Developing a system for automated monitoring of psychiatric outpatients: a first step to improve quality.

Objective: To evaluate an automated system of quality monitoring for psychiatric outpatients.

Design: Cross-sectional study.

Setting: Large outpatient psychiatry clinic in Kaiser Permanente--Northern California.

Participants: Approximately 1500 new psychiatric patients and 20 clinicians.

Interventions: This system gave clinicians data on new patients from validated instruments before their intake interviews, measured outcomes for the depressed and panic-disordered patients, and monitored the clinic's case-mix.

Main outcome measures: Clinic case-mix: Axis II disorders (Personality Disorder Questionnaire--Revised); emotional, social and physical functioning (Health Status Questionnaire 2.0); Axis I symptoms (Symptom Checklist-90); depression and panic disorder (Health Outcomes Institute Modules). Clinician reaction to system (telephone interview).

Results: The study population was 62.4% female; 73.9% Caucasian; 70% employed; 15.9% had evidence of personality disorder; 63% reduced daily activities because of emotional problems; 18% had depression; 7% had panic disorder. Over 75% of clinicians used the data reports and found them helpful; criticism focused on questionnaire length, inadequate training, numerous false-positives, and insufficient administrative support.

Conclusion: An automated patient monitoring system can be implemented; clinician involvement needs to be significant; more research is needed to establish the usefulness of standardized data and outcomes management.