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What to measure

The question of what to measure is relatively simple to answer once we understand why we are measuring. For example, if we are measuring to demonstrate that the mental health services are effective in reducing the most common symptoms and problems reported by patients seeking mental health treatment, then a patient self-report questionnaire consisting of items inquiring in a straight forward manner about the severity or frequency of symptoms and problems is needed. Any number of questionnaires exist for this purpose. They have all been shown to have items that tend to load on a common factor usually referred to as global distress. These questionnaires also correlate with one another, thus providing evidence of construct validity. Any new questionnaire containing a similar mix of items will be expected to give similar results.

Subscales can be created to measure improvement in work place productivity, quality of social supports, etc. These and other domains of “outcomes” may all be of interest to the clinician or customer. However, prior research suggests that these separate domains of “outcomes” tend to correlate with one another, so that measuring each with a separate inventory of multiple items can prove cumbersome while providing little additional real information.

If the purpose of measurement goes beyond simply evaluating outcomes and is intended to also provide information to improve outcomes, then the question of what to measure becomes somewhat more complex. Once we decide upon a measure of outcome, or outcomes, we need to then determine what additional measurements might give us information to help improve the outcomes.

For example, a growing body of research provides strong evidence of a relationship between the patient’s perception of the therapist, the therapeutic process, and the outcome of treatment. It appears likely from research, as well as real world experience, that encouraging patients to complete a brief therapeutic alliance questionnaire that is shared with the clinician is an effective strategy for improving outcomes for some patients.

Likewise, a patient’s perception of the treatment and expectation for improvement are likely to have an impact on the outcome of care. Similarly, the extent to which the patient is actively involved in making changes or utilizing skills learned in therapy is likely to have an impact on the outcome. Questions about the patient's beliefs about treatment, confidence in improvement, and active participation in treatment can give the skilled clinician information as to which patients may need more reassurance or perhaps a frank discussion about the treatment methods and expected benefits.

For more of the discussion of why to measure, see topics MeasureToEvaluate and MeasureToImprove.

-- JebBrown - 10 Jan 2007
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