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The Met Needs Index: a new metric for outcome assessment in mental health care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
2010 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 45, no 3, 425-432 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: No apt method has been available to assess and monitor the responsiveness of services in meeting ongoing needs of patients with long-term mental illness. The present study examines the utility of a new metric for such a purpose, the Met Needs Index (MNI), applied to the Camberwell Assessment of Need (CAN). METHODS: The MNI was estimated as an aggregated measure of met need or beneficial outcome, based on annual staff rated CAN-assessments of 321 outpatients (76% psychotic disorders) in psychiatric care during 7 years. Corresponding confidence intervals were estimated with the bootstrap percentile method. RESULTS: The overall MNI was estimated at 0.71 (95% CI 0.69-0.74), indicating that identified needs in general were met during 71% of the intervals between the annual assessments. However, the MNI for specific need domains of the CAN ranged from 0.89 (95% CI 0.84-0.93) for 'food' to 0.11 (95% CI 0.07-0.16) for 'sexual expression', indicating a significant variation in responsiveness of services to different types of need in this patient population. CONCLUSIONS: The MNI seems to be a useful and powerful metric for outcome assessment and monitoring of psychiatric services from a needs assessment approach.

Place, publisher, year, edition, pages
2010. Vol. 45, no 3, 425-432 p.
Keyword [en]
Needs assessment, Outcomes measures, Mental health care, Services evaluation, Severe mental illness
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-122805DOI: 10.1007/s00127-009-0080-yISI: 000274854200016PubMedID: 19533002OAI: oai:DiVA.org:uu-122805DiVA: diva2:311090
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2011-01-12Bibliographically approved
In thesis
1. The Camberwell Assessment of Need as an Outcome Measure in Community Mental Health Care
Open this publication in new window or tab >>The Camberwell Assessment of Need as an Outcome Measure in Community Mental Health Care
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.

We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.

A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.

In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2008. 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 310
Keyword
Psychiatry, needs assessment, outcome measures, mental health care, health service evaluation, severe mental illness, psychotic disorders, Psykiatri
Identifiers
urn:nbn:se:uu:diva-8439 (URN)978-91-554-7085-2 (ISBN)
Public defence
2008-03-06, Föreläsningssalen, Museum Gustavianum, Akademigatan 3, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-02-14 Created: 2008-02-14 Last updated: 2011-01-12Bibliographically approved

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