The application of statistical process control to manage global client outcomes in behavioral healthcare.

Statistical process control (SPC) techniques were applied to simulate monitoring the process of outpatient service delivery at two mental health centers using data collected 23 years earlier. Clients included in this study received between two and 21 psychotherapy visits during the previously conducted evaluation study. Global outcomes for clients were derived from weekly ratings of functioning provided by the client and therapist. The self-report and therapist ratings were aggregated, then combined across visits to estimate the rate of linear change in functioning. Rates of change were plotted in a control chart format, using the moving average of two scores to estimate the range. Special causes of high variability and a downward trend were noted for all discharges at both centers. Control limits were re-estimated for the discharges following the downward trend in scores. Subsequently, the service processes supporting global client outcomes no longer varied uncontrollably. However, upon estimating specification limits for global client outcomes, it was noted that the mean level of client outcome fell below the mean specified as the target and that some discharges yielded unacceptable outcomes.

[1]  John S. Oakland,et al.  Statistical Process Control , 2018 .

[2]  M. Gann,et al.  Total Quality Management in Health Care: A View of Current and Potential Research , 1994, Medical care review.

[3]  F. L. Newman.  Strengths, uses and problems of global scales as an evaluation instrument. , 1980, Evaluation and program planning.

[4]  Raymond G. Carey,et al.  Measuring Quality Improvement in Healthcare: A Guide to Statistical Process Control Applications , 2000 .

[5]  D. Nash,et al.  Managed care: past, present, and future. , 1996, The Medical clinics of North America.

[6]  P E Plsek.  Tutorial: Introduction to control charts , 1992, Quality management in health care.

[7]  D Blumenthal,et al.  The case for using industrial quality management science in health care organizations. , 1989, JAMA.

[8]  John B. Willett,et al.  Understanding correlates of change by modeling individual differences in growth , 1985 .

[9]  W. Lutz,et al.  Evaluation of psychotherapy. Efficacy, effectiveness, and patient progress. , 1996, The American psychologist.

[10]  J. C. Gerard,et al.  Performance improvement with a hybrid FOCUS-PDCA methodology. , 1996, The Joint Commission journal on quality improvement.

[11]  K. Wells,et al.  Issues and approaches in evaluating managed mental health care. , 1995, The Milbank quarterly.

[12]  Frederick L. Newman,et al.  Integrated clinical and fiscal management in mental health : a guidebook , 1985 .

[13]  R H Brook,et al.  Managed care is not the problem, quality is. , 1997, JAMA.

[14]  D. W. Young,et al.  Implementing total quality management in health care. , 1995, The Joint Commission journal on quality improvement.

[15]  D M Berwick,et al.  Continuous improvement as an ideal in health care. , 1989, The New England journal of medicine.

[16]  P B Batalden,et al.  Report cards or instrument panels: who needs what? , 1995, The Joint Commission journal on quality improvement.

[17]  D H Gustafson,et al.  Findings of innovation research applied to quality management principles for health care , 1995, Health care management review.

[18]  J. Iglehart,et al.  The American health care system. Managed care. , 1992, The New England journal of medicine.

[19]  A. Rosenblatt,et al.  Assessing outcomes for sufferers of severe mental disorder: A conceptual framework and review , 1993 .

[20]  F. L. Newman,et al.  Criteria for Selecting Instruments to Assess Treatment Outcomes , 1996, Outcome Assessment in Residential Treatment.

[21]  R. S. Green.  Three dimensions mental health professionals emphasize when judging levels of functioning of the severely mentally disabled in the community , 1993 .

[22]  D. W. Edwards,et al.  National health insurance, psychotherapy, and the poor. , 1979, The American psychologist.

[23]  Chip Caldwell.  The handbook for managing change in health care , 1999 .

[24]  A. Enthoven,et al.  A vision of quality in health care delivery. , 1997, Health affairs.

[25]  Marie E. Sinioris,et al.  Total quality management : the health care pioneers , 1992 .

[26]  E. O'Connor,et al.  Assessing the impact of continuous quality improvement/total quality management: concept versus implementation. , 1995, Health services research.

[27]  David Rogosa,et al.  A growth curve approach to the measurement of change. , 1982 .

[28]  E. Ziegel.  Juran's Quality Control Handbook , 1988 .

[29]  W. Edwards Deming,et al.  Out of the Crisis , 1982 .