Evaluation using case notes of psychiatric care in three different settings

A "system of outcome indicators for mental health care is urgently needed in order to ensure that clinicians, health authorities, and directors of public health can monitor and evaluate mental health care". We compared data drawn from case notes of patients admitted to three different psychiatric settings in inner London: a day hospital, a psychiatric ward in a general hospital, and an intensive care ward in a psychiatric hospital. These settings represent typical different aspects of acute psychiatric services in the National Health Service in England and Wales. This study provides the first recorded report of the outcome of routine psychiatric care assessed through case note review. The first outcome measure, the General Statement of Change (GSC), showed no significant differences between the settings. Comparing the mean Final Score of Change (FSC) for each setting there were no significant differences in symptom change between admission and discharge for the three settings. These findings are compatible with previous outcome studies that found no long-term difference in symptomatology when they compared patients treated by day or in-patient care. Our study suggests a way of assessing results in psychiatric care and identifies information that might be appropriately collected to build indicators to monitor and evaluate these services. Case notes may provide a potential source of data to measure the outcome of routine psychiatric care in terms of collecting base line information and deriving new types of outcome indicators. However, more attention is needed to record outcome assessment at discharge. One way of improving quality of case note recording is to study it systematically and demonstrate its usefulness not only for legal reasons but also for research and management.