Confidence in treatment results

Posted on 05/15/18 02:48:pm

As people research options for mental health or addiction treatment, they ultimately want to know one thing: does your treatment work?

Brad Riemann, PhDIt’s a fair and important question to ask, because those who come to Rogers are making a significant investment of time and resources, not to mention trusting their future to us,” comments Brad Riemann, PhD, chief clinical officer.

For more than 20 years, Rogers has been working to be able to answer the question in the most scientifically reliable way. Having refined the approach over time, Rogers conducts outcomes studies each year by analyzing approximately 600,000 assessments that patients take when they start treatment, at various points along the way, at discharge, and for many programs – 12 months later. These self-reported answers to the valid voluntary questionnaires allow us to see improvement in quality of life, depressive symptoms, obsessions and compulsions, or other indications of the patient’s mental health.

Examples of the questionnaires used for adults include:

  • Yale Brown Obsessive Compulsive Scale (YBOCS)1, which rates the severity and type of symptoms related to obsessions and compulsions
  • Quick Inventory of Depressive Symptomology (QIDS)2, which characterizes symptoms of a major depressive episode.
  • Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q)3 measures the degree of enjoyment and satisfaction experienced in various areas of daily functioning.
  • Eating Disorder Examination-Questionnaire (EDE-Q)4 assesses the overall severity of symptoms including restraint, eating concern, shape concern, and weight concern.
  • Difficulties in Emotional Regulation Scale (DERS)5 assesses emotional dysregulation symptom severity.

Putting results into action

Data from the outcomes studies are useful on many levels, starting with individual patients and extending across the industry:

  • On the individual level, since assessments are collected weekly or every two weeks depending on the program, results are used to make real-time adjustments in the approach to treatment. If a patient isn’t making progress based on these measurable metrics, there’s a tangible indication that changes are needed.
  • At the program level, Rogers is able to ensure that the overall program is effective and make adjustments as necessary.
  • Moving to the system level, the organization can compare program results across the System, share knowledge amongst sites, and replicate the therapies and approaches that are getting the best results.
  • Industry-wide, Rogers contributes to the practice of behavioral healthcare by publishing results of more than 25 outcomes studies a year in peer-reviewed medical and scientific journals and presenting at national and international conferences.

Maintaining gains

halverson.jpg“It’s gratifying to know that our treatments work, and these outcome studies allow us to quantify that our patients are getting better throughout treatment. But we also want to confirm that the new tools and skills they leave with will help them over the long haul,” explains Jerry Halverson, MD, chief medical officer.

That’s why Rogers does follow up assessments for a growing number of programs. Eventually, Rogers plans to assess all patients a year after their Rogers treatment to be certain that their improvements are sustained. 

Evolving science

With the implementation of our electronic health record in recent years, Rogers has an opportunity to collect and analyze a growing pool of data.

Brian KayBrian Kay, executive director of continuous improvement, says, “Ultimately, this allows us to better understand and demonstrate the quality of care being delivered across our system. The most exciting part is being able to use statistical analysis to gain insights into which factors contribute to the best outcomes for our patients.” 

“Our comprehensive approach to measurement-based care makes Rogers quite unique among mental health providers, and it also helps us to achieve the Quadruple Aim by assuring high quality care, comments. Dr. Halverson.

Rogers measures outcomes for each residential and outpatient program for adults and children and adolescents, and results are available at rogersbh.org under Treatment Outcomes. Referring providers may be interested in greater detail on the statistical analysis, which is available at rogersbh.org/clinicaloutcomes.

 

References
  1. Goodman, W.K; Price, L.H; Rasmussen, S.A; et al. (1989). "The Yale–Brown Obsessive–Compulsive Scale. I. Development, use, and reliability". Arch Gen Psychiatry. 46 (11): 1006–1011
  2. Rush, A. J., Trivedi, M. H., Ibrahim, H. M., Carmody, T. J., Arnow, B., Klein, D. N., ... & Thase, M. E. (2003). The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biological psychiatry54(5), 573-583.
  3. Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacology bulletin.
  4. Fairburn and Beglin, 1994Fairburn, CG and Beglin, SJ. Assessment of eating disorder psychopathology: Interview or self-report questionnaire. International Journal of Eating Disorders. 1994; 16: 363–370
  5. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54

Study demonstrates clinical and cost effectiveness of Rogers PHP and IOP continuum

A cost-benefit analysis for OCD treatment conducted by Dr. Brad Riemann, Brian Kay, and two professors has been published in the Journal of Clinical Psychiatry. The study compared the outcomes and costs of seven empirically-based treatment strategies including:

  • Antidepressant medication only
  • Antidepressant medication and antipsychotic
  • Antidepressant medication and CBT delivered one to one by a psychologist
  • Combination of medications and CBT in PHP
  • IOP only
  • PHP only
  • Combination of medications and PHP stepping down to IOP

The data analyzed included patient-reported outcome measures at admission, discharge, and one year after care as well as total charges for the care provided.

Results showed that the treatment with the highest benefit (best clinical outcomes and most cost effective) was the option of PHP stepping down to IOP. Of the seven treatment strategies analyzed, four used data from Rogers programs. The results validated that patients benefit from the outpatient continuum of care that Rogers offers.

“This study provides us with some very important findings. Specifically, someone following a continuum of care from partial hospitalization to intensive outpatient not only does better in the short run but also in the long run over the course of a lifespan when compared to other powerful treatments. The study also produced evidence that following this continuum provides significant health care cost savings,” comments Dr. Brad Riemann, PhD, chief clinical officer and study co-author.

Call 800-767-4411 or go to rogersbh.org to request a free screening.