1
|
Schneberk T, Bolshakova M, Sloan K, Chang E, Stal J, Dinalo J, Jimenez E, Motala A, Hempel S. Quality Indicators for High-Need Patients: a Systematic Review. J Gen Intern Med 2022; 37:3147-3161. [PMID: 35260956 PMCID: PMC9485370 DOI: 10.1007/s11606-022-07454-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Healthcare systems are increasingly implementing programs for high-need patients, who often have multiple chronic conditions and complex social situations. Little, however, is known about quality indicators that might guide healthcare organizations and providers in improving care for high-need patients. We sought to conduct a systematic review to identify potential quality indicators for high-need patients. METHODS This systematic review (CRD42020215917) searched PubMed, CINAHL, and EMBASE; guideline clearing houses ECRI and GIN; and Google scholar. We included publications suggesting, evaluating, and utilizing indicators to assess quality of care for high-need patients. Critical appraisal of the indicators addressed the development process, endorsement and adoption, and characteristics, such as feasibility. We standardized indicators by patient population subgroups to facilitate comparisons across different indicator groups. RESULTS The search identified 6964 citations. Of these, 1382 publications were obtained as full text, and 53 studies met inclusion criteria. We identified over 1700 quality indicators across studies. Quality indicator characteristics varied widely. The scope of the selected indicators ranged from detailed criterion (e.g., "annual eye exam") to very broad categories (e.g., "care coordination"). Some publications suggested disease condition-specific indicators (e.g., diabetes), some used condition-independent criteria (e.g., "documentation of the medication list in the medical record available to all care agencies"), and some publications used a mixture of indicator types. DISCUSSION We identified and evaluated existing quality indicators for a complex, heterogeneous patient group. Although some quality indicators were not disease-specific, we found very few that accounted for social determinants of health and behavioral factors. More research is needed to develop quality indicators that address patient risk factors.
Collapse
Affiliation(s)
- Todd Schneberk
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kylie Sloan
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Julia Stal
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Aneesa Motala
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Susanne Hempel
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, GNH 1011, 1200 N State Street Rm 1011, Los Angeles, CA, 90033, USA
- Southern California Evidence Review Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Lima IBD, Alves D, Furegato ARF. Mental Health Indicators for the Brazilian Psychosocial Care Network: A proposal. Rev Lat Am Enfermagem 2022; 30:e3599. [PMID: 35920537 DOI: 10.1590/1518-8345.5618.3599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/06/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to propose Mental Health Indicators aimed at management of the Mental Health Care Network, starting with convergence of their use, in countries with public health organization. METHOD an exploratory analysis of the indicators adopted and used in these countries, from the detailed analysis of their respective normative documents, considering the World Health Organization guidelines. After selection of the indicators, the Mental Health Matrix was adopted as a suggestion for their development and application in the Brazilian Psychosocial Care Network. The matrix was prepared in two dimensions, respecting the inclusion and exclusion criteria for the indicators studied, as follows: geographical (national/regional, local, individual), and time (entry, process and results). RESULTS the analysis indicates 41 indicators that presented diverse evidence regarding their use. All were allocated in the Mental Health Matrix, contributing as a metric to analyze the purpose of the Mental Health services, in the levels and phases of each dimension. CONCLUSION the indicators selected, distributed in the different Mental Health Matrix dimensions, are being made available for their use in management and in the clinical practice, as well as for scientific studies and, in the future, to be used as definers of Mental Health policies.
Collapse
Affiliation(s)
- Inacia Bezerra de Lima
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | - Domingos Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Antônia Regina Ferreira Furegato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| |
Collapse
|
3
|
Waibel S, Wu WL, Smith M, Johnson LK, Janke RD. Selection of Pediatric Mental Health Quality Measures for Health System Improvement in British Columbia Based on a Modified Delphi Approach. Front Pediatr 2022; 10:866391. [PMID: 35874563 PMCID: PMC9298984 DOI: 10.3389/fped.2022.866391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has highlighted the importance of mental wellbeing. The identification and implementation of quality measures can improve health outcomes and patient experience. The objective was to identify and define a core set of valid and relevant pediatric mental health quality measures that will support health system evaluation and quality improvement in British Columbia, Canada. METHODS The study consisted of four phases. First, a comprehensive database search identified valid pediatric quality measures focused on mental health and substance use (MH/SU). Second, the identified quality measures were mapped to focus areas, which were then prioritized by two stakeholder groups consisting of 26 members. Third, up to two representative measures for each prioritized focus area were pre-selected by an expert panel (n = 9). And fourth, a three-step modified Delphi approach was employed to (1) assess each quality measure on a 7-point Likert scale against three relevance criteria (representative of a quality problem, value to intended audience and actionable), (2) discuss the results, and (3) select and rank the most relevant measures. Forty-eight stakeholders were invited to participate; of those 24 completed the round 1 survey, 21 participated in the round 2 discussion and 18 voted in the round 3 selection and ranking survey. For round 1, consensus was determined when at least 70% of the response rates were within the range of five to seven. For round 3, Kendall's coefficient of concordance W was used as an estimator of inter-rater reliability. RESULTS One-hundred pediatric mental health quality measures were identified in the database search. Of those, 37 were mapped to ten focus areas. Pre-selection resulted in 19 representative measures moving forward to the Delphi study. Eleven measures met the consensus thresholds and were brought forward to the round 2 discussion. Round 3 ranking showed moderate to strong raters' agreement (Kendall's W = 0.595; p < 0.01) and resulted in the following five highest-ranked measures: level of satisfaction after discharge from inpatient admission due to MH/SU, number of patients experiencing seclusion or restraint, length of time from eating disorder referral to assessment, number of ED visits due to MH/SU, and number of readmissions to ED. CONCLUSION The selected core set of valid and relevant pediatric quality measures will support sustainable system change in British Columbia. The five top-ranked measures will be refined and tested for data collection feasibility before being implemented in the province.
Collapse
Affiliation(s)
- Sina Waibel
- Child Health BC, Provincial Health Services Authority, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Wan Ling Wu
- Child Health BC, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - L Kit Johnson
- Child Health BC, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Rita D Janke
- Child Health BC, Provincial Health Services Authority, Vancouver, BC, Canada
| |
Collapse
|
4
|
Thom J, Mauz E, Peitz D, Kersjes C, Aichberger M, Baumeister H, Bramesfeld A, Daszkowski J, Eichhorn T, Gaebel W, Härter M, Jacobi F, Kuhn J, Lindert J, Margraf J, Melchior H, Meyer-Lindenberg A, Nebe A, Orpana H, Peth J, Reininghaus U, Riedel-Heller S, Rose U, Schomerus G, Schuler D, von Rüden U, Hölling H. Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set. JOURNAL OF HEALTH MONITORING 2021; 6:34-63. [PMID: 35146320 PMCID: PMC8734140 DOI: 10.25646/8861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.
Collapse
Affiliation(s)
- Julia Thom
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Elvira Mauz
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Diana Peitz
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Christina Kersjes
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| | - Marion Aichberger
- Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin
| | - Harald Baumeister
- University of Ulm, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy
| | - Anke Bramesfeld
- Ministry for Social Affairs, Health and Equal Opportunities of Lower Saxony
- Hannover Medical School (MHH), Institute for Epidemiology, Social Medicine and Health System Research
| | | | | | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131; Rhineland Regional Council (LVR) - Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität Düsseldorf
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology
- German Network Health Services Research
| | - Frank Jacobi
- Psychologische Hochschule Berlin, Department of Clinical Psychology and Psychotherapy
| | | | - Jutta Lindert
- University of Applied Sciences Emden/Leer
- European Public Health Association, Section Public Mental Health
| | - Jürgen Margraf
- Ruhr-University Bochum, Mental Health Research and Treatment Center
| | - Hanne Melchior
- National Association of Statutory Health Insurance Physicians
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, Universität Heidelberg
- German Association for Psychiatry, Psychotherapy and Psychosomatics e.V
| | | | | | - Judith Peth
- University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Department of Medical Psychology
| | - Ulrich Reininghaus
- Central Institute of Mental Health, Medical Faculty Mannheim, Universität Heidelberg
| | - Steffi Riedel-Heller
- University of Leipzig, Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health
- German Association for Psychiatry, Psychotherapy and Psychosomatics e.V
| | - Uwe Rose
- Federal Institute for Occupational Safety and Health
| | - Georg Schomerus
- University of Leipzig, Medical Faculty, University of Leipzig Medical Center, Department of Psychiatry and Psychotherapy
| | | | | | - Heike Hölling
- Robert Koch Institute, Berlin, Department of Epidemiology and Health Monitoring
| |
Collapse
|
5
|
Makivić I, Švab V, Selak Š. Mental Health Needs Assessment During the COVID-19 Pandemic: Consensus Based on Delphi Study. Front Public Health 2021; 9:732539. [PMID: 34746080 PMCID: PMC8565715 DOI: 10.3389/fpubh.2021.732539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/17/2021] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic has revealed significant gaps in mental health in terms of unrecognized and unmet needs. The goal was to accurately assess the needs and identify gaps in this area during the epidemiological crisis. A Delphi study to identify the needs was conducted with a group of decision-makers, experts, and users of mental health services. A starting point of the Delphi study was prepared in two working groups, based on recognizable international recommendations and experiences of the practitioners from the field situation. This initial set of emergency measures was supplemented through the first Delphi round, and consensus about the importance was reached in the second round. A total of 41 activities were derived, the vast majority of which were rated with a score of 4 or more. Mental health activities, which should be addressed in terms of needs, can be divided into systemic measures and service measures. This study recognizes a need to reorganize services in the direction of improving local accessibility and strengthening the network of services for immediate responses to the psychological, health, and social needs of individuals, including those arising from crisis situations, such as COVID-19 pandemic. The results of this study are in line with the international recommendations and also influenced the formulation of the Action Plan of the National Mental Health Program, while some of the measures were already implemented during the publication of the research results.
Collapse
Affiliation(s)
- Irena Makivić
- Prevention and Promotion Programmes Management, National Institute of Public Health, Ljubljana, Slovenia
| | - Vesna Švab
- Prevention and Promotion Programmes Management, National Institute of Public Health, Ljubljana, Slovenia
| | - Špela Selak
- Prevention and Promotion Programmes Management, National Institute of Public Health, Ljubljana, Slovenia
| |
Collapse
|
6
|
de Lima IB, Bernadi FA, Yamada DB, Vinci ALT, Rijo RPCL, Alves D, Furegato ARF. The use of indicators for the management of Mental Health Services. Rev Lat Am Enfermagem 2021; 29:e3409. [PMID: 33852681 PMCID: PMC8040785 DOI: 10.1590/1518-8345.4202.3409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify indicators that can be used in the management of Mental Health Services. METHOD an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: "Which indicators can be used for the management of mental health services?". RESULTS a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management. CONCLUSION it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.
Collapse
Affiliation(s)
- Inacia Bezerra de Lima
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Diego Bettiol Yamada
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Domingos Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Antonia Regina Ferreira Furegato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| |
Collapse
|
7
|
Validity of police contacts as a performance indicator for the public mental health care system in Amsterdam: an open cohort study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:577-586. [PMID: 29450598 DOI: 10.1007/s00127-018-1499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The Public Mental Health Care (PMHC) system is a network of public services and care- and support institutions financed from public funds. Performance indicators based on the registration of police contacts could be a reliable and useful source of information for the stakeholders of the PMHC system to monitor performance. This study aimed to provide evidence on the validity of using police contacts as a performance indicator to assess the continuity of care in the PMHC system. METHODS Data on services received, police contacts and detention periods of 1928 people that entered the PMHC system in the city of Amsterdam were collected over a period of 51 months. Continuity of care was defined as receiving more than 90 days of uninterrupted service. The associations between police contacts and continuity were analyzed with multilevel Poisson and multivariate linear regression modeling. RESULTS Clients had on average 2.12 police contacts per person-year. Clients with police contacts were younger, more often single, male, and more often diagnosed with psychiatric or substance abuse disorders than clients without police contacts. Incidence rates of police contacts were significantly lower for clients receiving continuous care than for clients receiving discontinuous care. The number of police contacts of clients receiving PMHC coordination per month was found to be a significant predictor of the percentage of clients in continuous care. CONCLUSION The number of police contacts of clients can be used as a performance indicator for an urban PMHC system to evaluate the continuity of care in the PMHC system.
Collapse
|
8
|
Mohamadi K, Ahmadi K, Fathi Ashtiani A, Azad Fallah P, Ebadi A, Yahaghi E. Indicators of mental health in various Iranian populations. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14292. [PMID: 24719740 PMCID: PMC3965873 DOI: 10.5812/ircmj.14292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/29/2013] [Accepted: 12/08/2013] [Indexed: 11/16/2022]
Abstract
Background: Promoting mental health and preventing mental disorders are of the main concerns for every country. Achieving these goals requires effective indexes for evaluating mental health. Therefore, to develop mental health enhancement programs in Iran, there is a need to measure the state of mental health in Iran. Objectives: This study aimed to select a set of mental health indicators that can be used to monitor the status of mental health in Iran. Materials and Methods: This research work used Q-methodology which combines both quantitative and qualitative research methods for establishment of mental health indicators in Iran. In this study, 30 participants were chosen by purposive sampling from different types of professionals in the field of mental health. Results: Twenty seven mental health indicators were obtained from the Q-methodology. The most important indicators obtained in this study are as follows: annual prevalence of mental disorders, suicide rates, number of mental health professionals, mental health expenditures and suicide related deaths. Conclusions: This study provides mental health indices for measuring mental health status in Iran. These mental health indices can be used to measure progress in the reform policies and community mental health services.
Collapse
Affiliation(s)
- Khosro Mohamadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Khosro Mohamadi, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-9123274367, E-mail:
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | | | - Abbas Ebadi
- Baqiyatallah University of Medical Sciences,Tehran, IR Iran
| | - Emad Yahaghi
- Young Researchers and Elite Club, North Tehran Branch, Islamic Azad University, Tehran, IR Iran
| |
Collapse
|