Measuring Outcomes

Brian EastwoodTOP Implementation Manager2 June 2009

Measuring Outcomes

(in the drug field)

Clinical tool

Performance assessment

Value for money

Capacity to predict, measure and report

Are US studies applicable to UK population?

TOP will help answer questions

Shift from proxy to real outcomes

Key performance indicators

•Numbers in effective treatment

•Waiting times

•12 week retention

What we are planning to do with the data (1)

Level 0 Baseline Report

Level 1 Exit report

Baseline Follow up

0

28

A note on the reliable change index

Formula for RCI = x2 - x1

Sdiff

We first have to calculate the standard error of the difference term: Sdiff = √ 2 (SE)2 Where: SE = S1 √ 1 – rxx

RCI is conservative. There is a substantial boundary that must be crossed in order to be

deemed different – be it improved or deteriorated

A note on the reliable change index – is it reflected in other domains?

-12

-10

-8

-6

-4

-2

0

2

4

6

Psychological health Physical health Quality of life Injecting

AbstinentImprovedUnchangedDeteriorated

• Two agencies delivering the same treatment modality and agency Y is twice as effective as agency X

BUT

• Agency X has twice the proportion of service users who are associated with poor outcome than agency Y.

• With case-mix adjustment agency X is shown to be relatively more effective.

• Case-mix adjustment captures the relative progress made given the starting point.

X Y

A note on the case mix adjustment

What we are planning to do with the data (2)

Research into

Opioid and crack treatment effects

RCI

Tier 4

Cannabis

Employment, education and housing

Injecting

Health

Death

Integration into future key performance indicators

Measuring Outcomes

- Alcohol?

Is it appropriate for alcohol clients?

Could it be a useful clinical tool?

Working group to investigate TOP as a possibility?

Develop a new outcomes measure?