| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ALL ISSUES | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Book Reviews |
This volume is a timely and useful reference for clinicians, researchers, providers, and payers. It is an excellent primer for designing and implementing outcome assessment for those with little training or experience in this area.
The text begins with a thorough review of the myriad factors that have come together to create a "market-driven" mental health system. A thoughtful analysis of mental health's early attempts at managed care and why these were less than successful (overemphasis on cost containment at the expense of consumer care, choices, and satisfaction) leads to a compelling argument about how to best go forward with outcome assessment, and why forward progress is absolutely necessary.
The text comprises Part One, on the conceptual and practical aspects of outcomes assessment, and Part Two, providing detailed case examples of successful outcome programs. The first topic is divided into three areas: clinical outcomes, utilization outcomes, and consumer satisfaction.
Clinical outcomes almost invariably focus on the individual consumer and on changes that occur as a result of service intervention over time. A cursory overview is given of the statistical processes involved in the measurement of change; although for most readers it will be necessary to consult additional references for more specific information.
Utilization outcomes are typically associated with economic factors. Utilization, which technically refers to the amount of service utilized, is easier to measure than clinical outcomes. However, ease of measurement in no way limits the value of this information, since utilization outcomes have proven to be an excellent predictor of costs; and hence are the variable of primary interest in cost-offset analysis.
Consumer satisfaction, the third outcome assessment area, is different from the first two in that it often requires the development of company-specific measures. The preliminary steps one must consider in instrument development are described; again, though, the interested reader will need to look elsewhere for a more comprehensive guide to instrument construction.
Methodological strategies such as change analysis, outcome prediction, and decision analysis are discussed, with the most comprehensive coverage given to decision analysis. The final chapters of Part One educate the reader about consumer characteristics that may be relevant to measure, including patient background and demographic information that may be useful for case mixing, treatment matching, or needs-based assessment.
The authors do a superb job of showing the novice clinician what to do after an outcome study has been completed. The chapter "Using Outcomes to Improve Quality" is essential reading in the navigation of corporate policy and procedure. Another notable strength is the coverage of the diverse "players" in the game of managed care. The point is well made that the goals of each player (consumers, therapists, managers, researchers, sponsors) must be considered and must eventually come together if a useful study of outcome is to be undertaken and the results fed back into the system.
Part Two provides outstanding examples of outcome studies conducted in various mental health settings and can serve as a potential model to be followed in one's own setting. Detailed scenarios from acute inpatient, outpatient, substance abuse, and child/adolescent psychiatric settings are provided. The annotated bibliography describing 26 currently available outcome measures, with references, is a valuable resource in and of itself.
The Measurement and Management of Clinical Outcomes in Mental Health is a timely volume for anyone facing the inevitable in today's health care environment: assessment of accountability via outcome studies. It provides a practical and understandable introduction to the issues of definition, assessment, measurement, methodology, and organizational maneuvering inherent in any study of mental health clinical outcome. For the novice outcome researcher, it will serve as a valuable starting point for launching into the outcomes arena. For the seasoned veteran, it may well serve as a reminder of the complexity of the phenomena we are studying and suggest ways in which to improve our research and to more effectively implement it within our institutions.
Footnotes
Dr. Burlingame is Professor and Ms. Mosier a doctoral candidate in the Department of Clinical Psychology, Brigham Young University, Provo, UT.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ALL ISSUES | SEARCH | TABLE OF CONTENTS |
