PCOMS & Integrated Care: Better Outcomes and Reduced Dropouts…Again

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In this historical series of blogs, the previous post shared how several Partners for Change Outcome Management System (PCOMS) randomized clinical trials (RCT) broadened the applicability of PCOMS across client populations and problems. This final historical blog addresses the latest RCT which was conducted in three integrated care sites.

"Garbage in, garbage out"

I discussed the criticisms raised about PCOMS and debunked them in a previous blog about a misleading meta-analysis. That analysis, based on 14 RCTs, claimed that PCOMS was effective largely due to the use of only the Outcome Rating Scale as both the intervention and outcome measure. If you have heard the expression, “garbage in, garbage out” as a description of meta-analytic studies, it certainly applies here (see our critique). Six of the 14 RCTS did not find a feedback effect. Of those 6, four studies averaged less than 4 sessions (2 studies only averaged 2 sessions) and 4 studies reported that the PCOMS protocol was followed intermittently or not at all. Those studies, of course, were not worthy of inclusion.

garbage

Although that meta-analysis incorrectly claimed that the Outcome Rating Scale was the only measure of outcome in studies finding a feedback effect (several studies used other measures as well as real world outcomes like dropout), we wanted to put that issue to rest once and for all in our latest RCT. And we did.  Using the Patient Health Questionnaire-9 (PHQ-9), a symptom-based measure of depression, as well as the ORS and premature termination rates, we examined the PCOMS feedback effect via Better Outcomes Now in three integrated care sites.

What did we find?

Patients in the feedback condition achieved significantly (nearly double the rate) more clinically significant change as measured by both the ORS and PHQ-9. Feedback condition patients also attended significantly more sessions and dropped out significantly less that treatment as usual patients. Does this sound familiar?

The study is in press. Here is the full citation:

Duncan, B.L., Reese, R.J., Lengerich, A.J., DeSantis, B., Comeau, C.V., & Johnson-Esparza, Y. (in press). Measurement-based care in integrated healthcare: A randomized clinical trial. Families, Systems, & Health.

Email me at barrylduncan@comcast.net for a pre-publication copy. More on this study when it is published.

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