A case control study of the implementation of change model versus passive dissemination of practice guidelines for compliance in monitoring for metabolic syndrome.

We developed an intervention to improve compliance with guidelines for monitoring metabolic syndrome and compared compliance prior to intervention and three times post-intervention at three community mental health clinics in Texas. One test clinic received intervention and two other clinics served as controls. Fifty random charts were reviewed from each clinic for three specific, 1-2 weeks periods over the course of 18 months. There were significant improvements in the ordering of labs, the presence of lab results in the chart, and documentation of blood pressure, body mass index and waist circumference in the intervention clinic over time in comparison to the control clinics. Documented evidence of physician action with respect to out of range values remained low. Metabolic monitoring is a multi-step process. Removing barriers, creating specific procedures, and dedicating staff resources can improve compliance with monitoring.

Interrater reliability of using brief standardized outcome measures in a community mental health setting.

OBJECTIVE: Given psychiatry's need to implement measurement-based care, the study examined whether direct-care staff could reliably administer brief positive and negative symptom instruments to track symptom changes and inform clinical decision making. METHODS: Raters (82 case managers) were assessed at baseline. Training was provided for individuals not meeting reliability criteria. These individuals were reassessed to determine the effect of training. In addition, rater drift was assessed for raters judged to be reliable at baseline. RESULTS: Seventy-seven percent of direct-care staff met criteria for reliability either at baseline or after they received additional training. CONCLUSIONS: A majority of direct-care staff can be trained to reliability on brief scales of positive and negative symptoms that can be used to guide clinical decision making.