The provision of mental health services is an inherently complex matter. All Hospitals strive to continuously monitor, evaluate and improve the quality, safety, effectiveness and efficiency of the services they provide. To help them do that, Hospitals need an effective information infrastructure that enables their questions about quality, effectiveness and efficiency to be addressed. That infrastructure has three essential components — efficient processes for data collection, systems for data analysis and reporting, and people who have the resources and skills needed to use that information in service management and clinical quality improvement. It also has a number of critical attributes, including: that it uses a common language, enables comparison of like with like, has adequate reliability and validity, and protects the privacy and confidentiality of patients and, where appropriate, also of providers and payers. It must also operate alongside the existing clinical information systems that support the day–to–day provision of care without compromising the quality of care or imposing undue additional burden on clinicians or costs on hospitals.
Private hospitals with psychiatric beds have addressed their need for that infrastructure through the development and implementation of a ‘National Model for the Collection and Analysis of a Minimum Data Set with Outcome Measures’. In its current form, the National Model consists of guidelines that cover the specific data to be collected, the timing and procedures for the collection and submission of data by Hospitals for analysis, the reports to be derived from that data, and restrictions on access to data at all stages and at all levels of aggregation.
The agreed guidelines that specify how episodes of care are defined for statistical purposes, what clinical measures are to be collected, and at what points during the episode those measures should be collected are collectively referred to under the National Model as the Outcome Measures Protocol (OMP). The linkage of data collected under the OMP with the data Hospitals already must collect under the Hospitals Casemix Protocol (HCP) enables a comprehensive description of psychiatric patients’ needs for and responses to care.
The analysis and reporting framework employed by the CDMS operates under the Guidelines specified in the National Model to ensure that the privacy and confidentiality of the participating Hospitals and Payers is protected. Essentially, the guidelines require that aggregate statistics be partitioned on the basis of the identity of the responsible Hospital and Payer, with each Hospital or Payer then only being provided with identified statistical information about their patients’ or members’ care. Aggregate statistics about other Hospitals or Payers may only be provided in a format that ensures the responsible Hospitals or Payers cannot be identified. For example, each Hospital’s report is individualised so that they can identify themselves within charts and tables, but are unable to identify any other hospital.
The National Model’s guidelines that specify the restrictions that are applied to access to data and information are particularly important. Whilst the need for the protection of personally identified information is well understood, issues related to the use and access to information regarding providers and payers also must be addressed if Clinicians, Hospitals and Health Funds are to retain confidence in the probity of the processes of analysis and reporting.
Under the National Model, Hospitals collect two measures of patients’ clinical status, the HoNOS and MHQ-14, at key points in the clinical path — at Admission and Discharge from episodes of care, and where episodes are of extended duration, at Review every 91 days. That information is linked with administrative and clinical data already recorded by Hospitals under the Hospitals’ Casemix Protocol (HCP), and submitted on a quarterly basis to the CDMS in a personally de–identified format for analysis. On the basis of that data, the CDMS prepares and distributes Standard Quarterly Reports to participating Hospitals and Payers.
The HoNOS (Health of the Nation Outcome Scales) is a clinician–rated measure developed by the Royal College of Psychiatrists. Its’ twelve scales provide a comprehensive yet brief summary of the clinician’s assessment of the patient’s clinical status over the preceding period (two weeks at admission, three days at discharge). Scales 1 to 10 address behavioural, symptomatic and social problems; scales 11 and 12 are about the patient’s domestic and occupational environment, particularly the extent to which it may help or hinder their recovery.
The MHQ–14 (Mental Health Questionnaire, 14 item version) is a patient self–report measure consisting of items that address symptoms of fatigue, anxiety and depression and the impact of those symptoms on social and role functioning. The items were derived from the Medical Outcomes Study questionnaire used in the Rand Health Insurance Experiment. A single Total Score and four summary scores, traditionally referred to as Mental Health, Vitality, Social Functioning and Role Functioning, are derived from patients’ responses to the 14 items.
Collection of data in accordance with the requirements of the National Model, participation by Hospitals in the services offered by the CDMS, and submission of their data to the CDMS is voluntary. At present all private hospital-based psychiatric services in Australia participate in the CDMS.