***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : We conducted a prospect i ve trial r and omizing 75 physicians to either a control or intervention arm to evaluate the impact of providing patient-reported information on anxiety and other mental health symptoms and disorders to primary care physicians . Methods : Five hundred seventy-three patients of the study physicians who met entry criteria were r and omized to either usual care or usual care supplemented with feedback of patient-reported mental health information to physicians . This mental health information was derived from initial patient-reported question naires completed in waiting rooms of physicians contracted to a mixed-model health maintenance organization in Colorado . Main outcome measures included impact of intervention on rates of ( 1 ) chart notation of anxiety , depression , or other mental health diagnoses or symptoms ; ( 2 ) referral to mental health specialists ; ( 3 ) prescription of psychotropic medications ; ( 4 ) hospitalization ; and ( 5 ) office visits during a 5-month observation period . Results : Physicians receiving feedback on previously unrecognized and untreated anxiety patients were more likely to make chart notations ( adjusted odds ratio [ AOR ] = 2.51 , 95 percent confidence interval [ CI ] = 1.62 - 3.87 ) , to make referrals to mental health specialists ( AOR = 3.86 , 95 percent CI = 1.63 - 9.16 ) , and to see patients for more frequent outpatient visits ( AOR = 1.73 , 95 percent CI = 1.11 - 2.70 ) . Use of psychotropic medications and rate of hospitalizations did not differ significantly . Conclusions : Providing patient-reported mental health information to primary care physicians result ed in increased recognition and referral rates for previously unrecognized and untreated anxiety patients , plus an increase in primary care visits , without concomitant increases in the use of psychotropic medications or rate of hospitalizations BACKGROUND To date , the monitoring of patient progress using st and ardized assessment s has been neglected in hospital-based psychiatric care . Findings in outpatient psychotherapy have demonstrated clinical ly significant benefits for providing feedback to the sizeable minority of patients who were otherwise unlikely to experience positive outcome ( Lambert , 2007 ) . However , a similar system for presenting feedback on patient progress has not yet been assessed for group therapy within psychiatric inpatient setting s. The current study aim ed to develop and evaluate the effectiveness of a feedback system suitable for use in psychiatric services . METHODS In a nonr and omized trial , 1308 consecutive in patients and day patients , whose diagnoses were primarily depressive and anxiety disorders , completed the World Health Organization 's Wellbeing Index ( WHO-5 ) routinely during a ten-day cognitive behavioral therapy group . The first cohort ( n=461 ) received treatment as usual . The second cohort ( n=439 ) completed  monitoring measures without feedback , and for patients in the third cohort ( n=408 ) , feedback on progress was provided to both clinicians and patients midway through the treatment period . RESULTS Feedback was effective in reducing depressive symptoms ( F(1,649)=6.29 , p<.05 ) for those patients at risk of poor outcome , but not effective in improving wellbeing ( F(1,569)=1.14 , p>.05 ) . LIMITATIONS The current findings may be generalized to patient sample s that exhibit largely depressive disorders , however rigorous follow-up is warranted . CONCLUSIONS Similar to outpatient setting s , feedback appears to be beneficial for improving symptom outcomes but further time may be required for wellbeing to be affected OBJECTIVE To examine dem and characteristics , social desirability on clients '  rating of working alliance using the Session Rating Scale ( SRS ; Miller , Duncan , & Johnson , 2000 ) . METHOD Clients ( N = 102 ) at two sites were r and omly assigned to one of three alliance feedback conditions : ( a ) IF -- SRS completed in presence of therapist and the results discussed immediately afterward ; ( b ) Next Session Feedback -- SRS completed alone and results discussed next session ; or ( c ) No Feedback -- SRS completed alone and results not available to therapist . Clients completed the SRS for the first three sessions of treatment . RESULTS No statistically significant differences in SRS scores across the feedback conditions were found . Additionally , the analysis showed that SRS scores were not correlated with a measure of social desirability but were correlated with an established alliance measure . CONCLUSIONS The results indicate that alliance scores were not inflated due to the presence of a therapist or knowing that the scores would be observed by the therapist Abstract Background Shared Decision Making ( SDM ) is a way to empower patients when decisions are made about treatment . In order to be effective agents in this process , patients need access to information of good quality . Routine Outcome Monitoring ( ROM ) may provide such information and therefore may be a key element in SDM . This trial tests the effectiveness of  SDM  using ROM , primarily aim ing to diminish decisional conflict of the patient while making decisions about treatment . The degree of decisional conflict , the primary outcome of this study , encompasses personal certainty about choosing an appropriate treatment , information about options , clarification of patient values , support from others and patients experience of an effective decision making process . Secondary outcomes of the study focus on the working alliance between patient and clinician , adherence to treatment , and clinical outcome and quality of life . Methods / Design This article presents the study protocol of a multi-centre two-arm cluster r and omised controlled trial ( RCT ) . The research is conducted in Dutch specialised mental health care teams participating in the ROM Quality Improvement Collaborative ( QIC )  , which aims to implement ROM in daily clinical practice . In the intervention teams , ROM is used as a source of information during the SDM process between the patient and clinician . Control teams receive no specific SDM or ROM instructions and apply decision making as usual . R and omisation is conducted at the level of the participating teams within the mental health organisations . A total of 12 teams from 4 organisations and 364 patients participate in the study . Prior to data collection , the intervention teams are trained to use ROM during the SDM process . Data collection will be at baseline , and at 3 and 6 months after inclusion of the patient . Control teams will implement the SDM and ROM model after completion of the study . Discussion This study will provide useful information about the effectiveness of ROM  within a SDM framework . Furthermore , with practical guidelines this study may contribute to the implementation of SDM using ROM in mental health care . Reporting of the results is expected from December 2016 onwards . Trial registration Dutch trial register : TC5262 Trial registration date : 24th of June Background The main aim was to investigate the effect of using two brief feedback scales in mental health out-patient treatment six weeks after starting treatment , compared to treatment as usual . Hypotheses were that use of feedback scales would improve treatment alliance and patient satisfaction . Methods An open parallel-group r and omised controlled trial was conducted in an out-patient unit in a mental health hospital in Central Norway . Eight therapists trained in using the  feedback scales  in the  Partners for Change Outcome Management System ( PCOMS ) treated the intervention group . Seventeen therapists treated the controls  , providing treatment without using feedback scales . The main outcome measures were treatment alliance and patient satisfaction . Results Seventy-five patients participated . There were no differences between the groups in the intention to treat ( ITT ) analyses on alliance ( mean difference = 0.08 , 95 % CI −0.44 , 0.59 , p = 0.760 ) or satisfaction ( mean difference = 0.24 , 95 % CI −1.85 , 2.32 , p = 0.819 ) , and no statistically significant differences between the groups in the per protocol ( PP , n = 58 ) analyses on alliance ( mean difference = 0.32 , 95 % CI −0.84 , 3.16 , p = 0.137 ) or satisfaction ( mean difference = 1.16 , 95 % CI −0.84 , 3.16 , p = 0.248 ) six weeks after the treatment started . The effect size in favour of the PCOMS group increased from 0.07 for alliance and 0.06 for satisfaction in the intention to treat analysis to 0.40 on alliance and 0.31 for satisfaction in the per protocol analysis . Among the other outcomes , the PCOMS group had better motivation for treatment ( estimated mean difference ITT : 0.29 , 95 % CI 0.00 to 0.57 , p = 0.05 , PP : 0.28 , 95 % CI 0.04 , 0.52 , p = 0.024 ) . ConclusionS ix weeks after starting treatment , there were no effects on alliance and satisfaction from using two brief feedback scales . Since the per protocol analyses showed higher effect sizes , future investigations in a larger study with longer follow-up are warranted Abstract The current study examined the effects of providing treatment progress information and problem-solving tools to both patients and therapists during the course of psychotherapy . Three hundred and seventy patients were r and omly assigned to one of two treatment groups : treatment-as-usual , or an experimental condition based on the use of patient/therapist feedback and clinical decision-support tools . Patients in the feedback condition were significantly more improved at termination than the patients in the treatment-as-usual condition . Treatment effects were not a consequence of different amounts of psychotherapy received by experimental and control clients . These findings are consistent with past research on these approaches although the effect size was smaller in this study . Not all therapists were aided by the feedback intervention BACKGROUND Patient-clinician communication is central to mental healthcare but neglected in research . AIMS To test a new computer-mediated intervention structuring patient-clinician dialogue ( DIALOG ) focusing on patients ' quality of life and needs for care . METHOD In a cluster r and omised controlled trial , 134 keyworkers in six countries were allocated to DIALOG  or  treatment as usual ; 507 people with schizophrenia or related disorders were included . Every 2 months for 1 year , clinicians asked patients to rate satisfaction with quality of life and treatment , and request additional or different support . Responses were fed back immediately in screen displays , compared with previous ratings and discussed . Primary outcome was subjective quality of life , and secondary outcomes were unmet needs and treatment satisfaction . RESULTS Of 507 patients , 56 were lost to follow-up and 451 were included in intention-to-treat analyses . Patients receiving the DIALOG intervention had better subjective quality of life , fewer unmet needs and higher treatment satisfaction after 12 months . CONCLUSIONS Structuring patient-clinician dialogue to focus on patients ' views positively influenced quality of life , needs for care and treatment satisfaction OBJECTIVE To investigate the long-term effect on mental health symptoms and patient activation , from using the Partners for Change Outcome Management System ( PCOMS ) feedback scales in out-patient mental health consultations , compared to not using feedback scales . METHODS An open parallel-group r and omised controlled trial was conducted in a mental health hospital in Norway . Eight therapists treated the  intervention group , using two feedback scales , and seventeen therapists treated the treatment as usual group . RESULTS Seventy-five patients participated . Six and twelve months after starting treatment there were no significant effects on the primary outcomes mental health symptoms or patient activation . Compared to baseline assessment the PCOMS group had significantly improved their patient activation scores after twelve months . CONCLUSION We found no long-term effects from using the PCOMS scales on mental health symptoms or patient activation . PRACTICE IMPLICATION S This study shows that the use of a feedback system does not increase mental health outcomes or patient activation Abstract Objective : To test the effectiveness of two programmes to improve the treatment of acute depression in primary care . Design : R and omised trial . Setting : Primary care clinics in Seattle . Patients : 613 patients starting antidepressant treatment . Intervention : Patients were r and omly assigned to continued usual care or one of two interventions : feedback only and feedback plus care management . Feedback only comprised feedback and algorithm based recommendations to doctors on the basis of data from computerised records of pharmacy and visits . Feedback plus care management included systematic follow up by telephone , sophisticated treatment recommendations , and practice support by a care manager . Main outcome measures : Blinded interviews by telephone 3 and 6 months after the initial prescription included a 20 item depression scale from the Hopkins symptom checklist and the structured clinical interview for the current DSM-IV depression module . Visits , antidepressant prescriptions , and overall use of health care were assessed from computerised records . Results : Compared with usual care , feedback only had no significant effect on treatment received or patient outcomes . Patients receiving feedback plus care management had a higher probability of both receiving at least moderate doses of antidepressants ( odds ratio 1.99 , 95 % confidence interval 1.23 to 3.22 ) and a 50 % improvement in depression scores on the symptom checklist ( 2.22 , 1.31 to 3.75 ) , lower mean depression scores on the symptom checklist at follow up , and a lower probability of major depression at follow up ( 0.46 , 0.24 to 0.86 ) . The incremental cost of feedback plus care management was about $ 80 ( £ 50 ) per patient . Conclusions : Monitoring and feedback to doctors yielded no significant benefits for patients in primary care starting antidepressant treatment . A programme of systematic follow up and care management by telephone , however , significantly improved outcomes at modest cost Abstract Aim : The objective of the study was to evaluate the efficacy of the Outcome Question naire 45 ( OQ-45 ) with feedback in a Swedish psychiatric outpatient population using a r and omized controlled design . Method : In all 1720 patients made at least one regular visit to the clinics in the period 12 February 2007 to 10 February 2008 and received information about the study . Of these , 374 patients ( 22 % ) agreed to participate . After written consent , 188 patients were r and omized to the  feedback group and 1 
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We found insufficient evidence to support the use of routine outcome monitoring using PROMs in the treatment of CMHDs , in terms of improving patient outcomes or in improving management .
The findings are subject to considerable uncertainty however , due to the high risk of bias in the large majority of trials meeting the inclusion criteria , which means further research is very likely to have an important impact on the estimate of effect and is likely to change the estimate .