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Measuring Outcomes
Brian Eastwood
TOP Implementation Manager
2 June 2009
Measuring Outcomes
(in the drug field)
Key performance indicators
•Numbers in effective treatment
•Waiting times
•12 week retention
Clinical tool
Performance assessment
Value for money
Capacity to predict, measure and report
Are US studies applicable to UK population?
TOP will help answer questions
Shift from proxy to real outcomes
What we are planning to do with the data (1)
Level 0 Baseline Report
Level 1 Exit report
A note on the reliable change index
Formula for RCI =
28
x2 - x1
Sdiff
We first have to calculate the standard
error of the difference term:
Sdiff = √ 2 (SE)2
Where:
0
Baseline
Follow up
SE = S1 √ 1 – rxx
RCI is conservative. There is a substantial
boundary that must be crossed in order to be
deemed different – be it improved or
deteriorated
A note on the reliable change index –
is it reflected in other domains?
6
4
2
0
-2
-4
-6
-8
-10
-12
Psychological health
Physical health
Abstinent
Improved
Unchanged
Deteriorated
Quality of life
Injecting
A note on the case mix adjustment
X
Y
• Two agencies delivering the same treatment modality and
agency Y is twice as effective as agency X
BUT
• Agency X has twice the proportion of service users who are associated with poor
outcome than agency Y.
• With case-mix adjustment agency X is shown to be relatively more effective.
• Case-mix adjustment captures the relative progress made given the starting
point.
What we are planning to do with the data (2)
Research into
Opioid and crack treatment effects
RCI
Tier 4
Cannabis
Employment, education and housing
Injecting
Health
Death
Integration into future key performance indicators
Measuring Outcomes
- Alcohol?
Is it appropriate for alcohol clients?
Could it be a useful clinical tool?
Working group to investigate
TOP as a possibility?
Develop a new outcomes
measure?