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The dropout and the terminator: a methodological note on definitions

G R Morrow, A C Del Gaudio, P J Carpenter

    Journal of Clinical Psychology
    |July 1, 1977
    PubMed
    Summary
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    Using session counts to define patient dropouts is unreliable. Clinical judgment is more accurate than numerical criteria for identifying patient attrition in mental health services.

    Area of Science:

    • Clinical Psychology
    • Health Services Research
    • Psychiatric Epidemiology

    Background:

    • Accurate patient dropout classification is crucial for treatment efficacy and resource allocation.
    • Current methodologies for defining patient dropouts often rely on numerical criteria, such as session counts.
    • The clinical definition of patient dropout, based on expert judgment, is considered a gold standard.

    Purpose of the Study:

    • To compare the accuracy of numerical criteria (mean/median session count) versus clinical judgment in categorizing outpatients as dropouts.
    • To identify discrepancies between numerically defined dropouts and clinically defined terminators or dropouts.
    • To evaluate the validity of using session count as a proxy for patient dropout in clinical settings.

    Main Methods:

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  • A sample of 221 outpatients was analyzed.
  • Patients were categorized as dropouts using both numerical criteria (mean/median sessions) and a clinically based definition.
  • The agreement between these two classification methods was assessed.

    • Main Results:

    • Significant disagreement was found between numerical and clinical definitions of patient dropout.
    • Clinically defined terminators were frequently misclassified as dropouts using numerical criteria.
    • Many clinically defined dropouts were not identified when relying solely on the mean or median number of sessions.

    Conclusions:

    • Numerical criteria for defining patient dropouts (based on session counts) are not comparable to clinically based definitions.
    • Relying on session counts can lead to inaccurate classification of patient attrition.
    • Clinical judgment remains essential for accurately identifying and understanding patient dropout in outpatient settings.