Recently we asked ICANotes users for suggestions for outcome measurements. .
Here is a list of the suggestions we received: (The comments we received are below)
Thank you all for these suggestions. We will look at all these scales and see if we can use them.
If there are other suggestions we welcome them. However, please keep in mind that it is not the test itself that will appear in ICANotes. Instead, there will be a way to enter the results of the test. To see how this works, please see the Psych. Testiing section of the program, reachable from PN1, second column.
Test results that are a number range (eg 1-5 = Mild Depression, 6-10 = Moderate Depression, etc) work best.
Here are the scales or tests that were suggested:
BSI-18
ORS and SRS
Beck Depression Inventory (Already in ICANotes under Psych Testing, PN 1, column 2)
Short Form, Conners Scale, Parent rated
YMRS
Likert Scale 1-5
GAF (a number of users suggested using this Axis V scale for outcome measurement and a number asked that it be
graphed.)
CGAS
PHQ-9 (Already in ICANotes under Psych Testing, PN 1, column 2)
GAD-7
ASRS
BPRS
Y-BOCS (Already in ICANotes under Psych Testing, PN 1, column 2)
Beck Anxiety Inventory (Already in ICANotes under Psych Testing, PN 1, column 2)
CGI
CDI
Vanderbilt
QOLI
MyOutcomes
Burns Depression Checklist
Burns Anxiety Inventory
Obsessive Compulsive Inventory
Penn Inventory of Scrupulosity
HBIPS-5
Here are the comments we received:
"A couple of outcome measures that I have used within the school setting are as follows:
When discussing appropriate eye contact, the student will demonstrate appropriate eye contact with other students are talking on 3 out of 4 occasions.
When discussing appropriate classroom behavior, the student will identify appropriate classroom behaviors during 3 out of 4 trials.
I'm not sure if this is what you are looking for, but here they are if you need them!
Nori C. Mora, Ed.D.
"Hello
In fact, we just purchased the Brief Symptom Inventory - 18 (BSI-18) from Pearson for this very reason. Although we have not yet used this in our clinic, questions asked cover all the key points that the insurance is asking for. The test is measurable and is nationally recognized. We would love to see something similar to this be incorporated into ICA Notes!!!
Sincerely
Katie Gillies
Administrator"
"the work of barry duncan and scott miller is compelling. (ORS-outcome rating scale, and SRS-session rating scale) duncan and miller used to collaborate but have gone their separate ways. here are sites for both:
http://heartandsoulofchange.com/measures/
http://www.scottdmiller.com/?q=node/57
here is a site that has incorporated these scales:
https://www.mentalhealthpros.com/video/login/login_tutorial.htm" (Paula Tanis)
"likert scale 1-5 how effective was today's session? Do you feel session decreased symptoms?" (Dr. Cuellar)
"Becks Depression Scale
Shortform Connors Scale Parent rated
YMRS Young Mania Rating scale" (Kimberly Cotton)
"No expert on outcome measures here, but from working in mental health for county agencies I understand the GAF is important.
If you could also give us a CGAS (Childrens Global Assessment Scale) in addition to the GAF you provide us that would be very helpful.
It might also help to graph out the GAF and CGAS over time, but I'm not sure.
Thank you!
Ann Childers MD"
"I would like to be be able to graph the PHQ-9, the GAD-7, The ASRS for ADHD, the BPRS, liebowitz social anxiety scale and the Y-BOCS scales as a starting point." (Dr. Berger)
"Are you referring to rating scales? I have found the PHQ-9 very quick to administer and effective. The GAD-7 is helpful as well.
Jeff Benzick MD"
"I would like to see the CGI scale.
Thanks,
Tina"
"Dear ICANotes Team:
Could you develop a system for tracking readmissions within 30 days of discharge." (Vista U/N: utilizationreview)
"Also, re: monitoring and outcomes, we are being told that one area being closely scrutinized by JCAHO as well as State Health and CMS is that of simultaneous use of two or more neuroleptic agents, particularly at discharge. This is an area we have started to monitor very closely. It's cumbersome to do manually. I'll forward the criteria when I get them from our P.I. person." (Norm Snyder)
"This is a very difficult problem in psychiatry, as there are not many measurable outcomes that correlate with quality of care. I spent 15 years on the Board of Mountain Pacific Quality Health, who are the Medicare Quality Improvement Organization for Hawaii, Montana, Wyoming, and Alaska, and we never could come up with much in the way of quality measures for psychiatry. Quality measures are easiest for chronic management of diseases such as diabetes and asthma with clear guidelines for tests and procedures that represent optimal care. Much of the outcomes in psychiatry are subjective and not easily measured. The national quality standards (HEDIS) use two measures - length of time patients started on antidepressants for newly diagnosed depression stay on their medications, based on pharmacy records, and whether or not patients hospitalized for depression are seen in outpatient follow-up within 30 days of discharge. On the first, the data are often bad, since patients may or may not take meds they pick up, many patients are given samples that don't show up on pharmacy claims, and for various reasons health plan data often show patients as "newly diagnosed depression" when they are actually long established patients, have mixed depression and other diagnoses, etc. On the second measure, patients hospitalized for depression are a very small part of most of our outpatient practices. These two "measures" therefore fail to accurately reflect quality for well over 90% of what we do. I don't know of anyone who has come up with better measures for psychiatry either.
This whole scheme to track "outcomes" and reward "quality" and implement "pay for performance" is unfortunately misguided and fails to take into account the fact that at least half of health care is too complex to allow meaningful measures of "quality" or "outcomes" via standardized tools. This is even more true for psychiatry than for many other specialties.
Steve Kemble"
"The PHQ (Patient Health Questionaire) has been a good measure for depression symptoms. There is a child/teen version.
The Vanderbilt is a good child assessment for ADHD symptoms.
The Child Depression Inventory (CDI) is also a good child rating for depression." (Lori Lowans-Wells)
"Here is an idea: build buttons into the assessment portion which would indicate improvement, e.g. for depressive dx, anxiety sx, psychotic sx, manic sx and GAF button.
Gather data from those buttons in some kind of printatlbe report, e.g. Jane Doe had depression which improved over a 6 month period, GAF went from 50 to 75. The buttons are the key to making it easy." (Dr. DeLisle)
"compliance with medication" (Dr. Trachtenberg)
"Beck's Depression Inventory (and Anxiety) are quick and simple to score measures." (Dr. Machado)
"For psyche I use the GAF on Axis V." (Arleta Brown)
"It would be great if the outcome measure could be specific to the pathology being addressed in treatment (e.g. BDI) rather than an all encompassing measure. Beck measures we have found to be particularly helpful." (Todd Bennett)
"QOLI (quality of life inventory) is a brief yet helpful scale that
would be easily built into the system" (Loren Malkasian)
"I don't have a good outcome measure, since the symptomatology is so
broad in my patient population. One thing I would love to see,
though, is the ability for the patient to rate their response
independent of our clinical session. Could they be on a separate
computer, enter into ICANotes somewhere and independently fill out the
survey/questionnaire. Then when I see them, I have the results for
our session and part of the clinical record longitudinally. This
would save time in session and increase the objective collection of
data versus rater biases (mine)
John R. Whipple, MD
Lawrence, KS"
"Your "outcome measure' idea interests me. I would be willing to offer
statistical consultation. Knowing what type of data is to be analyzed
will guide both development and refinement of the "measurement
instrument" you seek to create. For example, the data as input to the
clinical notes is nominal and not continuous in its scalar properties,
this must be considered in instrument development. Also,when designing
a measurement instrument it is critical to construct it so it has
statistical power, the latter "power" is a technical mathematical
question. Again, for example, depending on whether one uses nominal or
continuous data one must select the correct nonparametric or
parametric statistical tests, and the "power" is influenced by the
former selection. The consultation is offered gratis, although I do
not have the time to develop the "outcome measure(s)" themselves.
Notice that the plural "measures" was used, for it must also be
considered that the many different populations you serve may have
different types of data. Please keep me abreast of your development,
and good luck! it's a great idea if well thought out and properly
constructed." (John Vicedomini, PhD)
"I would love something that would graph data in the form of a line
graph." (Renee Terrasi)
"I utilize My Outcomes. Perhaps a link can be integrated into each
account so an assessment can be "opened" while one has a chart open.
See https://www.myoutcomes.com/
This service costs less then $125 / year for a solo practitioner. It
is convenient, helpful and VERY easy to use. Also evidence based.
Contact:
Lowell Kasden or Caitlin Carlson
MyOutcomes®
Danya International, Inc.
8737 Colesville Road, Suite 1100 | Silver Spring, MD 20910
Phone: 240-645-1584 Fax: (240) 645-0970
www.danya.com | www.myoutcomes.com
If you're interested in learning more, please tell Lowell or Caitlin
that I recommended you.
John" (John Duggan)
"At our practice, we regularly use the Burns Depression Checklist,
Burns Anxiety Inventory, Obsessive-Compulsive Inventory-Revised, and
the Penn Inventory of Scrupulosity as repeated measures. We would very
much like to be able to somehow have those score integrated into
ICANotes. I would be glad to send you copies of the checklists if you
want to view them.
Ted" (Ted Witzig)
"Yes, these would be very helpful. I tend to use the GAF scores as a
way to measure outcomes but if you all could convert these scores into
a graph form it would be much easier to show our patients there
improvement or lack thereof. Also, I have come up with depression,
anxiety, PTSD and ADD patient reported scales but I have found that
these are time consuming, paper intensive and they then have to be
scanned. I would love for you all to integrate these into your program
so that patients can complete these online or on a PC in our waiting
room. Good luck." (Emanuel Martinez, MD)
"From Liz:
I cannot say that this is either effective or easy to use but we are
under significant pressure to document to HBIPS- 5. This is affecting
all inpatient psychiatrists and the goal is to document on discharge
(only) any patient who leave with a prescription for more than one
Antipsychotic agent. The criteria for the psychiatrist to do this
legitimately are very rigid and not easily achieved. There must be
documentation in the medical record that this patient has failed three
separate trials of monotherapy before going to the use of two agents.
I have been fooling around with the program and trying to come up with
a work around that will be an accurate account of the patient's
history with neuroleptic medications and that is clearly visible to
the provider as the notes are being made each day. Falling back on
the med log works but only in a limited way. Right now I have turned
the Notes and Risk Factors pink box on PN 2 into my mini-medication
tracking for the sickest patients. I can add any neuroleptic drug to
the ongoing list and jot down the reason it failed and know that I
have a "live running record" that will always populate the future
progress note of these ill patients. Plus, by using this box ONLY for
HBIPS-5 documentation, at discharge I am reminded that the this
patient requires specific documentation inside the DC summary. The
pink box being next to the "turn this note into a DC summary" button
is great.
There are some flaws as expected in a work around. But, for some
odd reason, administration is having fits since I am not using the box
for the specific reason Ira labeled it for. Tracking this stuff is an
administrative nightmare and I would be glad to talk to anyone who
wants to take this on.
As for other outcomes, the HBIPS documentation has maybe 10 areas
that require documentation. I think some of those areas are specific
to pharmacy and maybe nursing.
You guys know me, never a short answer.
Thanks, Liz" (Liz Lobao)
"Two Links for HBIPS: 5. from Liz
Specific criteria for HBIPS-5
http://manual.jointcommission.org/releases/TJC2011A/MIF0120.html
Link below is the big, ugly picture.
http://manual.jointcommission.org/releases/TJC2011A/HospitalBasedInpatientPsychiatricServices.html
Ira, I have no idea if you are following this specific mess but the
practice period is over and the results will be posted quarterly on
the web. Citizens will look and see if a specific psychiatrist as
pass the quarterly inspection. The entire subject annoys me to no
end, it is way too government telling docs how to practice medicine.
Anyway, it this is not the type of feedback you were looking for, I
recommend the DELETE button..
Having a tracking device for HBIPS would be a strong selling point for
the inpatient crowd.
Liz :-)".
