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2015 ; 52
(3
): 329-36
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Removing very low-performing therapists: A simulation of performance-based
retention in psychotherapy
#MMPMID26301424
Imel ZE
; Sheng E
; Baldwin SA
; Atkins DC
Psychotherapy (Chic)
2015[Sep]; 52
(3
): 329-36
PMID26301424
show ga
Therapists can impact the likelihood a given patient will benefit from
psychotherapy. However, therapists are rarely held accountable for their
patients' outcomes. As a result, low-performing providers likely continue to
practice alongside providers with high response rates. In the current study, we
conducted a Monte Carlo simulation to illustrate a thought experiment-what
happens to patient outcomes if therapists with the worst outcomes were removed
from practice? We drew initial samples of 50 therapists from 3 simulated
populations of 1,000 therapists with a mean patient response rate of 50% and
different effect sizes for therapist variability in outcomes. We simulated 30
patient outcomes for each therapist, with outcome defined as response to
treatment versus no response. We removed therapists with response rates in the
bottom 5% and replaced them with a random sample of therapists from the
population. Over 10 years, the difference in responses between the lowest and
highest performing therapists was substantial (between 697 and 997 additional
responses to treatment). After repeatedly removing the lowest performing
providers 40 times (simulating a 10-year time span), response rates increased
substantially. The cumulative number of patient responses (i.e., summing the
total number of responses across 10 years) increased by 4,266, 6,404, and 9,307
when therapists accounted for 5%, 10%, or 20% of the patient outcome variance,
respectively. These findings indicate that performance-based retention of
therapists could improve the quality of psychotherapy in health systems by
improving the average response rate and decreasing the probability that a patient
will be treated by a therapist who consistently has poor outcomes.
|*Professional-Patient Relations
[MESH]
|Clinical Competence/*statistics & numerical data
[MESH]
|Health Personnel/*statistics & numerical data
[MESH]
|Humans
[MESH]
|Mental Disorders/*therapy
[MESH]
|Monte Carlo Method
[MESH]
|Patient Satisfaction/*statistics & numerical data
[MESH]
|Psychotherapy/*statistics & numerical data
[MESH]
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