Fugard Andrew J B, Stapley Emily, Ford Tamsin, Law Duncan, Wolpert Miranda, York Ann
Research Department of Clinical, Educational and Health Psychology, University College London, 26 Bedford Way, WC1H 0AP, UK.
University College London, Anna Freud Centre, UK.
Child Adolesc Ment Health. 2015 Sep;20(3):155-162. doi: 10.1111/camh.12086. Epub 2014 Dec 24.
Patient-reported outcomes measures are increasingly being used in child and adolescent mental health services (CAMHS). League tables are a common way of comparing organizations across health and education but have limitations that are not well known in CAMHS.
Parent-rated Strengths and Difficulties Questionnaire (SDQ) outcomes data from 15,771 episodes of care across 51 UK CAMHS were analysed using funnel plots, an alternative to league tables.
While most services were indistinguishable from the national average there was evidence of heterogeneous outcomes and seven services had outcomes below 99.9% limits for SDQ added-value scores.
Funnel plots are powerful tools for navigating national data and can help prompt investigations using clinical theory and local service context. Examples are provided of factors to consider in these investigations. We argue that analyses of the local context are central to the valid application of funnel plots.
患者报告的结局指标在儿童和青少年心理健康服务（CAMHS）中越来越多地被使用。排行榜是比较卫生和教育领域各机构的常用方式，但存在一些局限性，而这些局限性在CAMHS中并不广为人知。
使用漏斗图（排行榜的一种替代方法）分析了来自英国51个CAMHS的15771例护理事件中家长评定的优势与困难问卷（SDQ）结局数据。
虽然大多数服务与全国平均水平没有差异，但有证据表明结局存在异质性，并且有7项服务的SDQ增值分数低于99.9%的界限。
漏斗图是处理全国数据的有力工具，有助于利用临床理论和当地服务背景推动调查。文中提供了这些调查中应考虑因素的示例。我们认为，对当地背景的分析是漏斗图有效应用的核心。
