Behavioural and Cognitive Psychotherapy

Research Article

Benchmarking Routine Psychological Services: A Discussion of Challenges and Methods

Jaime Delgadilloa1 c1, Dean McMillana2, Chris Leacha3, Mike Lucocka3, Simon Gilbodya4 and Nick Wooda5

a1 Leeds Community Healthcare NHS Trust, UK

a2 University of York, UK

a3 South West Yorkshire Partnership NHS Foundation Trust and University of Huddersfield, UK

a4 University of York, UK

a5 Leeds Community Healthcare NHS Trust, UK

Abstract

Background: Policy developments in recent years have led to important changes in the level of access to evidence-based psychological treatments. Several methods have been used to investigate the effectiveness of these treatments in routine care, with different approaches to outcome definition and data analysis. Aims: To present a review of challenges and methods for the evaluation of evidence-based treatments delivered in routine mental healthcare. This is followed by a case example of a benchmarking method applied in primary care. Method: High, average and poor performance benchmarks were calculated through a meta-analysis of published data from services working under the Improving Access to Psychological Therapies (IAPT) Programme in England. Pre-post treatment effect sizes (ES) and confidence intervals were estimated to illustrate a benchmarking method enabling services to evaluate routine clinical outcomes. Results: High, average and poor performance ES for routine IAPT services were estimated to be 0.91, 0.73 and 0.46 for depression (using PHQ-9) and 1.02, 0.78 and 0.52 for anxiety (using GAD-7). Data from one specific IAPT service exemplify how to evaluate and contextualize routine clinical performance against these benchmarks. Conclusions: The main contribution of this report is to summarize key recommendations for the selection of an adequate set of psychometric measures, the operational definition of outcomes, and the statistical evaluation of clinical performance. A benchmarking method is also presented, which may enable a robust evaluation of clinical performance against national benchmarks. Some limitations concerned significant heterogeneity among data sources, and wide variations in ES and data completeness.

(Online publication October 24 2012)

Keywords:

  • Benchmarking;
  • primary care;
  • depression;
  • anxiety

Correspondence

c1 Reprint requests to Jaime Delgadillo, Leeds Community Healthcare NHS Trust - Primary Care Mental Health, The Reginald Centre, Second Floor, 263 Chapeltown Road, Leeds LS7 3EX, UK. E-mail: jaime.delgadillo@nhs.net

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