Trajectories of patients with severe mental illness in two-year contact with flexible assertive community treatment teams using routine outcome monitoring data

An observational study

H.E. Kortrijk*, B. Schaefer, J. van Weeghel, C.L. Mulder, A. Kamperman

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Objective:
Using outcome data collected routinely over a continuous two-year treatment period, we wished to distinguish homogeneous subgroups of patients with a severe mental illness whose psychosocial problems followed a similar pattern over time. By identifying the effectiveness of health services for different patient groups, this approach allowed us to identify patients at risk of deterioration and those recovering from their symptoms.

Methods:
In total we included 2,660 patients who were in two-year continuous contact with a Flexible Assertive Community Treatment team (FACT). We collected outcome data on psychosocial functioning, needs for care and quality of life. We performed a latent class growth analysis (LCGA).

Results:
The LCGA identified six homogenous patient subgroups using trajectories of HoNOS scores. On the basis of the patterns of patients’ psychosocial problems over time, we labelled these as follows: 1) stable at a low problem-severity level (N = 709; 27%); 2) stable at a low medium problem-severity level (N = 1,208; 45%); 3) stable at a high medium problem-severity level (N = 528; 20%); 4) stable at a high problem-severity level (N = 116; 4%); 5) amelioration of problems (N = 42; 2%); and 6) deterioration of problems (N = 57; 2%). Patients with stable and a high severity of psychosocial problems had more practical and somatic unmet needs than those in other subgroups, and also had the fewest decrease in the number of unmet needs.

Discussion:
After linking patient subgroups with clinical features such as the need for care, we found that, over two years, most patients remained relatively stable in terms of psychosocial functioning, but that their unmet needs decreased over time. However, in terms of needs for treatment during two years of contact with a FACT team, patients in the subgroup with a stable and high problem-severity level tended to derive little or no benefit.
Original languageEnglish
Article number0207680
Number of pages16
JournalPLoS ONE
Volume14
Issue number1
DOIs
Publication statusPublished - 2019

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Community Mental Health Services
Deterioration
Trajectories
Monitoring
Health
Health Services

Keywords

  • CAMBERWELL ASSESSMENT
  • CRITERIA
  • HEALTH
  • NUMBER
  • PEOPLE
  • PREVALENCE
  • QUALITY-OF-LIFE
  • SCALES HONOS
  • SCHIZOPHRENIA
  • VERSION

Cite this

@article{c5401beedc6b4095ae7fb804030e47ca,
title = "Trajectories of patients with severe mental illness in two-year contact with flexible assertive community treatment teams using routine outcome monitoring data: An observational study",
abstract = "Objective: Using outcome data collected routinely over a continuous two-year treatment period, we wished to distinguish homogeneous subgroups of patients with a severe mental illness whose psychosocial problems followed a similar pattern over time. By identifying the effectiveness of health services for different patient groups, this approach allowed us to identify patients at risk of deterioration and those recovering from their symptoms.Methods: In total we included 2,660 patients who were in two-year continuous contact with a Flexible Assertive Community Treatment team (FACT). We collected outcome data on psychosocial functioning, needs for care and quality of life. We performed a latent class growth analysis (LCGA).Results: The LCGA identified six homogenous patient subgroups using trajectories of HoNOS scores. On the basis of the patterns of patients’ psychosocial problems over time, we labelled these as follows: 1) stable at a low problem-severity level (N = 709; 27{\%}); 2) stable at a low medium problem-severity level (N = 1,208; 45{\%}); 3) stable at a high medium problem-severity level (N = 528; 20{\%}); 4) stable at a high problem-severity level (N = 116; 4{\%}); 5) amelioration of problems (N = 42; 2{\%}); and 6) deterioration of problems (N = 57; 2{\%}). Patients with stable and a high severity of psychosocial problems had more practical and somatic unmet needs than those in other subgroups, and also had the fewest decrease in the number of unmet needs.Discussion: After linking patient subgroups with clinical features such as the need for care, we found that, over two years, most patients remained relatively stable in terms of psychosocial functioning, but that their unmet needs decreased over time. However, in terms of needs for treatment during two years of contact with a FACT team, patients in the subgroup with a stable and high problem-severity level tended to derive little or no benefit.",
keywords = "CAMBERWELL ASSESSMENT, CRITERIA, HEALTH, NUMBER, PEOPLE, PREVALENCE, QUALITY-OF-LIFE, SCALES HONOS, SCHIZOPHRENIA, VERSION",
author = "H.E. Kortrijk and B. Schaefer and {van Weeghel}, J. and C.L. Mulder and A. Kamperman",
year = "2019",
doi = "10.1371/journal.pone.0207680",
language = "English",
volume = "14",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "PUBLIC LIBRARY SCIENCE",
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Trajectories of patients with severe mental illness in two-year contact with flexible assertive community treatment teams using routine outcome monitoring data : An observational study. / Kortrijk, H.E.; Schaefer, B.; van Weeghel, J.; Mulder, C.L.; Kamperman, A.

In: PLoS ONE, Vol. 14, No. 1, 0207680, 2019.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Trajectories of patients with severe mental illness in two-year contact with flexible assertive community treatment teams using routine outcome monitoring data

T2 - An observational study

AU - Kortrijk, H.E.

AU - Schaefer, B.

AU - van Weeghel, J.

AU - Mulder, C.L.

AU - Kamperman, A.

PY - 2019

Y1 - 2019

N2 - Objective: Using outcome data collected routinely over a continuous two-year treatment period, we wished to distinguish homogeneous subgroups of patients with a severe mental illness whose psychosocial problems followed a similar pattern over time. By identifying the effectiveness of health services for different patient groups, this approach allowed us to identify patients at risk of deterioration and those recovering from their symptoms.Methods: In total we included 2,660 patients who were in two-year continuous contact with a Flexible Assertive Community Treatment team (FACT). We collected outcome data on psychosocial functioning, needs for care and quality of life. We performed a latent class growth analysis (LCGA).Results: The LCGA identified six homogenous patient subgroups using trajectories of HoNOS scores. On the basis of the patterns of patients’ psychosocial problems over time, we labelled these as follows: 1) stable at a low problem-severity level (N = 709; 27%); 2) stable at a low medium problem-severity level (N = 1,208; 45%); 3) stable at a high medium problem-severity level (N = 528; 20%); 4) stable at a high problem-severity level (N = 116; 4%); 5) amelioration of problems (N = 42; 2%); and 6) deterioration of problems (N = 57; 2%). Patients with stable and a high severity of psychosocial problems had more practical and somatic unmet needs than those in other subgroups, and also had the fewest decrease in the number of unmet needs.Discussion: After linking patient subgroups with clinical features such as the need for care, we found that, over two years, most patients remained relatively stable in terms of psychosocial functioning, but that their unmet needs decreased over time. However, in terms of needs for treatment during two years of contact with a FACT team, patients in the subgroup with a stable and high problem-severity level tended to derive little or no benefit.

AB - Objective: Using outcome data collected routinely over a continuous two-year treatment period, we wished to distinguish homogeneous subgroups of patients with a severe mental illness whose psychosocial problems followed a similar pattern over time. By identifying the effectiveness of health services for different patient groups, this approach allowed us to identify patients at risk of deterioration and those recovering from their symptoms.Methods: In total we included 2,660 patients who were in two-year continuous contact with a Flexible Assertive Community Treatment team (FACT). We collected outcome data on psychosocial functioning, needs for care and quality of life. We performed a latent class growth analysis (LCGA).Results: The LCGA identified six homogenous patient subgroups using trajectories of HoNOS scores. On the basis of the patterns of patients’ psychosocial problems over time, we labelled these as follows: 1) stable at a low problem-severity level (N = 709; 27%); 2) stable at a low medium problem-severity level (N = 1,208; 45%); 3) stable at a high medium problem-severity level (N = 528; 20%); 4) stable at a high problem-severity level (N = 116; 4%); 5) amelioration of problems (N = 42; 2%); and 6) deterioration of problems (N = 57; 2%). Patients with stable and a high severity of psychosocial problems had more practical and somatic unmet needs than those in other subgroups, and also had the fewest decrease in the number of unmet needs.Discussion: After linking patient subgroups with clinical features such as the need for care, we found that, over two years, most patients remained relatively stable in terms of psychosocial functioning, but that their unmet needs decreased over time. However, in terms of needs for treatment during two years of contact with a FACT team, patients in the subgroup with a stable and high problem-severity level tended to derive little or no benefit.

KW - CAMBERWELL ASSESSMENT

KW - CRITERIA

KW - HEALTH

KW - NUMBER

KW - PEOPLE

KW - PREVALENCE

KW - QUALITY-OF-LIFE

KW - SCALES HONOS

KW - SCHIZOPHRENIA

KW - VERSION

U2 - 10.1371/journal.pone.0207680

DO - 10.1371/journal.pone.0207680

M3 - Article

VL - 14

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 1

M1 - 0207680

ER -