Objective measurement of psychiatric symptoms: a quality improvement process for inpatient care

The objective measurement of patient improvement and outcome in mental health is a welcome, if challenging, goal. A continuous quality improvement (CQI) project was undertaken at an extended care facility in northeastern Ohio. The objectives of the CQI project, as delineated in May 1994, were to improve the administration of the Brief Psychiatric Rating Scale (BPRS) and the presentation and use of findings.

A cross-functional team, meeting between April and September 1994, made a series of recommendations. After a training program was initiated in fall 1994, interrater reliability of the BPRS increased. A schedule for BPRS evaluations resulted in more even distribution of evaluations within a quarter.

A new work group, formed in late 1994, reviewed previous system improvements and identified future directions. For example, it decided to refine the BPRS evaluation form itself to facilitate data entry of the evaluation information and to consider possible formats for clinically useful presentation of the serial evaluation data.

Actual clinical performance improvement indicators (as opposed to the administrative compliance indicators) were instituted to notify staff of significant patient improvement or deterioration, which in turn would prompt refinement of treatment.

The interrelationships and implications of BPRS-driven clinical outcome(s), length of hospital stay, and cost of services are being considered to determine the effects of new medications and other treatments.

As the complexity and demands of mental health care continue to rapidly evolve, symptom measurement and patient outcome are set to become critical determinants in the ultimate allocation of increasingly limited resources.