Trauer Tom
Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
Australas Psychiatry. 2004 Mar;12(1):48-54. doi: 10.1046/j.1039-8562.2003.02059.x.
To study the relative contribution of consumer, clinician and service factors to whether or not consumers completed a self-rating measure in the context of routine outcome measurement.
Four Victorian mental health services commenced routine outcome measurement in their adult services in mid-2000. Clinician-completed measures (Health of the Nation Outcome Scales (HoNOS) and Life Skills Profile (LSP)) and a consumer self-rated measure (Behaviour and Symptom Identification Scale (BASIS)) were entered into specialized software. Analyses were restricted to assessments conducted at review in the community.
Wide differences were observed between the four agencies in the rates of completion of the self-rating measure. Overall, consumer characteristics associated with greater likelihood of completion were lower age, non-organic diagnosis, lesser severity as measured by the HoNOS, and lesser disability as measured by the LSP. A more focused analysis showed that agency, lower age, and higher compliance were most reliably associated with completion. Significant proportions of clinicians had no recorded instances of consumer self-rating associated with their assessments.
Service and clinician factors appear to be equally important as consumer factors in whether or not a self-rating measure was completed. Information systems designed for outcomes measurement should include indications of whether or not a self-rating was invited, and, if not, why not. The results suggest that consumer self-rating is not yet firmly established in the outcomes measurement culture.
研究在常规疗效评估背景下,消费者、临床医生及服务因素对消费者是否完成自评测量的相对影响。
2000年年中,四家维多利亚州心理健康服务机构在其成人服务部门开始进行常规疗效评估。临床医生完成的测量指标(国民健康状况量表(HoNOS)和生活技能概况(LSP))以及消费者自评测量指标(行为与症状识别量表(BASIS))被录入专门软件。分析仅限于在社区复诊时进行的评估。
四家机构在自评测量完成率方面存在显著差异。总体而言,与完成可能性较大相关的消费者特征包括年龄较小、非器质性诊断、HoNOS测量的病情较轻以及LSP测量的残疾程度较轻。更具针对性的分析表明,机构、年龄较小和依从性较高与完成情况最可靠相关。相当比例的临床医生在其评估中没有记录到消费者自评的实例。
在自评测量是否完成方面,服务和临床医生因素似乎与消费者因素同样重要。为疗效评估设计的信息系统应包括是否邀请了自评的指示,如果没有邀请,原因是什么。结果表明,消费者自评在疗效评估文化中尚未牢固确立。