Devising the right system for measurement in mental healthcare is challenging but also extremely important. Systems of measurement provide the foundation for behavioral health screening, assessing treatment progress, and monitoring whether desired outcomes are achieved. When patient outcomes data can be examined over time, the right measures can help providers identify whether an intervention is of value to certain populations. Data also helps decrease unwarranted variation in care (diagnosis and treatment), which according to Walters Kluwer accounts for at least 25%, and possibly up to 65%, of the costs.
Importantly, a focus on outcome versus process measures can provide the most useful insights for improving mental health. In this post, we discuss the importance of outcome measures in behavioral healthcare and key considerations when establishing methods of evaluating behavioral health outcomes at a patient and system level.
Discussions of quality tracking within healthcare often begin with a look at processes, so let's do just that. What are process measures in healthcare? Process measures generally focus on an action that a physician or patient performs at a given point in time. For instance, a process measure based on patient behavior may be the taking of medication as prescribed while a process measure based on physician behavior may be the recording of a patient's temperature or blood pressure.
Process measures are reported in aggregate to provide an indication of a healthcare provider's or health system's success in maintaining or improving health. Examples include the percentage of people who have received some type of preventive service or the percentage of people who have been given some type of test.
But process measures tell only part of the story—they tell what was performed but not what came from that effort. They're simply indicators of progress along the path to a desired outcome.
That's where outcome measures come into play and why they're so important. Let's take a closer look.
Process measures focus on what was done. Outcome measures focus on the result of what was done. That's what makes them so essential within healthcare and, more specifically, within behavioral health.
What is considered an outcome measure? An outcome measure is a measure of a specific result or improvement. Outcome measure examples might include the percentage of patients adhering to their medication regime before and after treatment or a change in a patient's rating level of depression.
Regularly using outcome measures over time allows clinicians to identify improvement or deterioration of patients' conditions. Detecting changes in patients' health status provides a foundation to better inform treatment decisions. At the aggregate level, this data becomes valuable for quality monitoring and improvement.
Outcome measures are used in addition to process measures to ensure that the treatment is having its intended affect or identify when changes are needed.
Why are outcome measures important in healthcare? While that may be obvious, outcome measures aren't used as often as they could or should be in behavioral healthcare settings. As Proem Chief Medical Officer and Founder Dr. Tom Young states, "Unfortunately, there are multiple shortcomings concerning the usage of measurement-based care (MBC) by healthcare providers, one of which is its failure to be used. We recognize that MBC is used in other areas of medicine, but in behavioral health, it's not been as conscientiously applied."
The importance of outcome measures in healthcare concerns the reliable evidence they provide in indicating that treatment is making a difference and patients are improving. Both physicians and patients may track and report outcome measures. In fact, precisely because behavioral health outcome measures are almost impossible for clinicians to see in most cases, patient self-reporting can be especially important. This self-reporting often takes the form of completing assessments called “Patient-Reported Symptom Rating Scales” or “Patient-Reported Outcomes Measures (PROMs).
What is an example of a patient reported outcome? Examples of these types of outcome measures might include a patient's report on their level of anxiety or the last time they had a panic attack. These self-reports can be augmented by clinicians' own observations of patient behavior. Patients might report on measures related to symptoms, pain, physical activity, social and functional skills, social activity, medication use and side effects, or experience of care.
The underuse of outcome measures in healthcare — and particularly in behavioral health — can have a negative effect on patient health. Process-based measures are important to providing indications of care consistency and tracking what is being done for patient treatment. Outcome measures, though, provide better insights into the impact of those processes and are a better way of determining whether treatment made a measurable difference for the patient based on clinician and patient assessment.