What is it about?
This paper examines how best to measure the quality and quantity of care delivered by teams that deliver care for people experiencing a psychotic disorder within a learning health system. Psychotic disorders are complex disorders that affect thinking, perceiving and behavior. They tend to begin in adolescence and or early adulthood and have a lifelong impact. Early intervention with team based cares such as coordinated specialty care for psychosis has been shown to improve many outcomes. These team based interventions comprise several interventions that need to be coordinated and delivered according to the best evidence of what works. We measure the quality and amount of care delivered using fidelity scales. In a learning health system fidelity scales are used to measure the quality of care delivered so that we can compare and combine the treatments delivered by many teams just as we need standard outcome measures to compare the results delivered by the teams. The study identified several fidelity scales that were being used in one learning health system and chose the one that was used most often and that had been shown to be reliable and sensitive to change. This was the First Episode Psychosis Services Fidelity Scale (FEPS-FS) which has 36 items. The investigators then looked at the five other fidelity scales in use in the learning health system to examine what proportion of their items could be mapped onto the FEPS-FS. The results varied across the scales from 100% for the programs that used the FEPS-FS to between 80% and 47% for the programs that used other fidelity scales. The investigators concluded that mapping all the available fidelity information onto the FEPS-FS would generate useful information, but that in the long run it would be better if all programs used one common fidelity measure and used other scales to gather only additional information for a specific purpose.