The Measurement and Management of Clinical Outcomes in Mental Health

To Your Health, Wealth, and Outcomes.

The ancient wish of better health and greater wealth has been replaced by a new calculus in which outcomes assessment is seen as integral to the achievement of better health, and wealth is measured by the amount paid for health care. The authors have prepared an excellent text that relates these three key concepts—outcomes, health, and costs—and shows that managing outcomes, not just measuring them, is a key to success.

This text consists of four parts: Outcomes Management in Managed Behavioral Healthcare (one chapter), Conceptual and Practical Considerations in Practitioner Research (six chapters), Examples From Behavioral Healthcare Service Sectors (five chapters), and an annotated bibliography of commonly used outcomes measurement and management systems (26 systems).

The authors begin by presenting a detailed review of the dynamic of managed behavioral healthcare services and the changing context of these services—a growing consumer movement, new technology, and the evolution of performance-based organizations. Together, these factors provide strong impetus for the recent attention to outcomes measurement and management. Usually, these factors are considered separately; the authors bring them together into a cogent argument that helps us understand why attention to outcomes is so important for all practitioners.

The authors correctly point out that the consumer point of view is of growing importance in outcomes assessment. One would have hoped for a more integrated discussion of the consumer point of view, with explicit recognition that questions about access, appropriateness/quality, and outcomes can all be addressed from this point of view. Consumer satisfaction measures can be derived from the perceptions that consumers have in each of these domains.

Explicitly tackling the issue of outcomes management is a major contribution of this text. Because the mental health literature on this topic is extremely limited, both researchers and practitioners will find the presentation very enlightening. As the authors know, major efforts to measure outcomes in community and clinical populations without an explicit strategy for doing something about successes and failures are self-defeating.

Many practitioners will find the examples extremely useful as guides for their own behavior in approaching outcomes measurement and management. In the current era of rapid change in behavioral health care, much knowledge is not fully codified; hence, examples—some would say benchmarks—can serve as effective guides to action. The authors may wish to undertake a synthesis of the examples to determine what they share in common and in how they differ. This would be extremely useful to the field. Practitioners will also find the annotated bibliography very useful in identifying the domains of outcomes that require measurement and some commonly used measures that address these dimensions.

I have written elsewhere (1) about the crisis of quality in managed behavioral health care. Today, resources continue to erode away from the field because we lack common and essential tools—practice guidelines, outcomes measures, report cards, and performance indicator systems—to measure the quality of behavioral health care. Our services have been commoditized, yet our only measure of quality is price. This can have dire consequences for the field. The authors help us take a giant step in the direction of outcomes measurement and management as key factors in quality. For this reason alone, the text is must reading for all who currently practice psychiatry.