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OUTCOMES
Pages 226-240

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From page 226...
... in Appendix B points out. Differences in types of problems, the severities of problems, stages of illness and recovery, and other patient characteristics require a range of services and a multidimensional approach to measuring outcomes (Burnam, in press; Miller et al., 1995~.
From page 227...
... are not often found in managed care treatment systems and therefore cannot be included in current managed care outcomes studies. An additional issue affecting the definitions of outcomes for mental health and substance abuse treatment has to do with the public and policy expectations of treatment.
From page 228...
... We believe that the full evaluation of an organization has to combine knowledge of current outcomes with the standards-based information that lets you know and predict future outcomes. Paul Schyve Joint Commission on Accreditation of Healthcare Organizations Public Workshop, April 18, 1996, Washington, DC In approaching these multidimensional questions, the committee takes an evidence-based approach to defining outcomes in populations with substance abuse and mental health problems.
From page 229...
... It is also important to distinguish between outcomes measures that are broadly relevant to mental health-, alcohol-, and drug-related conditions and those that are specific to the different disorders and conditions, characteristics of patients with the disease, and particular levels of treatment. This chapter provides a general framework for the development of performance measures in the context of outcomes research.
From page 230...
... ~ General Measures of outcome in Behavioral Health Many variables are common to substance abuse and mental health treatment (see Table 7.2~. Some of the newly developed outcomes information management systems may make outcomes assessment more feasible to achieve (Kane et al., 1995)
From page 231...
... . Thus, Figure 7.1 provides an analytical framework for the development of an outcomes research base.
From page 232...
... The relative electiveness of different approaches needs to be known, and routine monitoring of outcomes in a treatment setting or system of care can be a basis for continuous quality improvement within a treatment delivery organization (Berwick, 1989~. A 1990 IOM study argued, "In a larger sense, outcome data provide an ethical justification for purveying treatment and a means of improving its electiveness.
From page 233...
... PERFORMANCE INDICATORS AS OUTCOMES MEASURES Table 7.3 lists potential performance indicators as outcomes measures that emerge from the outcomes literature. In addition to recognizing the importance of these treatment characteristics, studies have demonstrated the efficacies of particular treatment methods, such as coping skills training, cognitive behavioral therapies, methadone treatments at particular dosage levels, naltrexone therapy (naltrexone is a narcotic antagonist)
From page 234...
... Then, ongoing performance outcomes linked research can assess how well programs are doing, given what should be expected in terms of treatment characteristics and case mix. For a variety of practical and ethical reasons, however, it is not always possible to conduct highly controlled research to evaluate the impacts of various structural and process components of treatment on outcomes.
From page 235...
... However, some managed care organizations (such as Kaiser Permanente and Group Health Cooperative of Puget Sound) are initiating the use of routine outcomes monitoring systems; for example, they are establishing internal research divisions that perform research on their own internal standards and outcomes or contract with outside entities to conduct evaluations.
From page 236...
... Potential Data Sources for Outcomes Research The only data source that can truly assess outcomes is client-level outcome information. This usually involves sample surveys of clients, often combined with other indicators assessing the validity of selEreports, such as breath analysis and urinalysis in substance abuse studies.
From page 237...
... External moni' toting brings with it a higher potential for standardization across programs, the input of those with expertise in methodologies, and the credibility that comes from independent evaluations. Internal monitoring lacks those particular strengths, but offers the ability to collect the precise kinds of data most useful to managed care organizations in improving their particular programs.
From page 238...
... John Bartlett American Managed Behavioral Healthcare Association Public Workshop, April 18, 1996, Washington, DC SUMMARY Outcomes research does not yet explicitly identify those performance indicators associated with good outcomes across patient characteristics and types of pro' grams. Furthermore, few outcomes studies are under way that will provide this specific information, especially across types of managed care organizations and patient characteristics, in the near future.
From page 239...
... In the committee's view, outcomes research is vitally important to improving the evidence base for treatment electiveness. However, much needs to be done to standardize outcomes information and to link findings from outcomes research with the development of practice guidelines, performance measures, and accredit ration approaches.
From page 240...
... 1991. Treatment outcomes for drug abuse clients.


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