Young AS (VA VISN22 MIRECC)
Chinman MJ (VA VISN22 MIRECC)
Magnabosco J (VA VISN22 MIRECC)
Hassell J (VA VISN22 MIRECC)
Cohen AN (VA VISN22 MIRECC)
Mintz J (VA VISN22 MIRECC)
The VA has made a national commitment to improve access to effective, recovery-oriented mental health services. Previously, implementing these services has been very difficult. One major barrier has been a lack of routine psychiatric outcome data. Using existing medical records, it is often impossible to identify which patients would benefit from specific services. Computerized patient self-assessment could routinely measure outcomes at minimal cost. The objective of this project was to determine whether such a system can accurately administer research-quality outcome instruments to people with severe, chronic mental illness; and to evaluate a pilot project to implement routine outcome monitoring at mental health clinics.
We developed an audio computer-assisted patient self-assessment system (PAS). Patients access this internet-based system using a touch-screen monitor, and complete a survey of symptoms, drug use, medication side-effects, and adherence. Accuracy of assessment was evaluated in patients with schizophrenia or bipolar disorder who completed duplicate surveys 20 minutes apart: once face-to-face, and once using the computer. Reliability was assessed with correlations, and bias with mode x order repeated measures ANOVAs. The PAS was implemented at two large mental health clinics, one at a VA medical center and one in a non-VA public system. The PAS generates reports for clinicians and managers. Surveys, interviews and focus groups have been conducted with patients, clinicians, and managers to evaluate system usability, usefulness, and its effect on treatment provision and care organization.
Outcomes assessed by computerized and face-to-face interviews were similar (p<.05) and highly correlated. Most patients rated the PAS as easier, more enjoyable, and preferable. Patients completed the PAS faster. The PAS cost less than $2000 per kiosk, was easily integrated into care processes, and was well received by patients. The perceived value of outcome information varied by clinician and domain, ranging from somewhat to extremely valuable.
Computerized self-assessment is a reliable and valid method for evaluating outcomes in people with chronic mental illness. It is relatively easy to implement and sustain at typical clinics.
Routine patient self-assessment has the potential to support outcome monitoring broadly in the VA. Controlled research is needed to evaluate interventions that use this approach as part of efforts to improve care.