Research master thesis | Psychology (research) (MSc)
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Using a wide variety of clinical questionnaires might hamper the communication between clinicians and researchers in Routine outcome monitoring (ROM). Linking test scores to T scores as a common...Show moreUsing a wide variety of clinical questionnaires might hamper the communication between clinicians and researchers in Routine outcome monitoring (ROM). Linking test scores to T scores as a common metric might be a solution. Item response theory (IRT) is the preferred way to estimate T-scores. However, required software and a large dataset is needed for that. In this thesis, two methods were used to arrive at a common metric for often used questionnaires and their subversions: the BSI, BSI-18, the DASS-42 and the DASS-21. As one method, we used an IRT approach to estimate theta-based T-scores, leading to crosswalk tables. For the second approach, conversion formulas were estimated for raw scores to calculated T-scores based on the best-fitting regression equation between the raw scores and the previously estimated theta-based T-scores. Crosswalk tables and conversion formulas are both alternative ways to link individual scores to a common metric. It was investigated if conversion formulas are valid by comparing calculated T-scores with theta-based T-scores. The agreement between calculated T-scores and theta-based T-scores were high for all questionnaires except the DASS-42. The agreement was also lower at the extreme ends of the questionnaires (T= < 50 and T= >75). All in all, conversion formulas seem to be a good alternative for estimating a common metric. Offering different options to calculate common metrics can help in improving the communication between professionals in the clinical field. Increased involvement and better communication in ROM is able to increase the quality of mental health care.Show less
Background: The societal lockdown due to COVID-19 forced a change from in-person therapy to videoconferencing, which was introduced on March 16, 2020. Swift implementation of telehealth care was...Show moreBackground: The societal lockdown due to COVID-19 forced a change from in-person therapy to videoconferencing, which was introduced on March 16, 2020. Swift implementation of telehealth care was asked of therapists all over the country. Aim: To investigate whether the effects of treatment for personality disorders through videoconferencing were lower than through in-person therapy. Method: Patients who received treatment between January 2018 and May 2021 were divided into three groups, before (1), partially (2) and entirely during COVID-19 (3). With the ROM score OQ-45 SD as pre- and posttest measurements, a general linear model repeated ANOVA was conducted. We controlled for other variables that were potentially of influence on the achieved outcomes. Results: The hypothesis was not confirmed by the results. The results rather suggested that treatment through videoconferencing was more effective than treatment (predominantly) conducted through in-person. Conclusion: No evidence was found supporting the hypothesized diminished effects of treatment for personality disorder through videoconferencing. Videoconference therapy appeared non-inferior to face-to-face therapy for the treatment of personality disorders. The groups did not differ at the onset. However, treatments were shorter and the dropout rate was 15% higher in the videoconferencing group, which could have led to selection bias. Keywords: Personality disorder; COVID-19; treatment outcome; videoconference therapy; face-to-face therapy; observational design.Show less
The aim of this research was to test the test-retest reliability of two new indicators for quality of health care and compare these indicators with an indicator based on outcome of healthcare that...Show moreThe aim of this research was to test the test-retest reliability of two new indicators for quality of health care and compare these indicators with an indicator based on outcome of healthcare that has already been found reliable. These new indicators are based on the ratio between outcome and costs of treatment and the ratio between outcome and duration in days of treatment. The reliability of the three indicators is assessed with the Intra Class Correlation coefficient from data (N = 633) of a division of a mental health care institution specialized in the treatment of post-traumatic stress disorder. Outcome of the treatment was assessed with a pre- and posttest measurement of the severity of complaints, as measured with the symptomatic distress subscale of the Outcome Questionnaire 45.2. The reliability of the original indicator, based solely on outcome, was good (ICC = 0.613). The reliability of the indicator based on outcome and duration of treatment was fair (ICC = 0.549) and the reliability of the indicator based on outcome and costs was poor (ICC = 0.088). Presumably, these lower ICC values on the enriched indicators are a result of instability over time of the cost and duration components of the indicators in combination with a disproportionate increase of costs and days of treatment in comparison with outcome of treatment. The research suffered from low statistical power and this precludes definite conclusions about the statistical significance of differences in reliability among the indicators. For a better comparison of the test-retest reliability between the indicators with a statistical test, replication of this research with a larger set of evaluable treatments is necessary.Show less
Current mental health care systems evaluate the quality of care mainly based on the outcome of treatment. However, for patients, the time spent to achieve this outcome is a relevant factor which is...Show moreCurrent mental health care systems evaluate the quality of care mainly based on the outcome of treatment. However, for patients, the time spent to achieve this outcome is a relevant factor which is often overlooked in modern health care systems. For insurance providers, the incurred cost of treatment is an important criterion for quality of mental health care. In order to offer truly valuable care in the eyes of both of these parties, the result of treatment must measure up to its required effort, both temporal and financial. Including cost and duration in the evaluation of health care will ultimately benefit all parties involved. Therefore, the present study tests the validity of two new quality indicators based on the principle of value-based health care. Value here is defined as outcome relative to cost or outcome relative to duration. Data used was collected by Routine Outcome Monitoring at several outpatient clinics providing specialized mental health care in the Netherlands. MANOVA testing revealed that the two new quality indicators showed larger differences in quality of care than outcome alone. These results were supported by differences among clinics in the cost and duration of treatment per improved and recovered patient. Based on the results of this study, the use of quality indicators of value-based health care over outcome alone in the mental health care sector is advised.Show less
