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National Policy Context

National Policy Context. The introduction of Outcome Measurement into routine clinical practice is a national initiative Relates to quality & effectiveness objective of National Mental Health Plan (sine 1992) Covers both public and private psychiatry

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National Policy Context

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  1. National Policy Context • The introduction of Outcome Measurement into routine clinical practice is a national initiative • Relates to quality & effectiveness objective of National Mental Health Plan (sine 1992) • Covers both public and private psychiatry • Separate suites of measures for each age group - nationally agreed - mandatory

  2. How did we get here? • Suites of measures developed over 10 years of research & development • Adult OM suite implemented in four Victorian Adult services since 2000 • Advisory bodies established at Commonwealth, State & AMHS levels to guide implementation • Expert Groups • Victorian OM Reference Group • Local Implementation Committees

  3. Rationale - Why evaluate outcomes? • Outcome Measures inform us about an individual consumer’s health status at a given point in time • Comparison of measures taken at different timing points show what has changed (as a result of treatment) • This information enables us to reflect on what works for an individual client - or client group

  4. How can we use Outcomes Data • OM data can help by highlighting areas of progress, decline or stability for an individual consumer - this information can guide treatment planning • Can also be used to show consumer how things have changed • OM data can be aggregated to give an impression of how effective particular service components are

  5. What is a suite? • Each suite comprises a number of measures which cover symptom severity, level of functioning/disability and contextual information. • Consumer Self-Rating measure in each suite provides an opportunity to strengthen the dialogue between clinicians & consumers

  6. Why these measures? • The measures were chosen because they • are suitable for use in mental health services • can be used across different service settings • require minimal training, are simple to use & quick to complete (after a little practice!) • are valid & reliable (psychometric properties) • are sensitive to change over time

  7. KEY CONCEPTS • Mental Health Service Setting • Age Group • Episode of Mental Health Care • Collection Occasion

  8. Mental Health Service Setting Three choices:- Inpatient (overnight admitted)- Community Residential (24hr staffing)- Ambulatory Age Group - different suites apply • Three choices: • Child & Adolescent (less than 18yrs) • Adult (18 - 64 inclusive) • Older Persons (65 yrs +) SERVICE UNIT DETERMINES AGE GROUP

  9. Episode of Mental Health Care • The period in which a person receives care/services in any one settingTwo Business Rules • One Episode at a time • Change of MH setting = New Episode

  10. Collection Occasion(Reason for Collection) Three choices! • Admission = start of an episode of MH care • Discharge = end of an episode of MH care • Review = when an episode lasts longer than three months, outcomes should be reviewed at 3/12 intervals • (align with ISP review as much as possible)

  11. Who does What & When? • The Victorian OM ‘protocol’ determines WHAT needs to be collected (which measures) and WHEN (collection occasion) • Local protocol makes clear WHO is responsible for collection especially when one episode starts straight after the last one (e.g. inpatient episode followed by ambulatory episode or vice versa) • Local protocol can also add collection occasions (e.g. within an episode of ambulatory care when a consumer transfers to the care of another team )

  12. Episodes, cases, and collection occasions Course of Illness Episode of Care I Setting = Inpatient Episode of Care II Setting = Ambulatory Episode of Care III Setting = Ambulatory Ward A Ward B MST CATT MST Continuing care . . . 91 days Intake to community Discharge from community Discharge from inpatient 91 day review Admission to inpatient Case 1 Case 2 Period of no care Intake to community Collection occasions

  13. The NOCC Data Collection Protocol in Victoria

  14. 1. Movement between community and inpatient settings Do ratings need to be recorded for the end of the community episode, as well as at the beginning of the inpatient episode, when a consumer is transferred from ambulatory care to overnight inpatient care ?YES  Local arrangements need to allocate responsibilty (WHO?) to avoid duplication

  15. 2. Transfer between two wards of a psychiatric unit Is the transfer of a patient from one psychiatric ward to another, within the same hospital, a new episode requiring new data collection ?NO

  16. 3. Transfer of care between community teams Does a new cycle of data collection begin when case management is transferred from one ambulatory care team to another within the same organisation ?NO Local protocols may determine additional collection occasions (e.g. CCT to MST)

  17. 4. Multiple team involvement in case management Is each team expected to complete ratings on the consumer ?NO  Local protocols must identify WHO is responsible for completing ratings (and entering data on RAPID/CMI

  18. 5. Intended same day admissions Is each day of care a new inpatient episode, requiring a full set of ratings ? NO  An example here is day admission for ECT for a pre-determined number of occasions - this would be considered an ambulatory episode for OM purposes. An overnight stay would signal a change of episode.

  19. 6. Discharge from hospital on indefinite leave Does an inpatient episode of mental health care continue when a patient is placed on extended leave but remains, legally, an inpatient ?NO

  20. 7. Brief inpatient episodes Are discharge ratings required for very brief inpatient episodes? for episodes of less than 3 days, NO otherwise, YES

  21. 8. Rapid readmission to hospital If a patient is discharged from an inpatient unit and is readmitted within a very short period, is this a new inpatient episode or a continuation of the previous one ? It is a NEW EPISODE

  22. 9. Assessment only cases seen by community teams? Is outcomes and casemix data required on every person seen by community teams, regardless of whether they are accepted for treatment ?NO  When is is not immediately clear that it is an ‘Assessment Only’ situation, it should be assumed that collection is required

  23. 10. Consumers seen regularly, but at less than three monthly intervals How should the 3 monthly (91 day) review ‘rule’ be applied in these cases ? Does it mean that they will need to be seen more regularly ?NO  The National Mental Health Standards require three-monthly review of treatment plans - services should be working towards this standard for all active cases

  24. Data Collection module on RAPID/CMI allows all OM data to be entered for all clients with open ‘case’ Must identify Collection Occasion, date of rating etc Wellbeing Reporting Tool Provides reports on individual clients based on data entered via Wellbeing module(User Manual has details) Aggregate reports also available Wellbeing

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