APS Outcome-Informed CareClinician Training

APS Outcome-Informed CareClinician Training

OverviewOverview

• Importance & Benefits of Outcome-Informed Care

• APS Outcome-Informed Care Initiative– Goal– Process– Clinician Tool Kit

• Question & Answer

• Appendix– Resources– Research

What is Outcome-Informed Care?What is Outcome-Informed Care?

Outcome-Informed Care is the practice and system of providing psychotherapy

treatment that is informed by patient-reported treatment outcomes.

Importance of Outcome-Informed CareImportance of Outcome-Informed Care

• Routine patient feedback to clinicians improves treatment outcomes 26-35

– Identifies patients who are most at risk for treatment failure

– Increases identification of clinical risks• Suicide: Routine feedback improved detection by 15%

The Journal of Crisis Intervention and Suicide Prevention. Vol. 24, No. 2, 2003, pp. 49-55

• Substance abuse: Significant reduction in under-reporting with introduction of feedback

Joint Commission Journal on Quality and Safety, Vol. 30 (8), August 2004, pp. 448-454

– Early identification permits proactive work to keep patients engaged in treatment

Importance of Outcome-Informed CareImportance of Outcome-Informed Care

• Recommended by APA & IOM

– APA 2005 EBPP standard:“ongoing monitoring of patient progress and adjustment of

treatment as needed are essential to EBPP” (p. 3)

– IOM 2006 standard 4.2:“Clinicians and organizations providing services should:

– Increase their use of valid and reliable patient questionnaires or other patient-assessment instruments…to assess the progress and outcomes of treatment systematically and reliably

– Use measures of processes and outcomes of care to continuously improve the quality of care…” (p. 12)

Benefits of Outcome-Informed CareBenefits of Outcome-Informed Care

• Improves patient outcomes

• Objective measurement system– National normative database (1996 – present)– Case mix adjustment– Data demonstrates quality of care

• Provides data/trends not currently available – Collects patient self-reported diagnostic and symptom

information– Measures and tracks reported progress– Real-time treatment outcome report

APS Outcome-Informed Care InitiativeAPS Outcome-Informed Care Initiative

• GOAL: Assist clinician in improving member health

• Tactics:– Educate about outcome-informed care

– Provide tools to deliver outcome-informed care• Initial Clinician assessment (baseline)• Member survey (measures)

– Global Distress – Substance abuse– Therapist alliance– Overall health status

• Online Clinician toolkit (view/track patient feedback/outcomes)

– Alert clinician of member elevated risk

– Encourage voluntary enrollment in initiative via incentives

APS Outcome-Informed Care: ProcessAPS Outcome-Informed Care: Process

• APS:– Mail pre-printed Provider Assessment & Member

Survey with authorization packet– Post patient/member feedback on secure website– Contact clinician if member survey shows elevated risk

• Office staff:– Administer member survey every session– After clinician review, fax to 866-831-7962

• Clinician– Complete initial provider assessment– View outcome data on secure personal webpage

(clinician toolkit) within 24 hours view – Discuss with patients; create a culture of feedback

within each treatment

Provider AssessmentProvider Assessment

• Demonstrates outcomes – Baseline for member

survey– Case mix variables

• Data-driven– Tested– Measured

• User friendly – 1 page– 8 questions

Member SurveyMember Survey

• Measures – Global Distress

• Anxiety and depression• Interpersonal problems• Impaired productivity

(work & other daily activities

• Concerns about health problems

• Feelings of hopelessness & thoughts of suicide

– Substance abuse– Therapist alliance– Overall health status

Clinician ToolkitClinician Toolkit

• Secure online access to outcome data

• Summary statistics and case level data

– Graph progress for individual cases– Compare results to national benchmarks &

meta-analyses of psychotherapy studies

• Outcome data updated multiples times per day

Improved Outcomes: Success! (baseline 2006)Improved Outcomes: Success! (baseline 2006)

2006Baseline 2007

9% improvement

200822%

improvement

Question & AnswerQuestion & Answer

AppendixAppendix

Online ToolkitOnline Toolkit

Register or Login here

Links to FAQ, Forms & OIC information

Online Toolkit: RegistrationOnline Toolkit: Registration

Online Toolkit: AccessOnline Toolkit: Access

Appendix: ResourcesAppendix: Resources

• Frequently Asked Questionswww.psychoutcomes.org/APS

• Technical/Data/Web:admin@psychoutcomes.org datacenter@clinical-informatics.com801-541-9720

• General comments or questions:oic@apshealthcare.com 1.800.305.3720, extension 3320

Appendix: Supporting ResearchAppendix: Supporting Research

1. Wampold BE. 2001. The great psychotherapy debate: Models, Methods, and Findings. Mahwah NJ: Lawrence Erlbaum Associates. 272 pp. 2. Westen D, Morrison K. 2001. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An

empirical examination of the status of empirically supported therapies. J Consul Clin Psychol 69:875-99. 3. Sapyta J, Riemer M, Bickman L. 2005. Feedback to Clinician: theory, research, and practice. J Clin Psychol 61(2):145-53. 4. Hannan C, Lambert MJ, Harmon C et al. 2005. A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychol

61(2):155-63. 5. Lambert MJ, Harmon C, Slade K et al. 2005. Providing feedback to psychoClinicians on their patients progress: Clinical results and practice

suggestions J Clin Psychol 61(2):165-74. 6. Harmon C, Hawkins, Lambert MJ et al. 2005. Improving outcomes for poorly responding clients: The use of clinical support tools and feedback to

clients. J Clin Psychol 61(2):175-85. 7. Brown GS, Jones ER. 2005. Implementation of a feedback system in a managed care environment: What are patients teaching us? J Clin Psychol

61(2):187-98. 8. Miller SD, Duncan BL, Ryan S, et al. 2005. The Partners for Change Outcome Management System. J Clin Psychol 61(2):199-208. 9. Claiborn CD, Goodyear EK. 2005. Feedback in psychotherapy. J Clin Psychol 61(2):209-21. 10. Brown GS, Burlingame GM, Lambert MJ, et al. 2001. Pushing the quality envelope: A new outcomes management system. Psychiatr Serv

52(7):925-34. 11. Lueger RJ. 1998. Using feedback on patient progress to predict the outcome of psychotherapy. J Clin Psychol 54:383-93. 12. Lambert MJ, Whipple JL, Smart DW, et al. 2001. The effects of providing Clinicians with feedback on patient progress during psychotherapy: Are

outcomes enhanced? Psychother Res 11(1):49-68. 13. Lambert MJ, Whipple JL, Vermeersch DA, et al. 2002. Enhancing psychotherapy outcomes via providing feedback on client progress: A

replication. Clin Psychol Psychother 9:91-103. 14. Whipple JL, Lambert MJ, Vermeersch DA, et al. 2003. Improving the effects of psychotherapy: The use of early identification of treatment failure

and problem-solving strategies in routine practice. J Counsel Psychol 50(1):59-68. 15. Lambert MJ, Whipple JL, Hawkins EJ, et al. 2003. Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clin Psychol Sci

Prac 10:288-301. 16. Addis ME. 2002. Methods for disseminating research products and increasing evidence-based practice: Promises, obstacles, and future

directions. Clin Psychol Sci Prac 9:367-78. 17. Chorpita BF, Yim LM, Donkervoet JC, et al. 2002. Toward large-scale implementation of empirically supported treatments for children: A review

and observations by the Hawaii Empirical Basis to Services Task Force. Clin Psychol Sci Prac 9:165-90. 18. Herschell AD, McNeil CB, McNeil DW. 2004. Clinical child psychology’s progress in empirically supported treatments. Clin Psychol Sci Prac

11:267-88. 19. Manderscheid RW, Henderson MJ. 2004. Mental health, United States, 2002 executive summary. Admin Policy Mental Health 32:49-55. 20. Stirman SW, Crits-Christoph P, DeRubeis RJ. 2004. Achieving successful dissemination of empirically supported psychotherapies: A synthesis of

dissemination theory. Clin Psychol Sci Prac 11:343-59. 21. Rosenzweig S. 1936. Some implicit common factors in diverse methods of psychotherapy: “At last the Dodo said, ‘Everybody has won and all

must have prizes.’” Am J Orthopsychiatry 6:412-5. 22. Shapiro DA, Shapiro D. 1982. Meta-analysis of comparative therapy outcome studies: A replication and refinement. Psychol Bull 92:581-604. 23. Robinson LA, Berman JS, Neimeyer RA. 1990. Psychotherapy for treatment of depression: A comprehensive review of controlled outcome

research. Psychol Bull 108:30-49.

Appendix: Supporting ResearchAppendix: Supporting Research

24. Wampold BE, Mondin GW, Moody M, et al. 1997. A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “All must have prizes.” Psychol Bull 122:203-15.

25. Ahn H, Wampold BE. 2001. Where oh where are the specific ingredients? A meta-analysis of component studies in counseling and psychotherapy. J Counsel Psychol 48:251-7.

26. Chambless DL, Ollendick TH. 2001. Empirically supported psychological interventions: Controversies and evidence. Annual Rev Psychol 52:685-716.

27. Martindale C. 1978. The Clinician-as-fixed-effect fallacy in psychotherapy research. J Consult Clin Psychol 46:1526-30. 28. Luborsky L, Crits-Christoph P, McLellan T, et al. 1986. Do Clinicians vary much in their success? Findings from four outcome studies. Am J

Orthopsychiatry 56:501-12. 29. Crits-Christoph P, Baranackie K, Kurcias JS, et al. 1991. Meta-analysis of Clinician effects in psychotherapy outcome studies. Psychother Res

1:81-91. 30. Crits-Christoph P, Mintz J. 1991. Implications of Clinician effects for the design and analysis of comparative studies of psychotherapies. J

Consul Clin Psychol 59:20-6. 31. Wampold BE. 1997. Methodological problems in identifying efficacious psychotherapies. Psychother Res 7:21-43, 32. Elkin I. 1999. A major dilemma in psychotherapy outcome research: Disentangling Clinicians from therapies. Clin Psychol Sci Prac 6:10- 32. 33. Wampold BE, Serlin RC. 2000. The consequences of ignoring a nested factor on measures of effect size in analysis of variance designs.

Psychol Methods 4:425-33. 34. Huppert JD, Bufka LF, Barlow DH, et al. 2001. Clinicians, Clinician variables, and cognitive-behavioral therapy outcomes in a

multicenter trial for panic disorder. J Consul Clin Psychol 69:747-55. 35. Luborsky L, Rosenthal R, Diguer L, et al. 2002. The dodo bird verdict is alive and well—mostly. Clin Psychol Sci Prac 9:2-12. 36. Okiishi J, Lambert MJ, Nielsen SL, et al. 2003. Waiting for supershrink: An empirical analysis of Clinician effects. Clin Psychol Psychother

10:361-73. 37. Brown GS, Jones ER, Lambert MJ, et al. 2005. Identifying highly effective psychoClinicians in a managed care environment. Am J

Managed Care 11(8):513-20. 38. Wampold BE, Brown GS. 2005. Estimating Clinician variability: A naturalistic study of outcomes in private practice. J Consul Clin

Psychol.73(5): 914-923. 39. Kim DM, Wampold BE, Bolt DM. 2006. Clinician effects and treatment effects in psychotherapy: Analysis of the National Institute of Mental

Health Treatment of Depression Collaborative Research Program. Psychother Res. 16(2):161-172. 40. Matsumoto K, Jones E, Brown GS. 2003. Using clinical informatics to improve outcomes: A new approach to managing behavioral healthcare.

J Info Tech Health Care 1(2):135-50. 41. Brown GS, Jones ER, Betts W, et al. 2003. Improving suicide risk assessment in a managed-care environment. Crisis 24(2):49-55. 42. Brown GS, Herman R, Jones ER, et al. 2004. Improving substance abuse assessments in a managed care environment. Joint Commission J

Quality Safety 30(8):448-54. 43. Wells MG, Burlingame GM, Lambert MJ, et al. 1996. Conceptualization and measurement of patient change during psychotherapy:

Development of the Outcome Questionnaire and Youth Outcome Questionnaire. Psychother 33:275-283. 44. Lambert MJ, Hatfield DR, Vermeersch DA, et al. 2001. Administration and scoring manual for the LSQ (Life Status Questionnaire). East

Setauket, NY: American Professional Credentialing Services. 45. Burlingame GM, Jasper BW, Peterson G, et al. 2001. Administration and scoring manual for the YLSQ. East Setauket, NY: American

Professional Credentialing Services. 46. Vermeersch DA, Lambert MJ, Burlingame GM. 2002. Outcome Questionnaire: Item sensitivity to change. J Pers Assess 74:242-61.