1 / 36

CORE

CORE. Managing care provision for patients with mental disorders under NHS conditions in the UK Stuttgart, March 2002. CORE. C linical O utcomes in R outine E valuation. Scientific & Service Partners. Authors Michael Barkham Chris Evans

dexter-dejesus
Download Presentation

CORE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CORE Managing care provision for patients with mental disorders under NHS conditions in the UK Stuttgart, March 2002

  2. CORE • Clinical • Outcomes in • Routine • Evaluation

  3. Scientific & Service Partners Authors Michael Barkham Chris Evans Frank Margison John Mellor-Clark Janice Connell Chris Leach Mike Lucock

  4. Primary Funders • Mental Health Foundation • Counselling in Primary Care Trust

  5. NHS Implementation Programme • By end March 2001: HA should have in place protocols agreed and implemented between primary and specialist mental health services for the management of depression, anxiety disorders, ….. those requiring psychological therapies • By end March 2002: all HA should have reviewed these protocols to ensure they are being used and operating effectively.

  6. How the NHS is organised • Primary and secondary care • Primary Care Trusts now commissioners of services • Secondary care and primary care have psychological therapies • Severe, enduring mental illness a key target • Poor implementation of psychological treatments for severe disorders

  7. NHS initiatives • National Service Frameworks (one for mental health) • Local Implementation teams • Definite targets and priorities • Care Programme Approach • Suicide Prevention • New neuroleptics (NICE)

  8. Initiative meltdown!! • Integration of health and social care (new Health and Social Care Trusts) • Clinical and service governance • R&D re-organisation of funding • Appraisal • Guidelines • and Outcomes monitoring!

  9. Complementary paradigms Evidence-based Practice Practice-based Evidence

  10. Efficacy studies Randomised Controlled Trials Evidence-based practice as policy Practitioners Practice-based evidence Effectiveness studies Routine Clinical Treatment Practitioners

  11. Practice-based research • Logic, feasibility and plausibility should govern planning, data collection, and interpretation • Basic tenets of measurement remain: • validity, reliability, control of bias • completeness of data

  12. Requirements of a “core” measure • Pragmatic and user-friendly • Acceptable psychometric properties • Implementation on a broad basis • Computer-scannable • Co-ordinating centre • Extensions to other domains

  13. What is the CORE-OM? • 34 items on two sides of A4 • tick box completion • five response levels (0 to 4) • pan-theoretical (“CORE”) • simple language • hand scorable • computer scannable • short forms available

  14. CORE-System Practitioner Patient CORE Therapy Assessment Form Referral, support systems, use of services, medication, identified problems, risk, patient coping strategies CORE-OM CORE-SF A/B/A/B CORE End of Therapy Form Type of therapy, frequency, ending, risk, identified problems, benefits of therapy, change in medication CORE-OM

  15. Hub & Spoke Problem-specific core batteries Referential measures CORE

  16. What does it measure? • Four domains covered • Subjective well-being • Social functioning • Problems/symptoms • Risk • to self (harm/suicide) • to others • Eight items positively keyed • Mixture of high and low threshold items

  17. Clinical vs. non-clinical

  18. Stability of norms

  19. CORE-Support On site hand scoring CORE-OM PC On site data mounting & analysis CORE Team comprehensive analysis of CORE System Service Provider CORE Team processing of CORE-OM

  20. CORE Family of Measures CORE-OM Adults Older Adults Translations CORE-GP General Population Teen-CORE Adolescents Kiddy-CORE Children

  21. CORE Implementation T I M E C O R E-Short Form CORE-OM S E V E R I T Y CORE-Non Risk CORE-GP

  22. Severity Pre-therapy Time Post-therapy

  23. Service effectiveness

  24. Continuous outcome monitoring

  25. Current work I • CORE-GP CORE for the general population. 14 items (risk and high-level items removed) • Students, n=6000 • Compares well to GHQ-12 (.85 correlation) • Use for detection and screening • Then continue with full version

  26. Current work II • Norms for CORE 65+ • Means and cut-off broadly comparable to <65 population • Means somewhat lower: • Clinical 1.49 65+ 1.87 <65 • Non-clinical 0.63 65+ 0.76 <65

  27. Current work III • Teen-CORE • Several sites gathering clinical data • Jeremy Christie collecting normative data • “Kiddie-CORE” • still conceptual, design and methodological issues

  28. Current work IV • Translated versions of CORE • Cantonese version performs well • Norwegian version being prepared • other European language versions needed

  29. Current work V • Influencing the national agenda • Priority on severe and enduring mental illness • use of HoNOS and FACE • CORE for primary care?

  30. Conclusions • Need both efficacy and effectiveness studies • Need to develop a national network to advance ‘effectiveness’ agenda within context of clinical governance (i.e., quality) • Need to adopt standard core outcome battery + referential measures (i.e., UK appropriate norms) • Progress to the adoption of ‘systems’ of service evaluation (e.g., CORE System/FACE System) • Address problem of attrition • Build national data base to inform clinical effectiveness

More Related