Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via la Masa 19, 20156, Milan, Italy,
Soc Psychiatry Psychiatr Epidemiol. 2014 Feb;49(2):291-305. doi: 10.1007/s00127-013-0750-7. Epub 2013 Aug 6.
Using the reliable and clinically significant change approach, we aimed to identify meaningful outcome indicators for the Health of the Nation Outcome Scales (HoNOS) and to combine them in a single model. We applied these indicators to the 1-year outcome of two large samples of people attending community mental health services in Italy (cohort 1) and the Netherlands (cohort 2).
Data were drawn from two studies on routine outcome assessment. The criteria for meaningful outcome were defined on both study cohorts and both language versions of the scale. The model combined (a) two criteria for adequate change (at least 4 or 8 points change), (b) two cut-offs for clinically significant change (a total score of 10 was the threshold between mild and moderate illness, 13 between moderate and severe illness), and (c) a method for classifying stable subjects in three degrees of severity (stable in mild, moderate or severe illness). Results were compared with those given by the effect size (ES) and analysis of variance and covariance (ANOVA and ANCOVA).
For the proposed approach the outcome of cohort 1 was better than cohort 2, with 65-67% of its subjects showing a positive outcome compared to only 45-46%. The other reference methods (ES and ANOVA), however, showed a greater improvement for cohort 2. ANCOVA indicated that the differences were due to regression to the mean (RTM) which showed opposite effects across the two cohorts.
The proposed approach proved valuable and generalizable for interpreting outcome on HoNOS, scarcely influenced by the RTM effect. Its introduction could benefit outcome evaluation and management.
采用可靠且具有临床意义的变化方法，旨在确定国民健康结果量表（HoNOS）的有意义的结果指标，并将其组合成一个单一的模型。我们将这些指标应用于意大利（队列 1）和荷兰（队列 2）两个社区精神卫生服务机构的两个大型样本的 1 年结果。
数据来自两项常规结果评估研究。有意义的结果标准是在两个研究队列和量表的两种语言版本上定义的。该模型结合了（a）两种充分变化的标准（至少变化 4 或 8 分），（b）两种临床显著变化的切点（总分 10 是轻度和中度疾病之间的阈值，13 是中度和重度疾病之间的阈值），以及（c）一种将稳定患者分为三个严重程度的方法（在轻度、中度或重度疾病中稳定）。结果与效应量（ES）和方差分析和协方差分析（ANOVA 和 ANCOVA）给出的结果进行了比较。
对于所提出的方法，队列 1 的结果优于队列 2，65-67%的患者表现出积极的结果，而只有 45-46%的患者表现出积极的结果。然而，其他参考方法（ES 和 ANOVA）显示队列 2 的改善更大。ANCOVA 表明，差异归因于均值回归（RTM），该效应在两个队列中表现出相反的效果。
所提出的方法被证明对于解释 HoNOS 的结果是有价值且可推广的，几乎不受 RTM 效应的影响。引入该方法可以有益于结果评估和管理。
