Concordance between Patients and Their Case Managers Using the Health of the Nation Outcome Scales

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Abstract
Objective: Outcome assessment benefits from multiple perspectives, but these may differ. We aimed to compare patient and clinician ratings on respective versions of a well-known outcome assessment scale. Method: Case managers and their patients rated the patient's mental health problems using the clinician and self-rating forms of the Health of the Nation Outcome Scales (HoNOS). Results: One third of patients approached returned their self-rating form; non-return was associated with involuntary legal status. Patient ratings were significantly higher (worse) than case manager ratings on four of the twelve HoNOS items, and significantly lower on one. Overall, agreement levels were slight to moderate, but particularly low for the depressed mood item. Case managers tended to overestimate the actual degree of similarity between their own ratings and those of their patients. Conclusions: The findings support the proposition that patient and clinician perceptions of the patient’ problems represent two different sets of information.

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