Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands.
Int J Nurs Stud. 2013 Dec;50(12):1711-9. doi: 10.1016/j.ijnurstu.2013.05.004. Epub 2013 Jun 14.
The Health of the Nation Outcome Scales (HoNOS) is widely used to evaluate mental health care outcomes. For appropriate use and interpretation in routine clinical practice, further validation of the adapted version for older clients (HoNOS 65+) is needed.
The aim of this study is to compare scoring profiles produced by different categories of professionals, assess the internal consistency of the sum score and proposed subscales, and concurrent validity of the total sum score of the Dutch version of HoNOS 65+.
We used baseline data from fourteen mental health care organizations participating in the MEntal health care Monitor Older adults (MEMO), a nationwide routine outcome monitoring system. A total of 767 older clients, referred for gerontopsychiatric disorders, were administered HoNOS 65+ by non-academic (primarily nurses, n=430) or academic professionals (psychologists/physicians, n=337). Demographics and full DSM-IV classification, including the Global Assessment of Functioning (GAF), were derived from the electronic medical dossier.
HoNOS 65+ seemed to discriminate between clients with and without a depressive disorder, adjustment disorder, anxiety disorder and psychotic disorder on the items expected. In clients suffering from a depressive or psychotic disorder, nurses/social workers and physicians/psychologists did not differ in scoring on all items of HoNOS 65+. In clients with an adjustment disorder or anxiety disorder, professions differed in rating on two items. Confirmatory Factor Analyses supported neither the factor structure of the original HoNOS nor the initially reported structure of HoNOS 65+ version. Cronbach's alpha of the total sum score was 0.60. Internal consistency of previously identified subscales was low. A new set of subscales could not be identified satisfactorily. A medium-sized correlation of the HoNOS 65+ sum score and the GAF was found (r=-.30, p<.001).
It is preferable to use individual HoNOS 65+ items, to evaluate care outcomes. The HoNOS 65+ items discriminate between clients with and without a particular diagnosis. Nonetheless, in some of the most prevalent gerontopsychiatric disorders rating differs between professionals with different educational backgrounds.
《健康国家结局量表》（HoNOS）被广泛用于评估精神卫生保健的结果。为了在常规临床实践中进行适当的使用和解释，需要进一步验证适用于老年患者（HoNOS 65+）的改编版本。
本研究的目的是比较不同类别专业人员产生的评分模式，评估总分和拟议子量表的内部一致性，以及荷兰语版 HoNOS 65+总分的同时效度。
我们使用参与全国常规结果监测系统 MEMO（老年人心理健康监测）的 14 个精神卫生保健组织的基线数据。共有 767 名因老年精神障碍而被转诊的老年患者由非学术（主要是护士，n=430）或学术专业人员（心理学家/医生，n=337）施测 HoNOS 65+。从电子病历中获得人口统计学信息和完整的 DSM-IV 分类，包括总体功能评估（GAF）。
HoNOS 65+似乎能够区分有和没有抑郁障碍、适应障碍、焦虑障碍和精神病性障碍的患者，这与预期相符。在患有抑郁或精神病性障碍的患者中，护士/社工和医生/心理学家在 HoNOS 65+的所有项目上的评分没有差异。在患有适应障碍或焦虑障碍的患者中，不同专业人员在两项项目上的评分存在差异。验证性因子分析不支持原始 HoNOS 的因子结构或最初报告的 HoNOS 65+版本的结构。总分的克朗巴赫α系数为 0.60。先前确定的子量表的内部一致性较低。未能令人满意地确定新的子量表。发现 HoNOS 65+总分与 GAF 呈中等相关（r=-.30，p<.001）。
最好使用个别 HoNOS 65+项目来评估护理结果。HoNOS 65+项目能够区分有和没有特定诊断的患者。尽管如此，在一些最常见的老年精神障碍中，具有不同教育背景的专业人员之间的评分存在差异。
