Outcome research has documented worsening among a minority of the patient population (5 to 10%). In this study a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure was reviewed through the use of meta-analytic, mega-analytic, and multilevel analytic techniques. A pooled dataset from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were re-analyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians to help them intervene before treatment failure occurred. Intent-to-treat and efficacy analyses of the effects of feedback interventions were conducted to obtain the estimates of effects expected from implementation of this quality assurance system as a policy as well as in clinical trials. Three forms of feedback interventions—integral elements of this quality assurance system—were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (Clinical Support Tools and the provision of patient progress feedback to therapists). The Clinical Support Tool intervention was effective not only in terms of the amount of outcome enhancing effect, but also in the rate of patient recovery. The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.

Patient-focused research systems have been developed to monitor and inform therapists of patients' treatment progress in psychotherapy as a method to enhance patient outcome. 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 seventy patients at a hospital-based outpatient psychotherapy clinic were randomly 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. These findings are consistent with past research on these approaches although the effect size was smaller in this study. Treatment effects were not a consequence of different amounts of psychotherapy received by experimental and control clients. Not all therapists were aided by the feedback intervention.