Penington Edward, Williams Ryan, Tsiachristas Apostolos
Department of Psychiatry, University of Oxford, Oxford, UK
Department of Brain Sciences, Imperial College London, London, UK.
BMJ Ment Health. 2025 Jun 5;28(1):e301669. doi: 10.1136/bmjment-2025-301669.
Routine outcome data in secondary mental health services have significant potential for service planning, evaluation and research. Expanding the collection and use of these data is an ongoing priority in the National Health Service (NHS), but inconsistent use threatens their validity and utility. If recording is more likely among certain patient groups or at specific stages of treatment, measured outcomes may be biased and unreliable.
The objective is to assess the scale, determinants and implications of incomplete routine outcome measurement in a secondary mental health provider, using the example of the widely collected Health of the Nation Outcome Scores (HoNOS).
A retrospective cohort study was conducted using routine HoNOS assessments and episodes of care for patients receiving secondary mental healthcare from an NHS Trust in Southeast England between 2016 and 2022 (n=30 341). Associations among demographic, clinical and service factors, and rates and timings of HoNOS assessments were explored with logistic regressions. Relationships between total HoNOS scores and related mental health outcomes (costs, relapse and improvement between assessments) were estimated after adjusting for the likelihood of assessment.
66% of patients (n=22 288) had a recorded HoNOS assessment. Of the distinct episodes of care for these patients (n=65 439), 43% (n=28 170) were linked to any assessment, 25% (n=16 131) were linked to an initial baseline assessment, while 4.7% (n=3 094) were linked to multiple HoNOS assessments, allowing for evaluation of clinical progress. Likelihood and timing of assessment were significantly associated with a range of factors, including service type, diagnosis, ethnicity, age and gender. After adjusting for observed factors determining the likelihood of assessment, the strength of association between HoNOS scores and overall costs was significantly reduced.
Most of the activity observed in this study cannot be evaluated with HoNOS. HoNOS assessments are highly unlikely to be missing at random. Without approaches to correct for substantial gaps in routine outcome data, evaluations based on these may be systematically biased, limiting their usefulness for service-level decision-making.
Routine outcome collection must increase significantly to successfully implement proposed strategies for outcome assessment in community mental healthcare without inconsistent records undermining the use of resulting data.
二级心理健康服务中的常规结果数据在服务规划、评估和研究方面具有巨大潜力。扩大这些数据的收集和使用是英国国家医疗服务体系（NHS）的一项持续优先事项，但使用不一致会威胁到其有效性和实用性。如果在某些患者群体中或治疗的特定阶段更有可能进行记录，那么所测量的结果可能会有偏差且不可靠。
以广泛收集的《国家健康结果评分》（HoNOS）为例，评估二级心理健康服务提供者中常规结果测量不完整的规模、决定因素及影响。
采用回顾性队列研究，利用2016年至2022年期间英格兰东南部一家NHS信托机构为接受二级心理健康护理的患者进行的常规HoNOS评估和护理事件（n = 30341）。通过逻辑回归探讨人口统计学、临床和服务因素与HoNOS评估的率和时间之间的关联。在调整评估可能性后，估计HoNOS总分与相关心理健康结果（成本、评估之间的复发和改善）之间的关系。
66%的患者（n = 22288）有记录的HoNOS评估。在这些患者的不同护理事件（n = 65439）中，43%（n = 28170）与任何评估相关，25%（n = 16131）与初始基线评估相关，而4.7%（n = 3094）与多次HoNOS评估相关，从而能够评估临床进展。评估的可能性和时间与一系列因素显著相关，包括服务类型、诊断、种族、年龄和性别。在调整观察到的决定评估可能性的因素后，HoNOS评分与总体成本之间的关联强度显著降低。
本研究中观察到的大多数活动无法用HoNOS进行评估。HoNOS评估极不可能随机缺失。如果没有办法纠正常规结果数据中的重大差距，基于这些数据的评估可能会系统性地产生偏差，限制其在服务层面决策中的有用性。
必须大幅增加常规结果收集，以成功实施社区精神卫生保健中提议的结果评估策略，同时避免记录不一致破坏所产生数据的使用。
