ABSTRACT

Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long. Measuring outcomes of care is important to safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning. We describe the development in England of a new outcome measure for forensic mental health services. Patient interviews and multi-stakeholder focus groups were held to elicit key concepts. Thematic analysis was used to develop an outcomes framework. Fifteen patients participated in the interviews and 48 stakeholders in the focus groups. Six domains were identified in thematic analysis: ‘about me, my quality of life, my health, my safety and risk, my life skills and my progress’. Sixty-two stakeholders participated in the first round of the Delphi process, and 49 completed round two. Eight of the top fifteen outcomes were shared between patients/carers and professionals. Based on these results, a new outcome measure, the FORensic oUtcome Measure (FORUM), was developed including both a patient reported and clinician reported measure. Further assessment of the FORUM’s use to track patients’ progress over time, and facilitate shared decision-making and care planning, is required.

摘要

法医心理健康服务通过专门的社区团队为安全的精神病院中的人们提供护理。此类服务通常数量少且成本高，通常具有高度限制性，并且出院前住院护理的平均持续时间很长。衡量护理结果对于保护患者和公众、监测进展、告知治疗计划以及协助服务评估和规划非常重要。我们描述了英格兰法医心理健康服务新结果测量的发展。举行了患者访谈和多方利益相关者焦点小组，以引出关键概念。主题分析用于制定成果框架。15 名患者参加了访谈，48 名利益相关者参加了焦点小组。在主题分析中确定了六个领域：“关于我，我的生活质量，我的健康、我的安全和风险、我的生活技能和我的进步”。62 个利益相关者参与了第一轮德尔福流程，49 个完成了第二轮。前 15 个结果中有 8 个在患者/护理人员和专业人员之间共享。基于这些结果，开发了一种新的结果衡量标准，即法医结果衡量标准 (FORUM)，其中包括患者报告和临床医生报告的衡量标准。需要进一步评估 FORUM 用于跟踪患者随时间的进展，并促进共同决策和护理计划。开发了一种新的结果衡量标准，即法医结果衡量标准 (FORUM)，其中包括患者报告和临床医生报告的衡量标准。需要进一步评估 FORUM 用于跟踪患者随时间的进展，并促进共同决策和护理计划。开发了一种新的结果衡量标准，即法医结果衡量标准 (FORUM)，其中包括患者报告和临床医生报告的衡量标准。需要进一步评估 FORUM 用于跟踪患者随时间的进展，并促进共同决策和护理计划。