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: In Reply
Donald Emile Addington, M.B.B.S.; Emily McKenzie, M.Sc.; JianLi Wang, Ph.D.
Psychiatric Services 2012; doi: 10.1176/appi.ps.20120p721a
View Author and Article Information

Copyright © 2012 by the American Psychiatric Association.

In Reply: Burns has made three general points in his letter about our article on performance measures for schizophrenia services. First, he has endorsed the use of the Delphi process for engaging multiple stakeholder groups. Second, he has made pertinent observations about the process of using the Delphi based on his considerable experience working with multiple groups, including consumers. More specifically, he has pointed out the potential problem that occurs when groups rate many items as essential, and he has made several practical suggestions about how to encourage the group to be more focused and selective. We recognize the value of his suggestions and, in retrospect, we could have improved our Delphi process.

We have a different perspective on his third suggestion, to return to the Delphi group with improved directions in order to obtain a more focused group of performance measures with the goal of changing the practice of individual clinicians with a set of “performance measures that nobody could ignore.” The reason underlying our perspective is that we see the identification of measures as only a small step on the path to implementing performance measures in mental health services. In a prior systematic review, we examined the facilitators and barriers to implementing performance measures (1). The review identified seven broad factors that influenced the implementation of performance measures, including indicator characteristics, promotional strategies, implementation strategies, resources, individual factors, organizational factors, and external factors. In our article on performance measures, which is the subject of Burns' letter, we focused on one factor only, indicator characteristics.

We have previous experience with use of the Delphi process as part of the process of identifying performance measures for first-episode psychosis services (2). When we moved to implement these measures, we found that some measures rated as essential were, in practice, hard to specify with precision, and some were difficult to collect. When we studied the use of the available measures to compare services, only one measure, hospitalization, was sufficiently robust and widely available to be considered suitable for setting standards (3). We have since sought to increase the potential value of hospitalization as a performance measure for first-episode psychosis services. First, we developed a risk adjustment formula for hospitalization (4), and second, we tested the validity of hospitalization as a performance measure by demonstrating that it correlated with two other important outcome measures, quality of life and global psychopathology (5).

In conclusion, we see the systematic review and rating of evidence as essential first steps in developing performance measures. The Delphi is a useful next step to narrow the number of measures, but it reflects only opinion evidence, one of the weaker levels of evidence in evidence-based medicine. Further practical steps include the rigorous definition of measures and further research to validate the measures. All these steps would still address only one of the seven factors (indicator characteristics) that we identified as facilitators and barriers to implementing performance measures in mental health services.

Addington  D;  Kyle  T;  Desai  S  et al:  Facilitators and barriers to implementing quality measurement in primary mental health care: systematic review.  Canadian Family Physician 56:1322–1331, 2010
[PubMed]
 
Addington  D;  McKenzie  E;  Addington  J  et al:  Performance measures for early psychosis treatment services.  Psychiatric Services 56:1570–1582, 2005
[CrossRef] | [PubMed]
 
Addington  D;  Norman  R;  Adair  C  et al:  A comparison of early psychosis treatment services using consensus and evidence-based performance measures: moving towards setting standards.  Early Intervention in Psychiatry 3:274–281, 2009
[CrossRef] | [PubMed]
 
Addington  DE;  Beck  C;  Wang  J  et al:  Predictors of admission in first-episode psychosis: developing a risk adjustment model for service comparisons.  Psychiatric Services 61:483–488, 2010
[CrossRef] | [PubMed]
 
Addington  DE;  McKenzie  E;  Wang  JL:  Validity of hospital admission as an outcome measure of services for first-episode psychosis.  Psychiatric Services 63:280–282, 2012
[CrossRef] | [PubMed]
 
References Container
+

References

Addington  D;  Kyle  T;  Desai  S  et al:  Facilitators and barriers to implementing quality measurement in primary mental health care: systematic review.  Canadian Family Physician 56:1322–1331, 2010
[PubMed]
 
Addington  D;  McKenzie  E;  Addington  J  et al:  Performance measures for early psychosis treatment services.  Psychiatric Services 56:1570–1582, 2005
[CrossRef] | [PubMed]
 
Addington  D;  Norman  R;  Adair  C  et al:  A comparison of early psychosis treatment services using consensus and evidence-based performance measures: moving towards setting standards.  Early Intervention in Psychiatry 3:274–281, 2009
[CrossRef] | [PubMed]
 
Addington  DE;  Beck  C;  Wang  J  et al:  Predictors of admission in first-episode psychosis: developing a risk adjustment model for service comparisons.  Psychiatric Services 61:483–488, 2010
[CrossRef] | [PubMed]
 
Addington  DE;  McKenzie  E;  Wang  JL:  Validity of hospital admission as an outcome measure of services for first-episode psychosis.  Psychiatric Services 63:280–282, 2012
[CrossRef] | [PubMed]
 
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