Routine outcome monitoring and process quality in mental health care: a descriptive study in daily practice

Routine outcome monitoring (ROM) is used to improve quality of health care by improving the process of care. ROM was introduced nationwide in mental health care in the Netherlands with the primary goal of enhancing the quality of treatment. This study aims to establish the impact of ROM on the process quality of treatment in the daily practice of secondary mental health care in the Netherlands. Two cohorts from the same treatment programme were identified, before and after implementation of ROM. Data on patient characteristics, presence of baseline ROM measurement and indicators of the quality of the treatment process were retrieved from the electronic health care information system. Patient data were collected until 6 months after enrolment in the treatment programme. The magnitude of the effect of ROM on the quality of the treatment process was established. The pre-ROM cohort comprised 271 patients and 231 patients constituted the post-ROM cohort. In the ROM cohort, both indicators for process quality 'presence of treatment plan' and 'presence of cancellations' were significantly higher; the odd ratios were 3,37 [confidence interval (CI) 2.32-4.89] and 1,63 (CI 1.14-2.33), respectively. Indicators on process quality are important for understanding and establishing the impact of ROM in daily practice of secondary mental health care. Implementing ROM moderately increased the presence of a treatment plan. While this suggests improved treatment agreement, it did not result in better compliance of patients with individual treatment activities, as presence of cancellations was significantly higher after introduction of ROM