Perspective on Practice
Measuring clinical outcomes offers significant benefits to psychologists and patients. Use of outcomes measures can guide treatment decisions, pinpoint the need for additional professional education and training, and help patients recognize their own improvement. And as demand for outcome measurement proliferates across health care, psychologists are well suited to lead the development and appropriate implementation of such measurement within systems of care.
Psychologists are trained to develop outcome measures and understand how to evaluate such measures’ psychometric properties and appropriate use. Research supports routine use of outcomes assessment as a way to guide and improve care. Psychologists frequently indicate that when they measure outcomes as a routine part of care and gather information useful to treatment, patients have no concerns about completing such measures. Of course, measures are particularly meaningful to practice when the results provide direction for further provision of care and the psychologist shares the feedback with his or her patients.
The Voluntary Physician Quality Reporting System — formerly the Physician Quality Reporting Initiative — introduced by the Centers for Medicare and Medicaid Services in 2007 provides financial incentives for psychologists and other healthcare professionals who participate in Medicare to submit data on specified quality measures. In 2015, the reporting program will become mandatory, and health professionals who are eligible but don’t participate will be penalized with lower reimbursements.
Those who have used the system are aware that the measures are not outcomes measures as typically understood within psychology. That is, the PQRS measures usually are “process” measures and assess whether a practitioner did something whereas psychology outcomes measures are generally assessing changes in the patient. Third-party payers are also instituting outcomes reporting requirements, as are various organizations and institutions and these more often do assess patient change. Part of the rationale for such programs is to increase provider accountability. APA’s Criteria for the Evaluation of Quality Improvement Programs and the Use of Quality Improvement Data (PDF, 716KB) is intended to help psychologists review these and other quality improvement programs to determine the appropriateness of data collected, how such data can be used and how such programs might be implemented. One challenge for many psychologists is that it can be very difficult to identify and find measures that meet the specific needs of their practice settings. In order to address that need, APA’s 2010 President Carol Goodheart’s Advancing Practice Task Force created PracticeOUTCOMES: Measures for Psychologists, a database of information on tools useful for clinical practice. Available to members on MyAPA under APA Tools, this practical tool contains information on measure domains, features, costs and reliability, among other indicators. The database also allows members to compare measures side by side in order to help psychologists choose the right outcome measure for their practices. Information on additional measures is regularly added and members are invited to recommend measures for inclusion.
Our hope is that psychologists in practice will continue to increase their use of outcomes measures and to advocate for the appropriate inclusion of measurement across practice settings. When well thought out and implemented, outcomes measures can benefit individual practice and patients as well as the discipline. While psychologists are well aware of the benefits of quality psychotherapy, it can often be difficult to demonstrate those benefits to others in health care. Routine use of outcome measures is one strategy to capture data regarding psychology’s positive clinical outcomes. Appropriate sharing of such information with other health-care providers can only serve to enhance collaboration, leading to increased recognition of the value of psychological service and ultimately to improved access and care for patients who need psychological help.
For further information about PracticeOUTCOMES, please contact Dr. Lynn Bufka. As always, I welcome your comments.