North Warwickshire NHS Trust provides Community, Mental Health and Learning Disability Services to the three areas, North Warwickshire, Nuneaton and Bedworth & Rugby. Specialist Learning Disability Services are provided on a sub-regional basis through centres at Brooklands, Birmingham & Lea Castle, Kidderminster and various community sites. The Trust works closely with other agencies to ensure comprehensive and integrated health care is delivered to local people.
The Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) is the result of collaboration between the Royal College of Psychiatrists, the British Psychological Society and the Department of Health. HoNOS-LD measures global outcomes (improvement or deterioration) in people with learning disabilities who have additional mental health needs.
As with all clinical and scientific experiments, the variables measured must be robust and reliable. The main goal for North Warwickshire NHS Trust was to calculate whether each of the 18 items in the psychometric scales, used to determine improvement or deterioration, had acceptable inter-rater reliability (ie. whether the scoring between different raters or assessors was consistent throughout).
David Martin, Clinical Audit Co-ordinator at Brooklands, North Warwickshire NHS Trust explains, “The scales are an aid to clinical effectiveness among this vulnerable group of people. We knew the psychometric scales were easy-to-use but we had to be confident that the same scores would occur regardless of who the assessor was.”
With the help of SPSS software, the researchers recruited 26 field sites throughout the United Kingdom and gathered data on over 700 people each of whom had a learning disability and an additional mental health problem.
David Martin explains further, “After entering data into SPSS software we could easily reject the cases that did not meet the agreed methodological criteria. We were then left with 372 pairs of ratings. Each rating had been made independently by two assessors scoring at the same time, in the same setting, using the same information source. We measured the extent to which the pairs of assessors agreed with each other's scores”. SPSS data analysis software have for over 30 years enabled clinicians and researchers to conduct tests and experiments with the most robust statistical procedures available on the market. “If it wasn’t for SPSS, we would probably have used Microsoft Excel or similar software and had to have calculated Pearson's correlation coefficients only which would not be as reliable as other statistical tests for our purposes. It would also take hours to complete since spreadsheets aren’t designed for this type of research work which we can complete in SPSS in a matter of minutes”.
With the aid of SPSS software, North Warwickshire NHS Trust found that by calculating Cohen's Kappa for each of the 18 items, the Health of the Nation Outcome Scales for people with Learning Disabilities was demonstrated to have good inter-rater reliability and was reproducible. This means that the HoNOS-LD could be considered for routine use to improve clinical effectiveness amongst this often-overlooked group of people. “You can imagine that wrong or inconsistent scoring would be problematic and effect negatively the welfare of this group of people, but by using SPSS we are confident of our results”, said David.
David Martin concludes on an on-going but so far successful project, “We do not yet know what savings that this work has gained for the National Health Service or other organisations that help people with learning disabilities who have additional mental health needs. With the aid of SPSS software the potential is there to improve the clinical effectiveness of interventions for a vulnerable group of people and therefore the quality of life could improve measurably”.
The complete list of global SPSS success stories can be found here
“With the aid of SPSS
software the potential is
there to improve the
clinical effectiveness of
interventions for a
vulnerable group of
people and therefore
the quality of life could
improve measurably.”
- David Martin, Clinical Audit
Co-ordinator, Brooklands,
North Warwickshire NHS Trust
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