Development of a core set of performance measures for evaluating schizophrenia treatment services

The purpose of study was to identify a list of performance measures for schizophrenia treatment services and to assemble a multistakeholder group to reach consensus on a core list.

The study was conducted in two stages: first, a systematic review of the literature was conducted to identify a comprehensive list of measures; second, a consensus-building technique, the Delphi process, was used with participants from six groups of stakeholders: schizophrenia experts, mental health clinicians, mental health administrators, the payer (the Alberta Ministry of Health and Wellness), patients, and family members. Thirty stakeholders participated in three rounds of self-completed questionnaires. The degree of consensus achieved in the Delphi process was defined as the semi-interquartile range for each measure.

Ninety-seven measures were identified in the literature review. The Delphi method reduced the list to 36 measures rated as essential. The measures address eight domains of service-level evaluation: acceptability, accessibility, appropriateness, competence, continuity, effectiveness, efficiency, and safety. Despite the diversity in backgrounds of the stakeholder groups, the Delphi technique was effective in moving participants' ratings toward consensus through successive questionnaire rounds. The resulting measures reflected the interests of all stakeholders.

Several further steps are required before these measures are implemented and include working toward reliability and validity of specific measures, assessing the feasibility and cost-effectiveness of collecting the data, and finally, undertaking risk adjustment for outcome measures.