by the Kennedy Forum, only 18% of psychiatrists and 11% of psychologists in the U.S. routinely administer symptom rating scales to monitor treatment response.

So, if ya gotta do it: what should one look for in an outcomes measure? The JC recommends: 

  • ·       Well-established psychometric properties (i.e., reliability and validity) 

o   Instruments that are appropriate will have been tested for their reliability (consistency as a measure) and validity (measuring what they are intending to measure). 

  • ·       Documented sensitivity to change (i.e., the ability to detect true/meaningful changes over time)

o   Instruments that include a “reliable change index” or similar construct can be used to distinguish normal or expected variation from changes that are statistically significant or meaningful.  As one seeks to determine the impact of care, treatment, or services, it is critical to distinguish between changes that represent true improvement or deterioration versus typical variation that might be expected on a daily basis. 

  • ·       Use as a repeated measure (i.e., can reliably detect change from administration to administration)

o   Instruments that can be used as routine outcome measures will be administered repeatedly.  The frequency of use is an important consideration for organizations based upon the types and typical lengths of services they provide. The organization should select a tool or instrument that can be administered frequently enough to ensure that the care, treatment, or services the individual is receiving can be adjusted (when and if necessary).

  • ·       Established norms (i.e., the instrument can distinguish between populations that need or do not need services)

o   Depending upon the nature of the setting and population served, an individual’s score on an instrument should provide an indication of his or her current state relative to a norm or benchmark (e.g., clinical/non-clinical, healthy/non-healthy functioning, typical/non-typical, etc.).

Happy Holidays and Outcomes Measuring!