Outcomes measurement in psychiatry: a critical review of outcomes measurement in psychiatric research and practice

BACKGROUND Outcomes are measured to establish what works, in the context of evaluative research, and to improve the quality of care that is offered. Traditional outcomes focus upon biomedical endpoints, but there is an increased interest in patient based outcomes, which measure the impact of illness or healthcare interventions on the individual and how they live their day-today life. There are reasons to expect that the application of patient based outcomes would be especially relevant to the discipline of psychiatry. AIMS To explore the measurement of outcome in psychiatric research and practice, with particular reference to patient based outcomes. METHODS 1. A critical literature review of the outcomes movement in health care. 2. A survey and systematic review of the methods used to measure outcome in evaluative psychiatric research (randomised trials and outcomes research). 3. A survey of the use of outcomes measures by UK psychiatrists in their day-to-day practice. 4. A systematic review of the effectiveness of routine outcomes measurement in improving the quality of care for those with common psychiatric disorders. RESULTS An outcomes movement has emerged in healthcare, which can be understood in social, political and economic terms. Outcomes measurement in psychiatric research is dominated by the measurement of psychiatric symptoms, with little reference to patient based measures. Practising UK psychiatrists rarely measure outcomes. There are substantial practical and attitudinal barriers to the use of outcomes instruments in NHS mental health services. There is little evidence to support the potential for routine outcomes measures to improve the quality of mental healthcare. DISCUSSION Current mental health policy places great emphasis on the measurement of outcomes, and is likely to fail. The potential for patient based outcomes to be adopted in psychiatric research and practice has yet to be realised. The need for important research into the suitability and value of patient based outcomes measures in mental health research and practice is identified