Department of Psychology, University of Sheffield, Norfolk and Suffolk NHS Foundation Trust, Vita Health Group, Sheffield, England.
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, 1 Vicar Lane, Sheffield, S1 2LT, England.
Adm Policy Ment Health. 2024 Nov;51(6):970-987. doi: 10.1007/s10488-024-01403-0. Epub 2024 Aug 17.
To work with a psychological therapies service to implement a recovery plan, as required by a government body, aimed at improving patient outcomes (effectiveness) and decreasing practitioner variability (equity). A case-study utilizing components of a learning health system, including nationally mandated patient outcome data, comprising three 18-month phases: (1) retrospective baseline; (2) improving patient outcomes (management-led); and (3) reducing practitioner variability (clinician-led). Primary analyses focused on 35 practitioners (N = 35) who were constant across the three phases and their patients in each phase (N = 930, 1226, 1217, respectively). Reliable improvement rates determined patient outcomes and multilevel modeling yielded practitioner effects. To test generalizability, results were compared to the whole practitioner sample for each phase: (1) N = 81, N = 1982; (2) N = 80, N = 2227; (3) N = 74, N = 2267. Ethical approval was granted by the Health Research Authority. Patient outcomes improved in successive phases for both the core and whole practitioner samples with the largest impact occurring in the management-led intervention. Practitioner variability decreased in successive phases in both the core and whole practitioner samples except in the management-led intervention of the whole sample. Compared with the management-led intervention, the practitioner-led intervention yielded a decrease in practitioner effect exceeding 60% in the core sample and approaching 50% in the whole sample. The implementation of multiple components of a learning health system can lead to improvements in both the effectiveness and equity of a psychological therapy service.
与心理治疗服务机构合作，根据政府机构的要求实施恢复计划，旨在改善患者的治疗效果（有效性）并减少治疗师的差异（公平性）。本案例研究利用学习型医疗系统的组成部分，包括全国性规定的患者结果数据，包含三个 18 个月的阶段：（1）回顾性基线；（2）改善患者治疗效果（以管理为主导）；（3）减少治疗师的差异（以临床医生为主导）。主要分析集中在 35 名在三个阶段都保持不变的从业者（N = 35）及其每个阶段的患者（N = 930、1226、1217）。可靠的改进率确定了患者的治疗效果，多级模型得出了治疗师的影响。为了检验推广性，对每个阶段的所有治疗师样本进行了结果比较：（1）N = 81，N = 1982；（2）N = 80，N = 2227；（3）N = 74，N = 2267。健康研究管理局批准了伦理审查。核心和所有治疗师样本的患者治疗效果在连续阶段都有所提高，最大影响发生在以管理为主导的干预中。核心和所有治疗师样本的治疗师差异在连续阶段都有所减少，除了在整个样本的以管理为主导的干预中。与以管理为主导的干预相比，以治疗师为主导的干预在核心样本中降低了 60%以上的治疗师影响，接近整个样本的 50%。学习型医疗系统的多个组成部分的实施可以提高心理治疗服务的有效性和公平性。
