The importance of reliable and complete data
Ongoing monitoring and outcomes collection is an integral part of the IAPT clinical model.
Session-by-session outcome monitoring recording the care provided to patients and their clinical progress, helps services to improve data completeness and therefore obtain a more accurate picture of the service they provide including:
- Knowing the effectiveness of an intervention - If a treatment is not effective can it be improved/changed?
- Identifying effective practices - determine which practices to continue and build upon. Some activities may need to change in order to improve service delivery.
- Supporting clinical decisions and treatment planning- collection of outcome measures enables services to be responsive to the changing needs of the individual, for example stepping between different levels of treatment intensity when appropriate.
Making data informed decisions
Robust reporting and monitoring provides an opportunity to learn lessons about the way in which psychological therapies might best be provided, in order to maximize clinical outcomes. For example monitoring DNA rates or reviewing non-recovered cases and trying to identify themes or common patterns in the data and then making changes accordingly.
Ongoing monitoring also has a therapeutic value in itself, it also facilitates supervision and self-monitoring by clinicians. All these contribute to accountability, transparency and effectiveness.
Payments by Results - the future for IAPT Services?
The Payments by Results (PbR) system currently being developed for IAPT puts an even greater emphasis on the need for complete and reliable outcome data. IAPT PbR1 is unique in that it focuses on outcomes rather than just activity - the most significant weighting is given to clinical outcomes, at 50%.
Data quality and data completeness is identified as a key risk or issue to IAPT PbR. Commissioners need to be assured that IAPT providers are submitting the full data standard. If implemented successfully outcome-based contracts in IAPT have the potential to facilitate greater efficiency and choice in mental health services:
- Allowing commissioners to incentivise delivery of the outcomes that matter locally, for example improving access by older people
- Incentivising service providers to adopt practices that promote sustained recovery
- Providing greater transparency to mental health provision – making it clearer to see where money has come from and what it is being used for
- Improving patient choice - helping patients to make meaningful choices about the providers they decide to use.
However, none of these benefits can be realised without the foundation of accessible, reliable and complete data.
I will be discussing key learnings from delivering an outcomes focused cCBT service at the forthcoming Prism Showcase, in London on 18 September. This free of charge event should provide valuable insight into online therapies for IAPT providers.
We hope to see you there.
1. Information on IAPT Payments by Results is available at: http://www.iapt.nhs.uk/pbr/