Transcript Document

Experiences and lessons from
benchmarking Older Persons
Mental Health Services
Dr Rod McKay .
Braeside Hospital
National Mental Health
Benchmarking Project
27 November 2008
A joint Australian, State and
Territory Government Initiative
Goal of this presentation
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Describe results of participation in national
benchmarking of mental health services for
older people
Demonstrate how KPI data was used to
explore clinical practice
Method
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Review of documents utilised for the
benchmarking forums was conducted
Reflection upon the author’s experience of
participation and discussion with other
participants.
Who was involved?
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Seven older persons mental health services
from five Australian states
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Selected as representative of ‘good practice’
Expected to have a history of using data within
service
Facilitator and 2 project staff
3 to 5 individuals from each service
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Combinations of
 Senior clinicians (multiple disciplines)
 Service managers
 Information support staff
 Service project staff
What did we focus on?
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Understanding indicators and how to use them
Understanding each others services
Length of stay and factors that may impact
upon this
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Diagnosis
Outcome measure profiles
Allied Health Practice
ECT practice
Bed management
What did we find?
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All services provided ambulatory and community
services to consumers with mental illnesses including
psychotic illnesses, mood disorders and BPSD
Consumer profiles on the HoNOS 65+ were consistent
with nationally available data; and consistent with
diagnostic mixes of services
We had sufficient similarity to compare practice and
performance; despite significant differences in
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the proportions of consumers with different diagnoses
Available resources, and
Proportion of patients who were born overseas
All services had both strengths and weaknesses in
profile and performance
What did we find- selected KPIs
KPI
28 day readmission
rate
Mean of
Range
services (06-07) 2006-07
5%
3% to 7%
Mean Length of stay
45.6 days
Treatment days / 3
7.1 days
month community care
New Client Index
61%
Outcome readiness
129%
- inpatient
57%
-community
Post discharge care <7 59%
days
36 to 65 days
4.6 to 8.8 days
38% to 91%
89% to 193%
14% to 125%
22% to 75%
Further KPIs
KPI
Mean of
services (06-
Range
2006-07
Av Acute Episode
Cost
$29,361
$21,748$36,556
Cost/ 3 month
community care
% target pop.
community care
$1,860
$893- $2,599
0.8%
0.2-1.6%
% target pop.
inpatient care
Local access
inpatient care
0.16%
0.08-0.26%
72%
36-100%
07)
More KPIs…..
KPI
Mean of
services (0607)
Range
2006-07
New Client Index
61%
Area per capita
$30
resourcesambulatory
Area per capita
$57
resources- inpatient
38-91%
$9-$39
Preadmission
community care
Post discharge
community care
50%
22-81%
58%
22-75%
$32-$78
What did we do regarding differing Length
of Stay between services?
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All selected a sub set of patients staying
less than, or more than 60 days to identify
differences in
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Age
Gender
Language and residential care status
HoNOS 65+ profile
Diagnosis
ECT use
What did we find - Length of stay
Each service could identify groups who stayed longer, but
the factors were not the same between all services
Trend for LOS over 3 years was a slow gradual increase
Extracts from
benchmarking
workbook
One service demographics
>60 days
<60 days
44%
42%
74yrs
77yrs
32%
16%
24%
49%
requiring interpreter
25%
26%
Admission residence
……………………RACF
18%
30%
……………………home
82%
58%
…………………..other
0%
12%
Discharge residence
……………………RACF
47% (26% hostel)
47% (8% hostel)
……………………home
53%
50%
…………………..other
0%
3%
Change in residence
41%
30% change
male
Mean age
age <=70y.o.
CALD
One service synthesis
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Factors that appear to be most associated with
increased LOS are
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High scores on HoNOS65+ item 8 (‘other’) and item 9
(relationships’)
Living at home at admission
requiring hostel care on discharge
Being aged <=70yrs
Having a psychotic illness
Factors with weaker associations are
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High score on HoNOS65+ item 1 (behaviour) and
item 11 (living conditions)
Requiring a change in residence
What did we do - Length of Stay
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Discussed findings of analysis
Explored together different practice regarding
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Each service commenced their own improvement
project based on their own needs
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Allied Health staff resources and roles
Discharge practices
Flow to other services, where available
ECT practice
Eg changes to bed flow, ECT practice, social worker practice,
identifying consumers ‘at risk’ of long length of stay for more
intense early discharge planning
BUT these were mostly only starting implementation by
the end of benchmarking
What was useful?
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Using HoNOS 65+ (Routine Outcome
Measure) to understand clinical profiles of
consumers within teams
Extract from
benchmarking
workbook
What was useful?
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Improving understanding of the similarities
and differences in service provision between
organisations
Identifying areas of key differences in service
provision and performance
Establishing informal networks and contacts
Sharing intellectual resources (eg job
descriptions, clinical tools uses)
What was useful?
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collaborating in generating projects to explore
differences
initiating local projects to improve practice.
(with some limitations)
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the national KPI set and data from routine outcome
measurement collections have been valuable tools to
assist these processes.
Improved understanding of the use, and
limitations of the national Mental Health
KPIs; and indicators and related data in
general
What was problematic?
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Poorly compatible IT systems and financial systems
across states
Conducting ‘joint projects’ to change practice within
services
Range of data literacy of participants
Ability to recruit support/ project staff
Providing feedback to staff from participating
organisations not attending forums
Lack of rules regarding withdrawal from the forums
Time frames of forums vs time for practice change
Services finding time to do ‘homework’
Services integrating ‘benchmarking’ into ‘quality
improvement’
Were there time trends?
BUT…..
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All this considers mental health services for
older people as a ‘separate being’ to other
mental health services
What happens when we look into the results
of the adult mental health service
benchmarking?
What are there lessons to be
learnt?
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For OPMH services?
For Adult MH services?
For the use and creation of KPIs?
Adult vs Older Persons mental
health service performance
KPI
28 day readmission
rate
Mean Length of
stay
Treatment days / 3
month community
care
New Client Index
Outcome readiness
- inpatient
-community
Older Persons
Mean (06-07)
6%
Adult Mean (06-07)
45.6 days
13.9
7.1 days
9.7
61%
129%
57%
60%
89%
36%
12%
Adult vs Older Persons mental
health service performance
KPI
Older
Persons
Mean (06-07)
$29,361
Adult Mean
(06-07)
($584/day)
($680/day)
Cost/ 3 month
community care
% target pop.
community care
$1,860
$1,975
0.8%
1.5%
% target pop.
inpatient care
Local access
inpatient care
0.16%
0.3%
72%
84%
Av Acute inpatient
Episode Cost
$9,472
Adult vs Older Persons mental
health service performance
KPI
Older
Persons
Mean (06-07)
$30
Area per capita
resourcesambulatory
Area per capita
$57
resources- inpatient
Preadmission
50%
community care
Post discharge
58%
community care
Adult Mean
(06-07)
$57
$43
60%
89%
Conclusion
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Benchmarking can assist mental health services
for older people to
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improve their understanding of differences in practice
and performance;
generate useful local actions based upon these
KPI sets and routine outcome measurement
assist these processes
They can also assist discussions about
differences between mental health services for
different age groups; and their relative
performance
Conclusion
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Rewards for services require
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Staff to be supported to develop appropriate skills
Integrating benchmarking with service quality
processes
A willingness to question established ideas and
practices
Time