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Australia has been implementing routine outcome measurement in its specialized public sector mental health services for over a decade. It uses a range of clinician-rated and consumer-rated measures that are administered at set times during episodes of inpatient, ambulatory and community residential episodes of care. Routine outcome measurement is now embedded in service delivery, and data are made available in a variety of ways to different audiences. These data are used by policy-makers and planners to inform decisions about system-wide reforms, by service managers to monitor quality and effectiveness, and by clinicians to guide clinical decision-making and to promote dialogue with consumers. Consumers, carers and the general community can use these data to ensure that services are accountable for the care they deliver. This paper describes the status quo in Australia with respect to routine outcome measurement, discusses the factors that led to its successful implementation, and considers the steps that are necessary for its continued development. [ABSTRACT FROM AUTHOR]

The article presents the findings of a research conducted on examining whether feedback on outcome measures which enhance consumer outcomes, can represent clinically meaningful information regarding individual consumers to clinicians. It discusses the methodology of the research including Health of the Nation Outcomes Scales (HoNOS). It concludes that it is difficult to relate to the total scores on outcome measures and individual items to make them clinically meaningful for clinicians.

Objective: The aim of this paper is to describe the way in which particular Australian and New Zealand mental health services are making use of routine outcome data to foster clinical improvements for consumers. Method: We invited individuals who are responsible for implementing outcome data collection across the two countries to describe exemplary practices occurring within their own services, and present the resultant information in the form of case studies. Results: Outcome measurement is being used to guide clinical decision-making, engage consumers in treatment, foster a collaborative approach to care planning and goal setting, review consumers'' progress with treatment, inform questions about consumers'' eligibility for given programs, assist with discharge planning, improve the evidence-base on which services are founded, and evaluate particular models of service delivery. Conclusions: A number of mental health services are deriving useful information from routine outcome measurement, and using this to guide clinical practice. The examples provided here may offer some lessons for other services wishing to make better use of outcome data, and there may be some opportunities for the sharing of resources or infrastructure. Services that are already using outcome data to inform their clinical activities, and services that are keen to do so, will need ongoing support. [ABSTRACT FROM AUTHOR]

Object: The concept of recovery has been recognized as important in the treatment of mental illness. A number of specific instruments exist which are designed to: (i) measure recovery at an individual level; and (ii) assess the recovery orientation of services. The current review aimed to identify these and evaluate their potential for routine use in Australian public sector mental health services. Method: We identified potential instruments by drawing on existing reviews, searching MEDLINE and PsycINFO, and consulting with experts. We used a hierarchical criterion-based approach to assess whether given instruments might be candidates for measuring recovery in the Australian context. Results: We identified 33 instruments: 22 designed to measure individuals'' recovery and 11 designed to assess the recovery orientation of services (or providers). Four of the former (Recovery Assessment Scale; Illness Management and Recovery Scales; Stages of Recovery Instrument; Recovery Process Inventory) and four of the latter (Recovery Oriented Systems Indicators Measure; Recovery Self Assessment; Recovery Oriented Practices Index; Recovery Promotion Fidelity Scale) were identified as promising candidates for routine use in Australian public sector mental health services. Conclusions: Further work is required, however, to determine which, if any, might best be used for this purpose; the possibility that modifications to existing instruments or the development of new instruments might be required should not be ruled out. It might be desirable to invest in two instruments: one designed to measure individuals'' recovery and one designed to measure the recovery orientation of services. If Australia were to go down this path, it would make sense to align indicators in each as far as possible, and to ensure that they were consistent with existing endeavours aimed at monitoring and improving recovery-focused aspects of service quality. [ABSTRACT FROM AUTHOR]

Objective: Although Australia and the UK have both made efforts to systematize outcome measurement in mental health services, surprisingly little attention has been paid to how best to analyse routine outcome data in order to determine how services are performing. Methods: Outcome data collected in acute inpatient and ambulatory mental health services across Australia during the 2006-2007 financial year were used. three approaches to measuring effectiveness were explored: effect size (ES); the reliable change index (RCI); and standard error of measurement (SEM). Results: The most conservative results were produced by the RCI and the least conservative by the medium ES statistic and the SEM. By way of example, only 38.0% of inpatient admission-discharge periods of care showed significant improvement for adults when the RCI was used, whereas 67.4% and 72.9% did so when the medium ES and the SEM statistics were used, respectively. Conclusions: In any routine outcome measurement exercise, the degree of effectiveness demonstrated by services will depend on the specific statistical indicator used to judge effectiveness. Routine outcome measurement has the potential to answer a range of crucial performance-related questions, but only if the same metric is used. Discussion of the appropriate statistical approach to take to facilitate cross-service, cross-area and even cross-national comparisons warrants attention. [ABSTRACT FROM AUTHOR]

Objective: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. Method: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). Results: The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital stays; 47.6% were involuntary; 25-30% involved adverse incidents; bed occupancy averaged 88.4%; median length of stay was 8days (mean=14.59days); and 17.4% had a subsequent early readmission. Reportable aggressive incidents (11.2% of admissions) were intermittent (averaging 0.55 incidents per month per occupied bed) and associated with younger age, personality disorder, less serious aggression, longer periods of hospitalization, and subsequent early readmission. Less serious aggressive incidents (15.0% of admissions) were maximal in the first 24h (averaging 3.73 incidents per month per occupied bed) and associated with younger age, involuntary status, bipolar and personality disorders, the absence of depression, and longer hospital stays. Absconding (15.7% of admissions) peaked in the second week following admission and was associated with drug and alcohol disorder, younger age, and longer periods of hospitalization. Conclusions: By examining relationships between a core set of risk factors and multiple short-term outcomes, we were able to identify several important patterns, which were suggestive of the need for a multi-level approach to intervention, shifting from a risk management focus during the early phase of hospitalization to a more targeted, therapeutic approach during the later phase. But the latter approach may not be achievable under current circumstances with existing resources. [ABSTRACT FROM AUTHOR]

Abstract: Mental health services engagement in routine outcome measurement has created a demand for a coherent infrastructure. Two clinician instruments for adolescents (HoNOSCA) and adults (HONOS) are used across many countries. However, the increasing emphasis on youth suggests protocols with historically driven age divisions may obscure outcomes. The current study examines these instruments’ congruence with regard to youth mental health. Members of national mental health expert panels rated four vignettes before discussing perceived strengths and weaknesses. The instruments were strongly correlated and HoNOSCA resulted in more severe symptom scores. Most subscales and scales correlated as predicted with some important exceptions. ‘Problems with family relationships’, tracked by HoNOSCA, did not correlate with its HoNOS counterpart. Qualitative feedback indicated using the HoNOSCA scale ‘School attendance’ for vocational attendance would improve its applicability to young people. The instruments have a strong relationship. While either could be used, HoNOS will underestimate symptom severity in youth. The importance of family relationships for young people suggests that HoNOSCA is preferable. While sited in the Australian context, these findings should be applicable to other countries using these instruments, and should interest services considering the continuity of youth presentations and their outcomes. [Copyright &y& Elsevier]