PCOMS, Diagnosis and Acute Inpatient Care

Diagnosis and Acute Inpatient Care

Two recently published articles are now available--both take PCOMS to different places. The first discusses PCOMS as an alternative to psychiatric diagnosis. Rather than just giving lip service to the critique of diagnosis, this article proposes PCOMS as way to provide "second order change" and move away from diagnosis all together.  Here are the reference and abstract:

Duncan, B., Sparks, J., & Timimi, S. (2017). Beyond Critique: The Partners for Change Outcome Management System as an Alternative Paradigm to Psychiatric Diagnosis. Journal of Humanistic Psychology. 1-23. DOI: 10.1177/0022167817719975

Critics claim that current psychiatric diagnostic systems lack reliability, validity, and clinical utility; are incompatible with known evidence of how change occurs in psychotherapy; are compromised by bias; and risk harmful effects for clients. This article argues that the Partners for Change Outcome Management System (PCOMS), a transparent, egalitarian process

that collects and utilizes client feedback at each session, convincingly addresses these concerns. Furthermore, it suggests that PCOMS offers a viable alternative to the reimbursement and administrative functions of the Diagnostic and Statistical Manual of Mental Disorders  and the International Classification of Diseases. The authors propose that PCOMS represents a

radical realignment of the practitioner/client relationship via full, dialogical partnership at every level of psychotherapy practice and thus constitutes a step toward a new paradigm that reconnects psychotherapy and humanistic psychology with its core relational values.

The second articles takes PCOMS into an inpatient psychiatric unit.PCOMS improved the quality of care and was correlated with reduced readmission rates at an acute care inpatient unit.

Reese, R.J., Duncan, B., Kodet, J., Brown, H., Meiller, C., Farook, M., Lengerich, A., Vasilj I., Hong, S., & Bohanske, R. (2017). Patient feedback as a quality improvement strategy in an acute care, inpatient unit: An investigation of outcome and readmission rates. Psychological Services. http://dx.doi.org/10.1037/ser0000163

High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. Benchmarks were constructed using randomized clinical trials (RCTs) from inpatient treatment for depression, RCTs from patient feedback in outpatient settings, and national data on psychiatric hospital readmission rates. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression. Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide a path toward lower readmission rates in addition to other evidence-based strategies after discharge.

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