Outcomes and computers: a happy marriage. (outcome management for patients with chemical dependencies)

Outcomes management is not just the latest trendy buzzword to be generated by managed care. When conducted well, it yields remarkably important information that can improve clinical efficacy, as well as serve as a remarkable aid in practice/facility management and marketing in a very competitive arena.

It is also true that a central focus in behavioral health care today is on the outcome of chemical dependency treatment services. The ever-increasing demand for more quality and value from treatment, in tandem with fewer health care dollars, creates a marked need for being able to demonstrate clinical efficacy. Outcomes management has tour basic components: 1) patient satisfaction (globally integrated systems thai incorporate a variety of areas, including satisfaction studies of staff, clinicians, referral sources. and payors); 2) treatment outcomes (pre- versus post-treatment measures of symptom reduction from the patient's perspective and from independent measures by the clinician); 3) post-treatment follow-up studies (data collected at various points to monitor treatment efficacy: lack of recidivism/relapse. continued symptom containment or reduction, successful return to work/school. etc.); and 4) methods with which to associate the costs of various treatment methods and outcomes.

To date, treatment efficacy has only been studied in psychotherapeutic interventions; Eysnick's pioneering, yet methodologically flawed, research in the 1950s started the ball rolling. Many subsequent studies, however, have been almost doomed from the start to have limited generalizability or some other shortcoming. Few researchers, and even fewer clinicians, can agree on protocol, methodology, instrumentation, sampling, or statistical analyses for conducting such investigations.

One may then wonder how a practicing clinician, group, or facility may undertake such a study to any beneficial end.

First of all, outcomes management need not be sterile, overly controlled "bench" research. Scientists tend to prefer placebo treatments and control groups, but there is no less "science" in outcomes management. For clinicians, the process is more "micro-science." That is, outcomes management at the facility level does not seek to answer the bigger questions of "What technique is better?" or "Does psychotherapy work?" Instead it provides the facility with specific, ongoing feedback on its efficacy and efficiency of treatment. (Presumably various facilities combining their findings can address the larger questions.)

The clinician may feel a modicum of relief at realizing outcomes management is a "micro-science," yet is typically still concerned about finding the time and money to conduct such research. A growing number of consulting groups and subcontractors provide assistance in everything from structuring to running a system. Depending on volume of practice, program, or facility, such consulting firms may be quite cost-effective.

However, for others, doing-it-yourself may be an option. In undertaking a self-managed outcome research system, the fundamental building blocks are 1 ) a strong methodology that, "fits" in the practice (otherwise one risks "garbage in, garbage out" syndrome); and 2) computerization (literacy a must, fluency preferred). Methodology should include an informed consent form signed upon admission or at a first session. It should meet the Federal standard s for protection of human subjects. (A sample is attached, see Figure 1). Methodological procedures should also be designed to parallel one's standard treatment protocol. This will increase some paperwork, but streamlining makes this an efficient process .