Expensive Detour or a Way Forward? The Experience of Routine Outcome Measurement in an Aged Care Psychiatry Service

Objective: This paper describes and reflects upon the experience of a small, integrated aged care psychiatry service that has utilized the National Outcomes Casemix Collection (NOCC) routine outcome measurements within clinical practice, service management and evaluation. The goals of the NOCC initiative are reviewed in light of this experience. Conclusion: Routine outcome measurement has the potential to significantly improve aged care psychiatric service delivery. The service described has developed a model that the authors believe demonstrates the potential for routine outcome measures to improve the monitoring of patient progress, care planning, team communication, management and the understanding of service effectiveness – goals that are consistent with NOCC philosophy. However, this requires both ongoing development of infrastructure support and the willingness of clinicians to explore their utility.

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‘Traversing difficult terrain’. Advance care planning in residential aged care through multidisciplinary case conferences: A qualitative interview study exploring the experiences of families, staff and health professionals

Palliative Medicine ◽

10.1177/02692163211013250 ◽

2021 ◽

pp. 026921632110132

Author(s):

Suzanne Rainsford ◽

Sally Hall Dykgraaf ◽

Rosny Kasim ◽

Christine Phillips ◽

Nicholas Glasgow

Keyword(s):

Advance Care Planning ◽

Health Professionals ◽

Aged Care ◽

Shared Responsibility ◽

Care Staff ◽

Residential Aged Care ◽

Care Planning ◽

Qualitative Interview Study ◽

Case Conferences ◽

Advance Care

Background: Advance care planning improves the quality of end-of-life care for older persons in residential aged care; however, its uptake is low. Case conferencing facilitates advance care planning. Aim: To explore the experience of participating in advance care planning discussions facilitated through multidisciplinary case conferences from the perspectives of families, staff and health professionals. Design: A qualitative study (February–July 2019) using semi-structured interviews. Setting: Two residential aged care facilities in one Australian rural town. Participants: Fifteen informants [family ( n = 4), staff ( n = 5), health professionals ( n = 6)] who had participated in advance care planning discussions facilitated through multidisciplinary case conferences. Results: Advance care planning was like navigating an emotional landscape while facing the looming loss of a loved one. This emotional burden was exacerbated for substitute decision-makers, but made easier if the resident had capacity to be involved or had previously made their wishes clearly known. The ‘conversation’ was not a simple task, and required preparation time. Multidisciplinary case conferences facilitated informed decision-making and shared responsibility. Opportunity to consider all care options provided families with clarity, control and a sense of comfort. This enabled multiple stakeholders to bond and connect around the resident. Conclusion: While advance care planning is an important element of high quality care it involves significant emotional labour and burden for families, care staff and health professionals. It is not a simple administrative task to be completed, but a process that requires time and space for reflection and consensus-building to support well-considered decisions. Multidisciplinary case conferences support this process.

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Service user and clinician perspectives on the use of outcome measures in psychological therapy

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x15000598 ◽

2015 ◽

Vol 8 ◽

Cited By ~ 2

Author(s):

Graham R. Thew ◽

Louise Fountain ◽

Paul M. Salkovskis

Keyword(s):

Clinical Practice ◽

Service User ◽

Outcome Measurement ◽

Psychological Therapy ◽

Service Development ◽

Service Users ◽

Routine Outcome Measurement ◽

Episode Of Care ◽

Wide Range ◽

Clinician Perspectives

AbstractWhile the benefits of routine outcome measurement have been extolled and to some degree researched, it is surprising that service user opinions on this common therapy practice have largely not been investigated. This study aimed to assess service users’ experiences of completing measures during psychological therapy, with a view to exploring how therapists can maximize how helpful measures are in therapy. Fifteen participants completed surveys about the use of measures in their current episode of care. Ten clinicians also completed a survey about their use of, and views about, measures. Results showed that despite mixed experiences in how measures were explained and used, service users showed generally favourable attitudes towards their use in therapy, with them being perceived as most helpful when well integrated into sessions by their therapists. Clinicians reported using a wide range of measures, and generally endorsed positive beliefs about measures more strongly than negative ones. Implications for clinical practice, service development, and further research are discussed.

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