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Consistency of the Health of the Nation Outcome Scales (HoNOS) at inpatient-to-community transition

27 Apr 2016


The Health of the Nation Outcome Scales (HoNOS) are mandated outcome-measures in many mental-health jurisdictions. When HoNOS are used in different care settings, it is important to assess if setting specific bias exists. This article examines the consistency of HoNOS in a sample of psychiatric patients transitioned from acute inpatient care and community centres.


A regional mental health service with both acute and community facilities.


111 psychiatric patients were transferred from inpatient care to community care from 2012 to 2014. Their HoNOS scores were extracted from a clinical database; Each inpatient-discharge assessment was followed by a community-intake assessment, with the median period between assessments being 4 days (range 0–14). Assessor experience and professional background were recorded.

Primary and secondary outcome measures

The difference of HoNOS at inpatient-discharge and community-intake were assessed with Pearson correlation, Cohen's and effect size.


Inpatient-discharge HoNOS was on average lower than community-intake HoNOS. The average HoNOS was 8.05 at discharge (median 7, range 1–22), and 12.16 at intake (median 12, range 1–25), an average increase of 4.11 (SD 6.97). Pearson correlation between two total scores was 0.073 (95% CI –0.095 to 0.238) and Cohen's was 0.02 (95% CI –0.02 to 0.06). Differences did not appear to depend on assessor experience or professional background.


Systematic change in the HoNOS occurs at inpatient-to-community transition. Some caution should be exercised in making direct comparisons between inpatient HoNOS and community HoNOS scores.

Click here to view the full article which appeared in BMJ Open