frequently asked questions

How do I use the tracking function?

After a patient completes the OutcomeTracker scales, the provider receives an email indicating that a scale has been completed. For confidentiality reasons the email does not mention the patient’s name. The email contains a link to OutcomeTracker site. After logging in using your password, you will be brought to the patient’s completed form (which can then be printed).

OutcomeTracker also graphs patients’ total scores on the depression and anxiety scales. To access a graph of patient’s scores you need to login in to the OutcomeTracker site and select the patient’s name from the drop down list under Report 1.

What should I do if I patient did not complete the scales before their visit?

The Clinically Useful Depression Outcome Scale (CUDOS) and Clinically Useful Anxiety Outcome Scale (CUXOS) are available for free as pdf files and can be printed and given to patients to complete in the office.

How much does it cost each time the patient completes the scale?

The yearly license fee covers an unlimited number of uses during the year.

How do I interpret the scores on the CUDOS and CUXOS?

Extensive research and our clinical experience allowed us to derive empirically informed ranges of scores corresponding to a dimensional assessment of depression and anxiety severity.

Is the system HIPAA compliant?

The Outcome Tracker website is a secure, encrypted site housed on its own server. Because confidentiality and security is crucial to the success and widespread adoption of a web-based system multiple layers of protection are implemented.

How do patients use the OutcomeTracker system if they do not have a computer?

The OutcomeTracker system requires use of a computer. For patients without a computer paper versions of the CUDOS and CUXOS can be administered to patients.

Whom do I contact if I have a problem or question?

If you have questions regarding the Outcome Tracker, please contact customer support.
Email Support: MZimmerman@Lifespan.org

How do I help patients get started?

After determining that the patient is a computer user who has internet access and uses email then you should explain the purpose of the system (to measure and track their response to treatment, and to remind them of their appointments). It is helpful to give patients an instruction sheet (click here) for registering on the system. The instruction sheet should include your Provider Identification Number (PIN).

Why monitor outcome?

Imagine going to your primary care doctor with a fever and symptoms of an upper respiratory track infection. Your primary care provider puts his or her palm to your forehead and agrees that you feel warm. A course of treatment is recommended, you return in a couple of days, and he or she again feels your forehead and notes that you are cooler. Would you be happy with this approach towards care? Would you continue to see a doctor who evaluated your body temperature in this way? We would not accept this level of care from an internist, family practitioner, or pediatrician, and yet this is the community standard of care provided by most behavioral health clinicians when treating depression,, anxiety, and other psychiatric disorders.

To determine the impact of treatment it is necessary to evaluate outcome. In mental health clinical settings this typically is based on unstructured interactions that yield unquantified judgments of progress. This is at variance with other areas of medical care in which outcome is determined, in part, on the change of a numerical value. Body temperature, blood pressure, cholesterol values, blood sugar levels, cardiac ejection fraction, and white blood cell counts are examples of quantifiable variables that are used to evaluate treatment progress. In the mental health field, standardized, quantifiable outcome measures exist for most major psychiatric disorders, yet they are rarely used in routine clinical practice. Thus, to determine the impact of treatment it is not simply a matter of evaluating outcome, but rather a matter of measuring outcome. The use of standardized scales to measure outcome is consistent with the recent Center for Medicare and Medicaid Services Physician Quality Reporting Initiative, which is intended to increase clinicians’ motivation to systematically evaluate outcome by providing financial incentives to monitor outcome.

Why are there only 2 scales on the OutcomeTracker system?

At the present time Outcome Tracker includes two reliable and validated scales: the Clinically Useful Depression Outcome Scale (CUDOS) and the Clinically Useful Anxiety Outcome Scale (CUXOS) (click here to read more about the CUDOS and CUXOS, including the cutoff scores indicating severity levels).

Over time additional scales will be added to assess anger, drug and alcohol use problems, eating disorders, social phobia, agoraphobia, obsessive compulsive disorder, posttraumatic stress disorder, psychosis, mania/hypomania, pain, and somatic symptoms. Because it takes time (and money) to add scales to the OutcomeTracker system, we decided to make it available for use after the depression and anxiety scales, the two most frequently used scales in our practice, were loaded into the system. Moreover, the research on the reliability and validity of the CUDOS has already been published in peer-reviewed journals, and the first large validation study of the CUXOS is currently under review.

How does the CUDOS compare to other depression symptom questionnaires?

There are many self-administered depression scales, though some are less appealing as outcome tools for use in routine clinical practice because they are either too long (Beck Depression Inventory, Quick Inventory of Depressive Symptoms) lack adequate coverage of the DSM-IV diagnostic criteria (Zung Depression Scale), are expensive to purchase (Beck Depression Inventory), or are somewhat complicated to score (Zung Depression Scale). Because of ease of use considerations, we would recommend that either the CUDOS or the 9-item Patient Health Questionnaire (PHQ-9) be used by clinicians at every visit to monitor the course of depression. The PHQ-9 adheres to the construction of the DSM-IV criteria; thus compound DSM-IV criteria which refer to more than one symptom (e.g., insomnia or hypersomnia; increased or decreased appetite) are represented by a single item on PHQ-9. Since treatment decision-making might be influenced by whether a patient has insomnia or is sleeping too much, or has a reduced appetite or is eating too much, the PHQ-9 does not capture potentially clinically significant information. Also, in contrast to other depression scales, the CUDOS includes brief, valid, assessments of psychosocial impairment and quality of life.