0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
Performance Measures for Schizophrenia Research
Tom Burns, M.D.
Psychiatric Services 2012; doi: 10.1176/appi.ps.20120p721
View Author and Article Information

Dr. Burns is with the Department of Psychiatry, Oxford University, and with Warneford Hospital, Oxford, United Kingdom.

Copyright © 2012 by the American Psychiatric Association.

To the Editor: In developing of a set of performance measures for assessing schizophrenia treatment services, Addington and colleagues (1) have undertaken an important task and put a truly impressive effort into it. A more systematic approach to understanding a broader stakeholder assessment of care is much needed and timely, nowhere more than in schizophrenia. Schizophrenia has a range of fluctuating effects on patients, families, and society, and efforts to identify a single, self-evident measure for evaluating the effectiveness of services have not met with success.

The Delphi approach is an excellent technique for developing consensus and ranking consensus opinions and priorities. We have used it in a number of situations and have found it invaluable to understand treatment priorities (2,3) and outcome measures (4,5). It is, however, just a tool and should not be treated with too much respect. The instructions given must be detailed but also clear and precise, tailored to both the aim of the exercise and to the specific group engaged.

A clear understanding of the ultimate goal of the exercise is key. Although a Delphi process can be used solely for measuring consensus, users of the process are usually seeking consensus on judgments or priorities. This needs to be made clear, and the following statement is an attempt to do so: “Our aim is to identify the two most important performance measures in each domain. To achieve this, the whole range of the assessment ratings must be used.” Academics are generally comfortable giving a low rating to items, but clinicians and nonprofessionals need strong encouragement to do so. Many service user and caregiver advocacy groups struggle with assigning a low rating to any item and need constant encouragement to rank the importance of service elements. In our previous work, we had to keep reminding service users and caregivers that rating everything “important” or “essential” effectively wasted their vote: “If you rate everything important, then your ratings cancel each other out and you have no influence on the outcome.”

Addington and colleagues' Delphi process reduced 97 items to 36 that participants identified as essential. But this hardly moves us on, especially when one of the eight domains (appropriateness) ended up with 31 performance measures. I do not see how I could change my clinical practice on this basis—and promoting change in clinical practices must surely must be the ultimate purpose of the exercise. Addington and colleagues have got this far, and I would encourage them to return to the group to further refine the results. That way they would produce a focused consensus statement on schizophrenia care performance measures that nobody could ignore.

Addington  DE;  McKenzie  E;  Wang  JL  et al:  Development of a core set of performance measures for evaluating schizophrenia treatment services.  Psychiatric Services 63:584–591, 2012
[CrossRef]
 
Fiander  M;  Burns  T:  A Delphi approach to describing service models of community mental health practice.  Psychiatric Services 51:656–658, 2000
[CrossRef] | [PubMed]
 
Burns  T;  Yiend  J;  Fahy  T  et al:  Treatments for dangerous severe personality disorder (DSPD).  Journal of Forensic Psychiatry and Psychology 22:411–426, 2011
[CrossRef]
 
Burns  T;  Fiander  M;  Audini  B:  A Delphi approach to characterising “relapse” as used in UK clinical practice.  International Journal of Social Psychiatry 46:220–230, 2000
[CrossRef] | [PubMed]
 
Yiend  J;  Chambers  J;  Burns  T  et al:  Outcome measurement in forensic mental health research: an evaluation.  Psychology, Crime and Law 17:277–292, 2011
[CrossRef]
 
References Container
+

References

Addington  DE;  McKenzie  E;  Wang  JL  et al:  Development of a core set of performance measures for evaluating schizophrenia treatment services.  Psychiatric Services 63:584–591, 2012
[CrossRef]
 
Fiander  M;  Burns  T:  A Delphi approach to describing service models of community mental health practice.  Psychiatric Services 51:656–658, 2000
[CrossRef] | [PubMed]
 
Burns  T;  Yiend  J;  Fahy  T  et al:  Treatments for dangerous severe personality disorder (DSPD).  Journal of Forensic Psychiatry and Psychology 22:411–426, 2011
[CrossRef]
 
Burns  T;  Fiander  M;  Audini  B:  A Delphi approach to characterising “relapse” as used in UK clinical practice.  International Journal of Social Psychiatry 46:220–230, 2000
[CrossRef] | [PubMed]
 
Yiend  J;  Chambers  J;  Burns  T  et al:  Outcome measurement in forensic mental health research: an evaluation.  Psychology, Crime and Law 17:277–292, 2011
[CrossRef]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 1.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 9.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 6.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 10.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles
Schizophrenia genetics comes of age. Neuron 2014;83(4):760-3.