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Measuring the outcome of psychiatric care using clinical case notes

Akerman, Marco; (1993) Measuring the outcome of psychiatric care using clinical case notes. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

This thesis addresses the question: 'Can case notes be used to measure the outcome of psychiatric treatment?' Patient's case notes from three psychiatric units (two in-patient and one day hospital) serving Camden, London (N=225) and two units (one in-patient and one day- hospital) in Manchester (N=34) were used to assess outcome information of psychiatric care in terms of availability (are comparable data present for both admission and discharge?), reliability (can this data be reliably extracted?), and validity (are the data true measures?). Differences in outcome between units and between diagnostic groups were considered in order to explore the possibility of auditing the outcome of routine psychiatric treatment using case notes. Availability: For the Camden patients, 57% of all symptoms ratings made from their case notes were considered available information on admission and 55% of the symptoms reported as present on admission were also reported on discharge and could be assessed for change. However, the proportion of behaviour (8%) and social (32%) items reported in the case notes was very much lower. Reliability: Two observers compared abstracting for 15 Camden case notes and showed kappa coefficients ranging from 0.65 to 0.85. Validity: Symptom and syndrome ratings in the Manchester case notes were compared with independent Present State Examination (PSE) ratings and showed overall measures of sensitivity (0.43 and 0.56), of specificity (0.91 and 0.95) and of positive predictive value (0.62 and 0.69), respectively. Scores of change at discharge in the Manchester notes were compared with independent Comprehensive Psychopathological Rating Scale (CPRS) measurements and showed weak association. The results indicate that routine case notes do not contain complete information to assess the outcome of psychiatric treatment and prospective collection would be needed to improve availability of data. There was no difference in the average improvement of Camden patients between the three settings when symptom change between admission and discharge were assessed, a finding which is supported by studies in the literature comparing outcome of different sites of treatment.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Measuring the outcome of psychiatric care using clinical case notes
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Thesis digitised by ProQuest.
Keywords: Health and environmental sciences; Clinical case notes; Psychiatric care
URI: https://discovery.ucl.ac.uk/id/eprint/10109866
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