Mental health and Substance abuse
CHANGES WITHIN THE health care system have prompted health care providers and researchers to re-evaluate and modify the process of service system evaluation. Evaluation research conducted throughout the 1980s focused primarily on the structure and processes of health care. In contrast, evaluation research shifted its focus to the measurement of treatment outcomes during the 1990s [Jennings et al 1999 and Sederer et al 1996]. Issues that drove the outcomes measurement movement included escalating health care costs, consumer advocacy for needed and appropriate services, increased focus on evidence-based practice, implementation of managed care in both the private and public mental health care systems, and development of new service delivery systems [Auslander et al 1998, Campbell 1998, Chisholm et al 1997, Kolb et al 2000, Rosswurm and Larrabee 1999 and Teague et al 1997].
[Buckley 1993] conceptualizes the evolution of evaluation research as a decreased focus on the service delivery organization and a simultaneous emergence of a person-centered focus. This evolution represents a shift away from “persons served within individual specialty mental health organizations towards persons with significant needs for mental health services and supports, regardless of the number or type of organizations” (p. 1). Likewise, [Campbell 1998] notes that early research efforts evaluated mental health service systems according to “measures of output and volume” (p. 13), but states that current evaluation research increasingly emphasizes patients’ values and “broadened measurements of outcomes that encompass not only symptom reduction, but functional status and quality of life” (p. 13).
Basic research in the fields of neuroscience and genetics are crucial for understanding the etiology of mental illness and for developing new treatment approaches [U. S. Department of Health and Human Services 1999]. Furthermore, the person-centered, humanitarian domain of clinical service research is important for understanding what consumers expect in treatment. Outcomes measurement can illuminate the humanistic aspects of service research by acknowledging the importance of the consumers’ opinions in the process of service system evaluation.
The purposes of this report are to describe the findings of a study that investigated consumers’ perceptions of service quality in public-sector psychiatric hospitals, report on the feasibility of using recently developed instruments to measure consumer satisfaction and outcomes of mental health services, and determine whether patient characteristics were predictive of satisfaction with mental health services.
Literature review
[Docherty and Streeter 1996] suggest that outcome measurement should include several dimensions, including symptoms, social and interpersonal functioning, work functioning, rates of treatment utilization, health status and perceptions of global well-being, health-related quality of life, and satisfaction with services. Service satisfaction is the outcome dimension most commonly used to determine consumers’ opinions about the services they receive. In their work with policy makers and researchers at the national level, consumers have advocated to include measurement of satisfaction as an indicator of service quality.
Definitions of satisfaction with services
According to [Ruggeri 1994], the subjective nature of satisfaction makes it difficult to define; however, he acknowledges that this subjectivity can provide a “unique opportunity in service evaluation to take account of and examine the perspective of consumers” (p. 215). In general, a person’s perceptions of satisfaction are based on expectations, experiences, and results of overall treatment [Ruggeri 1994]. [Lebow 1982] defined satisfaction as the “extent to which treatment gratifies the wants, wishes, and desires of clients for services” (p. 244). Likewise, [Pascoe 1983] defined satisfaction as a cognitive and affective reaction to the context, process and results of a service encounter. [Teague 2000] maintains that satisfaction research addresses both the process and outcomes of care; the process dimension is measured by the respondents’ assessments of the interactions between patients and providers, and the outcomes dimension is measured by patients’ summary judgments of an overall episode of care.
[Ware and Snyder 1975] propose that satisfaction is a multidimensional construct that encompasses five domains: quality of care, convenience, finances, physical environment, and availability. Current researchers concur that satisfaction is a multidimensional construct, but further maintain that antecedent factors such as personal values, expectations, perceptions and previous experiences can influence levels of satisfaction and dissatisfaction [Mahon 1996]. Others suggest that service performance is an important indicator of service quality and that service quality is an antecedent to service satisfaction [deRuyter et al 1997].
National initiatives to measure service quality
Movement towards a person-centered approach to evaluation research has led researchers and policy-makers to expand the concept of service quality beyond satisfaction and thereby identify and define broader domains that are important to consumers. Key activity in this movement took place in 1993, when the Center for Mental Health Services (CMHS) and the Mental Health Statistics Improvement Program (MHSIP) created a Task Force that consisted of consumers, family members, representatives of federal, state, and local mental health and substance abuse systems, advocacy groups, policy analysts, and service researchers [Center for Mental Health Services 1996]. The primary focus of the Task Force was to develop a consumer-oriented report card with domains, indicators, and measures for adults with serious mental illness who receive treatment in community settings [Center for Mental Health Services 1996 and Teague et al 1997]. The report card was intended to help consumers, state agencies, and corporate purchasers compare the quality and cost of mental health and substance abuse services across healthcare organizations.
Tags: substance abuse