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Baptista H, Mendes JM, MacNab YC, Xavier M, Caldas-de-Almeida J. A Gaussian random field model for similarity-based smoothing in Bayesian disease mapping. Stat Methods Med Res 2018; 25:1166-84. [PMID: 27566771 DOI: 10.1177/0962280216660407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Conditionally specified Gaussian Markov random field (GMRF) models with adjacency-based neighbourhood weight matrix, commonly known as neighbourhood-based GMRF models, have been the mainstream approach to spatial smoothing in Bayesian disease mapping. In the present paper, we propose a conditionally specified Gaussian random field (GRF) model with a similarity-based non-spatial weight matrix to facilitate non-spatial smoothing in Bayesian disease mapping. The model, named similarity-based GRF, is motivated for modelling disease mapping data in situations where the underlying small area relative risks and the associated determinant factors do not vary systematically in space, and the similarity is defined by "similarity" with respect to the associated disease determinant factors. The neighbourhood-based GMRF and the similarity-based GRF are compared and accessed via a simulation study and by two case studies, using new data on alcohol abuse in Portugal collected by the World Mental Health Survey Initiative and the well-known lip cancer data in Scotland. In the presence of disease data with no evidence of positive spatial correlation, the simulation study showed a consistent gain in efficiency from the similarity-based GRF, compared with the adjacency-based GMRF with the determinant risk factors as covariate. This new approach broadens the scope of the existing conditional autocorrelation models.
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Affiliation(s)
- Helena Baptista
- NOVA Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jorge M Mendes
- NOVA Information Management School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ying C MacNab
- Epidemiology and Biostatistics, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Miguel Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - José Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Cardoso G, Papoila A, Caldas-de-Almeida J. A RCT of a staff training intervention to promote quality of care in long-term residential facilities–the PromQual study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionThe shift of hospital-based to community-based mental health care, introduced the need to assess and promote quality of residential services.ObjectivesThis RCT aimed at assessing the effectiveness of a staff training intervention to improve quality of care in residential facilities.MethodsTwenty-three units with at least 12-hour on-site staff support per day in Portugal were assessed with the quality instrument for rehabilitative care (QuIRC) filled online by the manager. A random sample of service users were interviewed using standardised measures of autonomy, experiences of care, quality of life, and the time user diary (TUD) for level of activity. The intervention group units (n = 12) received workshops and a four-week hands-on training of the staff versus TAU in the control group (n = 11). All units and users were reassessed at 8-months. The staff knowledge gained during the workshops was assessed using pre- post-test. Generalized linear mixed effects models were used.ResultsThe residential units were mainly in the community (n = 17, 73.9%), and had QuIRC mean scores above 50% in the following dimensions : living environment, self-management and autonomy, social inclusion, and human rights. Service users’ level of activity (TUD) at 8-months did not differ between intervention and control groups. At 8 months, all QuIRC dimensions scored higher in the Intervention group, without reaching statistical significance. Pre- post-tests comparison showed a significant increase in the knowledge acquired by the staff.ConclusionsThe intervention had impact on the staff's knowledge without reaching significant change of users’ activity and quality of care of the units.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Bramesfeld A, Amaddeo F, Caldas-de-Almeida J, Cardoso G, Depaigne-Loth A, Derenne R, Donisi V, Jørgensen M, Lindelius B, Lora A, Mainz J, Mulder CL, Szecsenyi J, Killaspy H. Monitoring mental healthcare on a system level: Country profiles and status from EU countries. Health Policy 2016; 120:706-17. [PMID: 27178799 DOI: 10.1016/j.healthpol.2016.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
AIMS Routinely collected data can be used to monitor the performance and improve the quality of mental healthcare systems. Data-based and system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) are increasingly being implemented in EU countries. They are believed to be indispensable for the sustainable improvement of the quality of mental healthcare. However, there is a paucity of comparative research on national strategies in quality monitoring. This study explores the status of system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) in EU countries. It aims to provide a descriptive overview, which is intended to be the first step for comparative research in this field. METHODS Case studies of system-level QMP-MHCs were gathered from eight EU countries. Experts from each country were asked to describe their approach using a template. These experts were all members of a Europe-wide network of researchers and members of public institutions involved in quality assessment and performance monitoring of mental healthcare. RESULTS Country profiles were gathered from England, Denmark, France, Germany, Italy, the Netherlands, Portugal, and Sweden. All these countries have - or are in the process of implementing - system-level QMP-MHCs. Implementation seems to be facilitated when a national performance monitoring programme for general healthcare is already in place, although in the Netherlands, a QMP-MHC was established without being attached to a general monitoring programme. All the monitoring programmes described use various quality and performance indicators; some systems enhance this methodology with the addition of qualitative assessment methods such as peer reviews linked to accreditation processes. CONCLUSIONS Research is needed to better understand the historical, political and technical backgrounds of the different national cases and to explore the effectiveness of different improvement mechanisms on the actual quality of healthcare. Policy makers and those designing performance measurement programmes are recommended to look across the borders of their own healthcare systems as there are many ways to assess performance and many ways to feedback results to service providers. No evidence is available whether one of these methods is superior to the others in improving the quality of mental healthcare.
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Affiliation(s)
- Anke Bramesfeld
- AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany.
| | - Francesco Amaddeo
- Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy
| | - José Caldas-de-Almeida
- CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Anne Depaigne-Loth
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
| | - Rose Derenne
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
| | - Valeria Donisi
- Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy
| | - Mette Jørgensen
- Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark
| | | | - Antonio Lora
- Department of Mental Health, Lecco General Hospital, Lecco, Italy
| | - Jan Mainz
- Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark
| | - Cornelis Lambert Mulder
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Joachim Szecsenyi
- AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
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Cardoso G, Papoila A, Tomé G, Caldas-de-Almeida J. Characteristics and Quality of Care of Residential Units for People with Long-term Mental Illness in Portugal. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)32083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cardoso G, Pacheco C, Caldas-de-Almeida J. Quality of care in longer term mental health institutions in Portugal. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionDeinstitutionalisation of the mentally ill is an ongoing process in European countries. Quality of care in residential facilities, however, was seldom assessed in part due to the lack of adequate instruments.ObjectivesTo assess the quality of care in Portuguese residential facilities for long term mental patients.MethodsQuality of care in residential facilities was assessed with the toolkit developed by the DEMoBinc study using interviews with the units’ managers, and the users.ResultsThe 20 units assessed across Portugal were mainly located in the city; 13 were in a hospital setting and 7 in the community. Most of the units (90%) had no maximum length of stay, and 60% were mixed-gender; 85% of the users were not compulsory. Most of the units (60%) had no one-bedrooms, and their aim was rehabilitative in 40%, and rehabilitative plus providing support in 40%. The rate of patients with a bank account was 49.4%, 32.4% were in charge of their finances, while only 14.1% had voted.In hospital vs. community units patients were more frequently men (80.5 vs. 53.8%) and older (51.1 ± 13.7 vs. 43.3 ± 9.6, p < .001). In community units the treatment was more frequently explained (50 vs. 26.3%), patients’ involvement was higher (40.4 vs. 19.5%), while mean GAF scores (64.9 vs. 60.2) did not differ.ConclusionsPortuguese results show that in spite of the effort to create new facilities for the longer term mentally ill, a lot still has to be done to improve the quality of care they provide.
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Taylor TL, Killaspy H, Wright C, Turton P, White S, Kallert TW, Schuster M, Cervilla JA, Brangier P, Raboch J, Kališová L, Onchev G, Dimitrov H, Mezzina R, Wolf K, Wiersma D, Visser E, Kiejna A, Piotrowski P, Ploumpidis D, Gonidakis F, Caldas-de-Almeida J, Cardoso G, King MB. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems. BMC Psychiatry 2009; 9:55. [PMID: 19735562 PMCID: PMC2753585 DOI: 10.1186/1471-244x-9-55] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/07/2009] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. METHODS We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. RESULTS We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). CONCLUSION Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
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Affiliation(s)
- Tatiana L Taylor
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| | - Helen Killaspy
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| | - Christine Wright
- Division of Mental Health, St. George's University London, London, UK
| | - Penny Turton
- Division of Mental Health, St. George's University London, London, UK
| | - Sarah White
- Division of Mental Health, St. George's University London, London, UK
| | - Thomas W Kallert
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Mirjam Schuster
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | | | | | - Jiri Raboch
- Psychiatric Department of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Kališová
- Psychiatric Department of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Georgi Onchev
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Hristo Dimitrov
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, University of Trieste, Trieste, Italy
| | - Kinou Wolf
- Dipartimento di Salute Mentale, University of Trieste, Trieste, Italy
| | - Durk Wiersma
- Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Ellen Visser
- Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - José Caldas-de-Almeida
- Department of Mental Health, Faculdade de Ciencias Medicas, New University of Lisbon, Lisbon, Portugal
| | - Graça Cardoso
- Department of Mental Health, Faculdade de Ciencias Medicas, New University of Lisbon, Lisbon, Portugal
| | - Michael B King
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
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