Sue Eisen

According to Sue Eisen, PhD, Principal Architect of the BASIS-32, the instrument was developed because while there were several instruments available to measure outcomes in outpatient populations, few adequately represented all of the problems that brought people to inpatient treatment.The BASIS-32 can be incorporated into the clinical care system at this level through routine assessment at admission, and the information obtained through the BASIS-32 can be used to better plan a course of treatment.Furthermore, by comparing responses from admission and discharge, it is possible to quantitatively determine whether a patient feels his or her condition has improved and, if so, in which specific areas of symptoms or functioning.Change can thus be analyzed both at the individual level, and at the aggregate level within particular programs, which can facilitate the detection of trends in outcomes, for better or worse.

While the BASIS-32 was developed for inpatient populations, it can be used in outpatient populations, although obtaining follow-up information from this population can prove to be difficult.According to Eisen, "Application in this population depends upon the acceptance of the whole process, and this usually depends on how well the BASIS-32 is integrated into the system."Eisen believes that success with this population has to do with administration efforts- refusal rate is quite low when clinicians work the BASIS-32 into the visit, as opposed to having support staff administer the survey in the waiting room.McLean recently completed a collaborative outcome study of mental health outpatients using the BASIS-32.This study included 400 patients, and provides evidence of the psychometric robustness of the BASIS-32 when used with outpatients.

As for other caveats related to administration, Eisen said that it is important to consider who may be unable to complete the BASIS-32, based on a condition (IE, severe dementia) or level of alertness (IE, sedation due to medication).At McLean Hospital in Belmont, Massachusetts, where Eisen is the Assistant Director of the Department of Mental Health Services Research, strategies have been devised to facilitate administration, including the use of laminated cardboard scales that the respondent can use to "show" a response to a verbal reading of the BASIS-32."We do not know the percentage of those who are unable to complete the BASIS-32, in the past it was around eight or ten per cent, but often times, by waiting a day, a client may become more stable clinically," said Eisen.
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In terms of limitations of the BASIS-32, Eisen stressed, "It was not designed to replace clinical assessment- it should be used instead as a supplement."She stated that as for realistic goals of the BASIS-32, after resolution of an acute episode, one can hope to maintain the level where the client was at prior to such an episode.She also stressed that clinicians or researchers using the BASIS-32 should be realistic when setting goals for its application.

The BASIS-32 has been requested for use by more than 1,000 health care organizations in the United States and abroad.Currently, several managed care organizations, consulting companies, and performance measurement developers are looking at the possibility of the BASIS-32 playing a role in terms of decision support.

Permission and documentation to use the instrument can be obtained by contacting Susan V. Eisen, PhD, Department of Mental Health Services Research, McLean Hospital, 115 Mill Street, Belmont, MA 02178.FAX: 617-855-2948.