McLaughlin Patrick, Brady Philip, Carabellese Felice, Carabellese Fulvio, Parente Lia, Uhrskov Sorensen Lisbeth, Jeandarme Ingeborg, Habets Petra, Simpson Alexander I F, Davoren Mary, Kennedy Harry G
National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland.
Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari 'Aldo Moro', Puglia, Italy.
BJPsych Open. 2023 Oct 13;9(6):e193. doi: 10.1192/bjo.2023.578.
Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.
To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.
A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire.
Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score.
Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.
卓越是推动患者治疗效果持续改善的一种品质。卓越必须是可衡量的。我们着手根据七个领域（价值观与权利、临床组织、一致性、时间尺度、专业化、常规结果指标、研究与发展）中组织和复杂程度的四个层次（基础、标准、进步和卓越）来衡量法医精神卫生服务的卓越程度。
验证一种测量量表的心理测量特性，以测试法医服务的哪些客观特征可能与卓越相关，例如大学联系、服务规模以及不同治疗安全级别的综合患者路径。
通过改良的德尔菲法设计了一份调查问卷。来自5个司法管辖区48个法医服务机构的临床或学术法医负责人完成了问卷。
回归分析发现，安全级别数量、关联的患者路径、住院团队数量和联合大学任命情况可预测卓越总分。
按照分层治疗安全组织且与大学和研究机构有紧密联系的大型服务机构，在这项卓越程度衡量指标上得分更高。一个不足之处是这些都是自评。通过同行评审以及诸如研究产出的质量和数量等客观指标，可靠性可能会得到提高。未来，需要研究影响患者获得更好治疗效果的其他客观指标的决定因素，包括缩短住院时间、降低累犯率和再入院率，以及改善身心健康和生活质量。
