1. The Oregon Change Index Outcomes Management System: Development, Implementation, and Results
Seth Bernstein, Ph.D.
ABHA Executive Director
Jeb Brown, Ph.D
Center for Clinical Informatics

2. Outcomes Informed Care
Use of valid and reliable clients self report outcomes questionnaires.
Frequent measurement for all clients.
Frequent feedback to clinicians on outcomes for all clients as treatment unfolds.
Use of therapeutic alliance measure encouraged.

3. Outcome Measurement
An outcome questionnaire provides a structured and consistent method that invites the patient to communicate how they are feeling
Repeated administrations during treatment lets the patient communicate how they are changing over time

4. Measurement and Judgment
Clinicians are trained to use clinical judgment to assess symptoms and level of patient distress.
No outcome measure can replace clinical judgment, but it can inform judgment.
An outcome measure is a separate channel of communication, and the information obtained may be different than from clinician assessment based on face to face interviewing

5. Measuring Distress
All outcome measures appear to primarily measure “global distress”.
Subscales for symptoms, role functioning and interpersonal relationships are all highly correlated with core “global distress factor”
Reliability: consistency with which test measures factor; .90 or higher desirable
Validity: all outcome measures show high degree of correlation with one another

6. Picking An Outcome Measurement Tool
Most assessment measures were . . .
Developed for research – not the real world of practice
Diagnostically based rather than treatment-oriented
Instrumentation is lengthy and burdensome
Not designed for concurrent measurement
Often not linked to improved outcomes or enhanced service quality
Designed in piecemeal fashion – not integrated or comprehensive
Provided for separate stakeholders – not integrated for system, clinical and consumer levels

7. Picking An Outcome Measurement Tool
What we needed was a tool that provided:
Sensitive, accurate, real time estimates of meaningful clinical change over time
Sensitive and informative characterization of process indicators (therapeutic alliance, treatment modality, readiness to change, etc.)
Sensitive, informative, real time feedback to consumers (youth and families) and clinicians

8. Oregon Change Index (OCI) 1.0
Low High
How are you feeling about yourself?
O O O O O O O O O O
How are your relationships with family and friends?
How are you functioning at work or school or other activities?
How are you feeling overall?
How is your progress with treatment plan goal #1?
How is your progress with treatment plan goal #2?
How are you feeling about your relationship with your therapist/case manager?
[1]The first four questions of the Oregon Change Index, ABHA ©2002 are derived from the ORS, developed by Scott D. Miller and Barry L. Duncan ©2000 and are used with their permission.

9. Oregon Change Index 2.0 How are your relationships with family?
How are your relationships with friends?
How are you functioning at work or school or other activities?
How are you feeling overall?
How is your progress with treatment plan goal #1?
How is your progress with treatment plan goal #2?
Is the therapy being helpful to you?
[1]The first four questions of the Oregon Change Index, ABHA ©2002 are derived from the ORS, developed by Scott D. Miller and Barry L. Duncan ©2000 and are used with their permission.

10. The Youth Oregon Change Index (Y-OCI) 2.0
How are your child’s relationships with family?
How are your child’s relationships with friends?
How is your child functioning at school?
How is your child functioning at play?
How is your child’s progress with treatment plan goal #1?
How is your child’s progress with treatment plan goal #2?
Is the therapy being helpful to your child?
[1]The first four questions of the Oregon Change Index, ABHA ©2002 are derived from the ORS, developed by Scott D. Miller and Barry L. Duncan ©2000 and are used with their permission.

11. Outcomes Management System
Provides means to capture outcome data and provide feedback to clinicians.
Forms mailed weekly for data entry.
Monitoring and feedback on OCI completion rates.
Weekly Active Case Reports ed to clinicians.

12. Active Case Report

13. Trajectory of Change Graph

14. Annual Outcomes Report

15. Outcomes trending upwards

16. Outcomes are good, but….
Aggregated data shows that the average patient improves during treatment, but…
There is wide variation in outcomes from one patient to another.
Knowledge of the “average outcome” doesn’t help us improve outcomes.
The interesting information is in the differences in outcomes…
What practices or treatment methods are associated with better outcomes?
Which patients do we do well with? Where do we need to improve?
Are services allocated effectively so that those with the most severe symptoms are receiving treatment of sufficient frequency and duration?

17. Challenges Ahead
Clinicians and managers remain unsure about the meaning/validity of the data
Solution: Help clinicians and managers “own” the data, identify threats to the reliability and validity of the data, and recommend solutions.
Clinician/manager anxiety due to fear of measurement
Solution: Continuously reinforce message that outcomes are important but the data is not used to “punish” anyone. Foster on organizations culture of continuous quality improvement.

18. Challenges Ahead
Uncertainty about use of OCI with various sub populations of patients.
Solution: Use “study code” field on OCI from to identify sub populations for further study.
Clinicians uncertain about the value of feedback
Solution: Improve data entry processes so that Active Case Report consistently contains data from sessions within the past week.
Mandates for “Evidence based practices”
Solution: Provide evidence that outcomes informed care can lead to improved outcomes through use of “evidence based meta-methods’.