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Book Review   |    
The Measurement and Management of Clinical Outcomes in Mental Health
David A. Pollack, M.D.
Psychiatric Services 1998; doi:
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by John S. Lyons, Kenneth I. Howard, Michael T. O'Mahoney, and Jennifer D. Lish; New York City, John Wiley & Sons, 1997, 290 pages, $55

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For most of us in community and public-sector mental health practice, the concept of outcomes is both an old and a new idea. We have always been alert to the effects of our services and have used the results of program and individual treatment interventions to justify our continued funding and existence. However, with the advent of managed care systems and eroding public funding for services, we are being pushed even harder to demonstrate the effectiveness of our services to a variety of interested parties.

This book is intended for administrators and clinicians in a range of mental health settings, but it is obviously appropriate for organized mental health care systems, especially those with public-sector patients. It is clearly laid out and progresses logically from the conceptual framework and methodology for conducting various forms of outcomes activities to the practical application of those techniques to address service delivery questions in a variety of settings.

The first section begins by laying out the importance of outcomes as a form of accountability in the age of managed care. However, it quickly proceeds to actual principles for what, how, and when to measure. The authors effectively describe and interrelate the various approaches to outcomes measurement with the purposes and methods of outcomes management, with particular emphasis on clarifying whether the goals are for change analysis, decision analysis, or outcomes prediction. The three chapters that lay out these complicated concepts and methods are very well written, but may require a second or third reading to fully integrate their combined value.

The next chapter describes the importance of systematically attending to various consumer characteristics, such as demographic characteristics, diagnosis, functioning, illness or symptom severity, and social supports, in order to accomplish three goals of outcomes management—namely, treatment matching (for example, level-of-care decisions), case- mix adjustment, and needs-based planning. The last two chapters in this section focus on the relationship between outcomes management and quality improvement and the need to recognize the potential ethical, psychological, and organizational barriers to implementing these strategies successfully.

The second section applies the methods described in the first to a sequence of clinical service settings. These chapters give real examples of how specific outcomes projects have been, and can be, used to improve care, justify continued funding, refine level-of-care decisions, and manage service utilization. The settings include acute psychiatric, adult outpatient, addictions, child and adolescent, and community-based care systems.

The authors, who are mainly associated with managed care and outcomes assessment at Northwestern University, have done a terrific job of assembling a very complicated and crucial body of information in a most presentable and understandable way.The Measurement and Management of Clinical Outcomes in Mental Healthwill likely find its way into the offices of many administrative and clinical directors as we all struggle with the mandate to honestly and economically demonstrate the value and impact of the services we provide. I cannot recommend it highly enough.

Dr. Pollack is medical director of Mental Health Services West and associate director of the public psychiatry training program at Oregon Health Sciences University in Portland.

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