Mental Health Costing Study Workshop

Transcription

1 Mental Health Costing Study - Workshop Mental Health Costing Study Workshop Wednesday, 7 May 2014 Discussion Paper Presented by: HealthConsult Recommendations That attendees: 1. DISCUSS the Discussion Paper for Consultation, at Attachment A. Overview As part of the development of the study methodology, HealthConsult have developed a Discussion Paper to provide stakeholders with an early opportunity to comment on the key features of the methodology, provide advice on any refinements, and maximise the utility and acceptance of the final cost dataset. The Discussion Paper has been released on the IHPA website for public consultation with a deadline of 5.00pm, Friday 30 May This workshop is the key way for members of the Mental Health Working Group (MHWG), Mental Health Costing Study Steering Committee (MHCSSC), NHCDC Advisory Committee (NAC), Mental Health Information Strategy Standing Committee (MHISSC) and jurisdictions to contribute. The discussion from the workshop and the responses received from the public consultation will inform the ongoing development of the Mental Health Costing Guidelines, the Data Quality Assurance Framework and the Data Request Specification. Background The Discussion Paper includes chapters that previously been considered and commented on by IHPA committees as part of the Project Plan, Roles and Responsibilities document and the New (draft) Data Element Definitions Working Paper. Key Issues Throughout the Discussion Paper there are questions posed and approaches proposed that relate to the conduct of the mental health costing study. These questions are designed to promote discussion on areas that stakeholder views are sought. Scope: Chapter 4 outlines the scope of the mental health costing study. The question of how to best collect data relating to patients that are not treated within a specialised mental health service is a key issue requiring stakeholder input. An IHPA analysis of Admitted Patient Care data from has identified that there are approximately 80,000 patients that are assigned to a mental health DRG but have no psychiatric care days. It has been suggested that the majority of these patients may fall within the mental health care type and therefore the costs need to be captured for the purposes of the costing study. Data definitions: Chapter 6 outlines the proposed data definitions for the new data elements phase of mental health care, first recent episode of mental health care and mental health intervention. Section 6.1 outlines the phase of mental health care. Stakeholder input into the definition for the new data domain 5 Initial assessment / Brief Intervention is required to ensure that it is clinically relevant and practical to collect. The proposed data collection points for phase

2 Mental Health Costing Study - Workshop of care are outlined in Stakeholder input into whether these are reasonable and practical is required. Section 6.2 outlines first recent episode of mental health care. Stakeholder input is required as to whether the suggested title of the data element and the definition is clear and reasonable. Section 6.3 outlines the mental health intervention. There has already been extensive work undertaken in relation to the development of the Mental Health Intervention Classification (MHIC). It is proposed that for the purposes of the costing study the MHIC is used unchanged. IHPA will maintain a register of proposed amendments that can be considered at a later stage. Stakeholder input into the whether the collection of mental health interventions is reasonable and practical is required. Costing methodology: Chapter 8 outlines the costing methodology that will be used to cost mental health patient episodes / service contacts. It is proposed that the Australian Hospital Patient Costing Standards will be applied and that the Mental Health Costing Guidelines (still to be developed) will provide a how to cost guide for the purposes of the costing study. Section 8.2 outlines the first step in the patient costing process, aligning all costs to all products. Stakeholder input is required in relation to the treatment of consultation liaison services and the process for dealing with in-reach and outreach services. Section 8.3 outlines the second step in the patient costing process, overhead cost centre allocation. Historically specialist mental health services have not been costed for the National Hospital Cost Data Collection therefore they may have not attracted an appropriate allocation of overhead costs. It is proposed for the purposes of the costing study that the costing models that are set up reflect a fair allocation of overheads to the final cost centres involved in the provision of mental health services. Stakeholder input into whether this is reasonable is required. Section 8.4 outlines the third step in the patient costing process, allocation of costs to product categories. The proposed process for ensuring this is done accurately is to undertake a series of one-off short surveys to obtain a robust basis for assigning labour costs to the most appropriate product category. Stakeholder input into whether this process is reasonable is required. Section 8.5 outlines the fourth step in the patient costing process, the allocation of costs to patients / clients. Stakeholder input as to the reasonableness of the processes for the allocation of costs within patient is required. Next Steps and Future Opportunities for input The discussion from the workshop and the responses received from the public consultation will inform the ongoing development of the Mental Health Costing Guidelines, the Data Quality Assurance Framework and the Data Request Specification. The development of the Mental Health Costing Guidelines is ongoing and these will be refined following the pilot phase of the project, and throughout the costing study as required. Prior to the Mental Health Costing Guidelines being finalised for implementation at the pilot sites, there will be further opportunities to provide feedback on the items included in the Discussion Paper. It should be noted that IHPA is also developing the Activity Based Funding Mental Health Data Set Specification for publication in December 2014, with a discussion paper circulated to jurisdictions for comment in April Whilst the two processes are being conducted separately, they are related and will inform each other throughout development. Independent Hospital Pricing Authority Page 2 of 3

3 Mental Health Costing Study - Workshop Attachments A. Discussion Paper for Consultation Contact Name: James Downie Phone: james.downie@ihpa.gov.au Independent Hospital Pricing Authority Page 3 of 3

4 Prepared for the Independent Hospital Pricing Authority Mental Health Costing Study Discussion Paper for Consultation IHPA is calling for submissions on this Discussion Paper by the closing date of Friday, 30 th May, 2014 HealthConsult Pty Ltd ACN Level 3, 86 Liverpool Street, Sydney, New South Wales, 2000 Phone (02) Fax (02) th April 2014

5 Table of Contents Section Page INTRODUCTION MENTAL HEALTH SERVICES DATA COLLECTION AND CLASSIFICATION CONSULTATION ON THE MENTAL HEALTH COSTING STUDY METHOD... 2 PROJECT MANAGEMENT, GOVERNANCE AND STAKEHOLDER ENGAGEMENT PROJECT MANAGEMENT AND GOVERNANCE ARRANGEMENTS STAKEHOLDER ENGAGEMENT STRATEGY... 4 STUDY DESIGN KEY FEATURES OF STUDY DESIGN ROLE AND RESPONSIBILITIES OF STUDY SITES ROLE AND RESPONSIBILITIES OF HEALTHCONSULT SELECTION OF STUDY SITES... 9 SCOPE OF THE MENTAL HEALTH COSTING STUDY MENTAL HEALTH CARE TYPE DEFINITION DEFINITION OF A STUDY SITE SERVICES INCLUDED AT STUDY SITES DATA COLLECTION AND MANAGEMENT ARRANGEMENTS ETHICS APPROVAL DATA COLLECTION DATA MANAGEMENT DATA QUALITY ASSURANCE PROPOSED DATA DEFINITIONS - NEW ITEMS PHASE OF MENTAL HEALTH CARE FIRST RECENT EPISODE OF MENTAL HEALTH CARE MENTAL HEALTH INTERVENTION DATA REQUEST SPECIFICATIONS HIGH LEVEL DATA REQUEST SPECIFICATION TIMING OF DATA SUBMISSIONS COSTING METHODOLOGY USE OF THE AUSTRALIAN HOSPITAL PATIENT COSTING STANDARDS STEP 1: ALIGNING ALL COSTS TO ALL PRODUCTS STEP 2: OVERHEAD COST CENTRE ALLOCATION... 33

6 8.4 STEP 3: ALLOCATION OF COSTS TO PRODUCT CATEGORIES STEP 4: ALLOCATION OF COSTS TO END CLASSES (PATIENTS/CLIENTS) ISSUES ASSOCIATED WITH OTHER STANDARDS IN THE AHPCS NEXT STEPS GLOSSARY OF TERMS... 40

7 List of Abbreviations Abbreviation ABF ACT AHPCS AIHW APHA CL CPLG DRG FMT FoC HoNOS IHPA ISC MHCA MH-CASC MHCG MHCSSC MHIC MHISS MHWG NAC NGO NHCDC NHDD NMDS NOCC NSW NT OCR Qld RUG-ADL SA Tas TTR UQ Vic WA Meaning Activity Based Funding Australia Capital Territory Australia Hospital Patient Costing Standards Australian Institute of Health and Welfare Australian Private Hospitals Association Consultation Liaison Consortium Project Leadership Group Data Request Specification Fieldwork Management Teams Focus of Care Health of the Nation Outcomes Scales Independent Hospital Pricing Authority Information Strategy Committee Mental Health Council of Australia Mental Health Classification and Service Costs Mental Health Costing Guidelines Mental Health Costing Study Steering Committee Mental Health Intervention Classification Mental Health Information Standards Subcommittee Mental Health Working Group NHCDC Advisory Committee Non Government Organisation National Hospital Cost Data Collection National Health Data Dictionary National Minimum Dataset National Outcomes and Casemix Collection New South Wales Northern Territory Optical Character Recognition Queensland Resource Utilisation Groups Activities of Daily Living South Australia Tasmania Teaching, Training and Research University of Queensland Victoria Western Australia

8 1 Introduction As part of the continuing development of activity based funding (ABF) arrangements for Australian hospitals, the Independent Hospital Pricing Authority (IHPA) has appointed a consortium led by HealthConsult to undertake a costing study to inform the development of the Australian Mental Health Care classification. This Chapter briefly sets out the context for the mental health costing study and the purpose of this Discussion Paper. 1.1 MENTAL HEALTH SERVICES DATA COLLECTION AND CLASSIFICATION There have been a number of national mental health-specific data collections and one classification system developed and implemented in Australia, including: Admitted Patient Mental Health Care National Minimum Data Set; Community Mental Health Care National Minimum Data Set; Residential Mental Health Care National Minimum Data Set; Mental Health Establishments National Minimum Data Set; National Outcomes and Casemix Collection (NOCC); and Mental Health Classification and Service Costs (MH-CASC) classification (one-off study). None of these data collections nor the MH-CASC classification system are widely accepted within the mental health sector as suitable for use in ABF. Accordingly, in 2012, consistent with its responsibilities for the specifying the classification and data collection methodologies associated with implementing ABF, IHPA commissioned a consortium led by The University of Queensland (UQ) to develop a recommended definition for mental health services that could be consistently applied for ABF purposes within the mental health sector and between jurisdictions. The resultant definition and cost drivers for mental health services project comprised of two stages: Stage A Defining mental health services; and Stage B Analysis of cost drivers, including recommended framework for classification development. The UQ project has been completed and there were 28 recommendations arising from Stages A and B. As part of this work, UQ concluded that a comprehensive costing study was required to progress ABF in the mental health sector, as much of the data (particularly the cost data) was of poor quality and other variables identified as important cost drivers, for example patient clinical ratings, were either incomplete or not collected at critical points in the overall episode of mental health care. As a result, IHPA commissioned the HealthConsult-led consortium to undertake the mental health costing study for a six month period at a sample of Australian public hospitals, community mental health services, and at a minimum of three private hospitals. IHPA specified that the sample should include a mix of consumers and service locations to ensure a representative set of costs are collected. The study will produce a dataset that includes characteristics of the clients/patients, as well as a measure of the costs of providing mental health services that can be used as the basis for developing a new classification system. The classification system will then be used to further ABF implementation. Independent Hospital Pricing Authority Page 1

9 1.2 CONSULTATION ON THE MENTAL HEALTH COSTING STUDY METHOD This Discussion Paper outlines the processes that are proposed to conduct the mental health costing study. It has been produced to underpin a process of stakeholder consultation through inviting public submissions. In particular, potential respondents should note: Throughout the paper there are questions posed and approaches proposed that relate to how the mental health costing study will be conducted. Stakeholders are invited to provide feedback on the questions and/or to indicate the suitability or otherwise of the proposed approaches, where possible, with reasons and suggestions for alternative approaches; IHPA is calling for submissions on this Discussion Paper. Submissions must be ed as MS Word or RTF attachment to submissions.ihpa@ihpa.gov.au by 5.00pm on Friday, 30 th May All submissions will be published on the IHPA website ( unless respondents specifically identify any sections that they believe should be kept confidential due to commercial or other reasons; and In addition to the public consultation process, HealthConsult is receiving additional input from interested parties by working with a Steering Committee convened by IHPA that represents the wide range of stakeholders in the mental health sector. IHPA s standing Mental Health Working Group also has a significant oversight role for the study. Potential respondents should note that the approaches proposed in this Discussion Paper have not been endorsed by IHPA. They are presented as a mechanism for gauging stakeholder views, as well as to provide a basis for identifying the methodological refinements that may be required to produce a fit-for-purpose set of utilisation and costs data on mental health services. The HealthConsult consortium will have regard to the contents of submissions received, as well as the results of the investigations undertaken with invited stakeholders, in generating the mental health costs dataset for use by IHPA in developing the Australian mental health classification system. Independent Hospital Pricing Authority Page 2

10 2 Project management, governance and stakeholder engagement This Chapter describes the overarching project management and governance arrangements, as well as the key features of the stakeholder engagement strategy. 2.1 PROJECT MANAGEMENT AND GOVERNANCE ARRANGEMENTS The key design features of the project management and governance arrangements include: Project management and governance: the study team is being led by Joe Scuteri as Project Director and Lisa Fodero as Project Manager. The key governance groups are the Mental Health Costing Study Steering Committee (MHCSSC), the Mental Health Working Group (MHWG), the Mental Health Classification Steering Committee (MHCSC) and the NHCDC Advisory Committee (NAC). The structure is shown in Figure 2.1. Figure 2.1: Mental health costing study project governance and management structure Pricing Authority IHPA Executive Management Relevant IHPA Working Groups/Committees: NHCDC Advisory Committee, Mental Health Working Group, Mental Health Classification Steering Committee Consortium Project Leadership Group (CPLG): Joe Scuteri, Lisa Fodero, Jim Pearse, Paul Zadow and Lilian Lazarevic IHPA Project Management Team (Jennifer Nobbs, Natalie Bryant, Chereta Daylight) Project Director: Joe Scuteri Project Manager: Lisa Fodero Mental Health Costing Study Steering Committee (MHCSSC) FMT 1: Lisa Fodero & Cathy Baker (HealthConsult) Fieldwork Management Teams (FMT) FMT 2: Paul Zadow & Alexis St George (HealthConsult) FMT 3: Jim Pearse & Deniza Mazevska (Health Policy Analysis) FMT 4: Lilian Lazarevic & Darren Button (Health Outcomes International) Specialist Advisors Frank Quinlan (Mental Health Sebastian Rosenberg Council of Australia) (mental health policy Stephen Farish (stakeholder engagement and program (statistical advisor) advisor providers and development advisor) consumers) Support Consultants: Cathy Baker, Paul Zadow, Alexis St. George, Thivya Sornalingam and Diah Elhassen Contracted services: Website developer Database developer Fieldwork management: support for the 25 study sites will be provided by four two-person Fieldwork Management Teams (FMTs). This approach will ensure that there is always back-up available for the site management process. A portfolio management approach will be used, and all FMTs will be allocated an about equal number of sites in their portfolios. All communications between the project team and study sites/jurisdiction health authority staff will be via the assigned FMT, so that study sites can be assured of a single point of contact. All sites in a jurisdiction will be assigned to the same FMT, so the health authority officers also have single point contact. Study site support: a key objective of the study is to build capacity in ABF related work in the participating sites. To achieve this aim, a close monitoring approach will be adopted to provide the support needed by study sites. Members of the FMTs will be based in Sydney and Adelaide for the duration of the project, which will give rapid and, if necessary, on site access to training and support Independent Hospital Pricing Authority Page 3

11 for study sites. Study sites in the other jurisdictions will be allocated to the FMTs to evenly balance the workload, and adequate travel budgets have been assigned to the FMTs to allow on-site training and support to be provided in locations where there are no resident consortium team members. Consistent issues resolution: a Consortium Project Leadership Group (CPLG) has been established that includes representation from the senior consortium members that are providing significant resource input. The CPLG is also responsible for resolving project issues that arise; it includes the leaders of all four FMTs to ensure that the impact on all study sites is considered. For the more complex issues, the CPLG will refer matters to the MHCSSC for advice. 2.2 STAKEHOLDER ENGAGEMENT STRATEGY Effective stakeholder engagement will be a critical success factor for the study. The proposed stakeholder engagement strategy has three overarching aims: to create multiple opportunities for stakeholders to provide input into the study and ensure that their views are respected and properly considered; to partner with stakeholders in the execution of the study to ensure it is fit for purpose and to build support for the study outcomes; and to build knowledge, understanding and hence capacity in ABF in the mental health sector. The stakeholder engagement strategy is predicated on a partnership approach. Liaison with stakeholders will be transparent and collaborative. The Mental Health Council of Australia (MHCA) is part of the consortium to advise HealthConsult on developing strategies for effective stakeholder engagement and where, practical, to assist HealthConsult to execute those strategies. The proposed approach recognises the value of local expertise and seeks to leverage that expertise by working in partnership with the selected study sites to achieve outcomes that are beneficial to all parties. It recognises that the successful completion of the study will be the result of developing effective relationships with all stakeholders. The key features of the proposed stakeholder engagement strategy are: Study website: a specific website is being developed at to act as a communication vehicle for the study. The website will have publicly accessible sections (general study information) and secure access sections limited to study participants. The restricted access section will include all approved study documentation; information on how to raise issues and who to contact; an issues register that lists issues raised and how they were resolved, and generates notification to all study site coordinators; and an FAQ page setting out the answers to commonly asked questions. The website will be regularly updated throughout the study. Clinician engagement: clinician engagement will be sought through a number of processes. At study sites, clinicians will be consulted by the FMTs for the purposes of providing information on the study and explaining the benefits of participation. Clinicians at study sites will also be engaged in the processes for reviewing the interim and final data generated by the study to ensure face validity. Outside of study sites, expert clinical input will obtained from the clinician members of the MHWG and MHCSSC, both of which are meeting regularly throughout the study. All of the major professional disciplines involved in the delivery of mental health services are represented by members of one or both those Committees and there is the opportunity to form small ad-hoc subgroups of members to receive more detailed input on specific issues as required. Independent Hospital Pricing Authority Page 4

12 Jurisdictional health authority/private sector peak body engagement: representatives of the jurisdictional health authorities and private sector are also being engaged in a variety of ways. They will be specifically consulted about various aspects of the study starting with the selection of study sites. They are represented on the MHCSSC and MHWG. In addition, they will be invited, along with representatives of study sites, to attend the state/territory based review workshops being held in October to discuss the preliminary results of the first tranche of study data. Broader mental health sector stakeholder engagement: aside from the study-specific website there are a number of opportunities for broader mental health sector stakeholders to contribute to the study. There are a number of representatives of key stakeholder groups professional, industry (including private and NGO sectors), consumers and carers as members of the MHCSSC and MHWG. Also, throughout the study, senior project team members will be available to make presentations to, and receive feedback from, key stakeholder groups and/or industry conferences. Consultation questions Comments on the proposed stakeholder engagement strategy are welcome. Are there other processes that should be considered to facilitate stakeholder engagement throughout the study? Independent Hospital Pricing Authority Page 5

13 3 Study design This Chapter presents the key features of the study design, describes the roles and responsibilities of the participating sites and the HealthConsult consortium, and presents the site selection strategy. 3.1 KEY FEATURES OF STUDY DESIGN The key features of the study design include: a prospective collection of utilisation and costs data at the patient/client level from 1 st July to 31 st December, 2014 in at least 25 mental health service (minimum of three private sector) sites that are representative of mental health services and clients in Australia; the development of a Mental Health Costing Guidelines document that will be the reference point for work at the 25 participating study sites; maximal use of existing mental health datasets at each participating site, supplemented by the primary data collection needed to obtain some study specific data elements; the use of two-person FMTs in the HealthConsult consortium that will provide on-site training and support to participating sites throughout the data collection period; a process that builds skills and capacity in ABF related projects with the objective of creating expertise in casemix costing in the 25 study sites and the mental health sector more broadly; the use of strict protocols, including an application for ethics approval, to ensure the preservation of the privacy and confidentiality of the data at both client and service levels; and the availability of funding from IHPA to support the appointment of a project manager at each participating site for the duration of the study. Consultation questions Comments on the broad features of the study design are welcome. 3.2 ROLE AND RESPONSIBILITIES OF STUDY SITES IHPA has invited jurisdictional health authorities, Catholic Health Australia and the Australian Private Hospitals Association (APHA) to nominate mental health services to participate in the study. This section describes the intended role and responsibilities of study sites. Feasibility assessment questionnaire: for sites interested in participating in the study, the assigned FMT will work with staff at the study site to complete a feasibility assessment questionnaire, which will gather the information needed to ensure that the service is in a position to successfully complete the study. The questionnaire will gather information about the availability of resources, systems and data at the site. Key requirements will be that sites either have access to, or are prepared to acquire, software to undertake the patient level costing; and that they already participate in national mental health data collections, preferably including the National Outcomes and Casemix Collection (NOCC). Having regard to the feasibility assessment results, IHPA will work with HealthConsult, the jurisdictional health authorities and representatives of the private sector to ensure that the full spectrum of mental health services is addressed by the study. Independent Hospital Pricing Authority Page 6

14 Ethics approval: Study sites will work with IHPA, if required, to obtain ethics approval for the study from a properly constituted ethics committee. IHPA is liaising with jurisdictional health authorities to ensure that the chosen process is suitable across Australian jurisdictions. Study site coordinator: after completion of the feasibility assessment process, a study site coordinator will need to be appointed at each participating site. The coordinator will become the key point of contact for the allocated FMT. All arrangements relating to a sites participation in the mental health costing study will be made through the study site coordinator. Study set up: study sites will need to participate in the study set up process before 20 th June, The process will involve an up to two day site visit by the allocated FMT. As part of the visit local arrangements for data collection and generation of the patient level costs will be agreed. The FMT will also provide training to the relevant study site staff, including the clinicians who may be involved in assessing the new data elements, particularly phase of care. Data collection: study sites will need to collect data on mental health services meeting the definition of the mental health care type (see Chapter 4) for the six month period from 1 st July to 31 st December, Most of the required data will already be collected for other purposes (e.g. for the admitted patient national mental health care national minimum dataset (NMDS), the community mental health care NMDS, the mental health establishments NMDS and the NOCC). There will be at least three new patient characteristics data elements (phase of care, first recent episode of mental health care, and mental health intervention). As well as patient data, costs data need to be collected to allow the patient level cost model to be developed. Collected data needs to be submitted to HealthConsult every two months (i.e. three submissions in the six month period). Patient level costing: study sites will need to undertake the patient level costing locally, and will need access to appropriate software. Ideally the costing would be done every two months, and the costs data would be provided with the patient data. It is recognised that some sites may not have the capacity to undertake the costing three times. The allocated FMT will provide support to the study site throughout this process, including site visits to assist with the setup of the patient level cost model. FMTs will also advise on appropriate cost allocation methods and on achieving compliance with the Australian Hospital Patient Costing Standards (AHPCS), so as to generate data that meets the required quality standard. Data cleansing: processed data will be returned to each study site three times during the study (i.e. once following each submission) along with an analysis of any errors. Study sites will need to correct and resubmit data where the quality assurance process has identified errors. There is provision for FMTs to make site visits as part of the data cleansing process to assist sites to deal with any difficult issues that may arise (e.g. to change the set up of the patient level cost model). Workshop attendance: representatives of study sites will be invited to attend one workshop, in about October 2014, to discuss interim data and share experiences with their peers in other study sites in relation to the study. There will be a workshop in each jurisdiction where there is at least one participating site. Workshop attendance is not compulsory, but desirable as a capacity building and quality improvement mechanism. Study close out: study sites will need to participate in the study set close out process in January to February The process will involve an up to one day visit by the allocated FMT. As part of the visit, there will be a short workshop where processed data from the study site will be presented. The purpose will be to ensure that the study data appropriately represents the situation with respect to mental health services and costs at the study sites for the period 1 st July to 31 st December, Independent Hospital Pricing Authority Page 7

15 3.3 ROLE AND RESPONSIBILITIES OF HEALTHCONSULT This section describes the intended role and responsibilities of the HealthConsult team. Development of study infrastructure: HealthConsult will develop the study infrastructure including the Mental Health Costing Guidelines (MHCG which will consolidate the costing methodology, the data request specification (DRS), and the data quality assurance framework) and the study website. All components of the infrastructure will be updated as necessary during the course of the study and current versions will always be available on the study website. Ethics approval: HealthConsult will work with IHPA to obtain ethics approval for the study from a properly constituted ethics committee. IHPA is liaising with jurisdictional health authorities to ensure that the chosen process is suitable across Australian jurisdictions. Study site support: HealthConsult will provide support via the FMTs to all participating sites throughout the study, commencing with the completion of the feasibility assessment questionnaire and concluding with the study close out visits. On-site support will include initial set up and training, and re-training at follow up visits where required. It will also include a study close out process, with the aim of leaving behind skills and capacity in study sites to take forward the costing of mental health services. Site support is a crucial part of ensuring the success of the study, and a key to generating good quality data. Data quality assurance: HealthConsult will be responsible for assuring the quality of the study data. A range of strategies will be used from processing of interim data with feedback to sites, including identifying errors, through to systematically comparing data from sites to establish consistency in the data collection and costing processes. A key part of the later task will be the application of the costing data quality assurance framework, and the FMTs working proactively with study sites to ensure that the minimum quality standard has been met. Capacity building workshops: HealthConsult will organise and facilitate experience sharing and capacity building workshops in about October, Preliminary data will be analysed and presented at the workshops as part of the data quality improvement strategy. There will be a workshop in each jurisdiction where there is at least one participating site, so the workshops are easy to access for staff from study sites. Jurisdictional health authority staff and selected other key stakeholders will also be invited to the workshops. HealthConsult will ensure that the privacy and confidentiality of data provided by study sites is not compromised in the presentations made. Issues resolution: HealthConsult will run a comprehensive issues resolution process for any matter raised by stakeholders. Study sites and jurisdictional health authority staff may raise issues via the project website or directly with their allocated FMT. Other stakeholders can raise issues via the website or with the project manager. HealthConsult has set a performance standard of responding to 90% of issues on the day they are raised and all issues no later than the next working day. Complex issues will be dealt with by the CPLG to ensure that the needs of all study sites are considered in reaching a decision. Where necessary, these issues will be referred to the MHCSSC for advice and decision. The resolution to all issues will be posted on the study website, so all study sites are aware of the outcome and consistency is maintained. Dataset consolidation: HealthConsult will be responsible for consolidating the study data across sites to provide a patient level dataset (de-identified) containing patient and service characteristics as well as the measured cost. This dataset will become the basis for the development of the new mental health classification system. Stakeholder engagement and communication: HealthConsult will ensure that the study website is kept up to date and that issues resolution and FAQ pages cover all of the relevant issues. Additionally senior members of the HealthConsult consortium will be available to meet with key mental health stakeholder groups to provide information about the study and where appropriate Independent Hospital Pricing Authority Page 8

16 receive feedback. These senior team members will also attend key industry meetings and make presentations if those processes are considered beneficial to building understanding of the study. 3.4 SELECTION OF STUDY SITES A critical feature of the study design will be selecting the mental health services that will participate in the prospective collection of data. As the study aims to support classification system development, rather than to derive cost weights for an existing system, there is no theoretical optimum number of data points (the more data points, the more robust the statistical analysis supporting classification development will be). Similarly, the sample size cannot be chosen to contain the sampling error for the cost of each category in the classification to a given threshold (as the number and make-up of endclasses is not known). So, selecting the study sample is mostly about stakeholders having confidence that all mental health services settings and mental health client groups are fairly represented, as well as having a manageable number of sites given the time constraints applying to the study. In order to develop an initial sampling strategy, publicly available databases that contain information on mental health care provided in the variety of service sectors (government, non-government and private) and settings (e.g. specialist psychiatric hospitals, community rehabilitation centres, mental health wards in general hospitals) were obtained. Table 3.1 sets out the number of mental health services by setting, jurisdiction and sector. Table 3.1: Number of mental health services by jurisdiction and type, Australia, Type of service NSW Vic Qld WA SA Tas ACT NT Total Public psychiatric hospitals Public acute hospitals with a specialised psychiatric unit or ward Government-operated residential mental health services Non-government-operated residential mental health services Community mental health care services ,082 Private psychiatric hospitals np Np np np 44 Total ,445 Source: Specialised Mental Health Facilities - Mental Health Services in Australia, Australian Institute of Health and Welfare, March 2013; np = not published IHPA requires that the study involve a sample of Australian public hospitals, community mental health services and at a minimum of three private hospitals. Thus, it is assumed that all services enumerated in Table 3.1 may be in scope. The HealthConsult consortium is working with the IHPA Project Management Team and the wider stakeholder groups to clarify the study scope, but it appears that there will be around 1,450 services that need to be represented by the sample. Also, there is clear evidence that there are important cost differentials that apply to providing services in country locations (including regional, remote and/or isolated locations) relative to metropolitan locations. Similarly, for clients from country locations receiving treatment services in metropolitan locations additional costs are incurred in the provision of services. Taking these issues into consideration a distribution of the sample of 25 study sites is proposed in Table 3.2. Table 3.2: Suggested distribution of study sample sites Public Hospitals Private Hospitals Community mental health services Jurisdiction General Specialist Psychiatric Residential Non-residential Total Metro Regional Metro Regional Metro Regional Metro Regional Metro Regional NSW Victoria Queensland Western Australia South Australia Tasmania * * 0 1 ACT Northern Territory Total Independent Hospital Pricing Authority Page 9

17 Metro = Located in metropolitan area; Regional = Located in regional/rural area; * Tasmania declined the invitation to nominate a site; the selection will be allocated to another jurisdiction once all nominations are received, so as to improve sample balance. IHPA has determined that within this broad sampling framework, jurisdictional health authorities and private hospital sector peak groups will be invited to nominate mental health services to participate in the study. The nomination process was in progress at the time of preparing this discussion paper. It is expected that the process will yield in excess of 25 nomination for study sites, from which the most balanced study sample, having regard to the framework proposed in Table 3.2 will be selected. There will be a number of issues to work through in finalising the study sites. It is recognised that the majority of mental health service contacts now occur in the community sector, and that costs are now roughly evenly split between hospital and community mental health sectors. Also, although hospitals and community-based services are listed separately in Table 3.2, it is recognised that many hospitals also operate community based mental health services (using these sites increases the potential for record linkage between admitted and non-admitted mental health services). So, it is not intended to exclude community based mental health services operated by hospitals, rather Table 3.2 seeks to specifically include community based mental health services that may not be operated by hospitals (e.g. by public sector community based mental health services or NGOs). Also, in selecting the final study sites, there will be a preference for choosing sites that provide reasonable volumes of mental health services (so as to maximise the coverage of the sample in terms of the volume of mental health activity (admitted and non-admitted in hospital and community sectors) generated to support classification development). The sites will need to cover services provided to patients/clients in the major mental health target groups including child and adolescent, youth, adult and older persons. There will also need to be regard to ensuring sufficient representation of clients from recognised priority groups (Indigenous people, people from culturally and linguistically diverse backgrounds, people living in rural and remote locations, etc.). For this purpose some sites will need to be selected where these clients are over-represented relative to their numbers in the general population and/or where there are specialist services that target these priority groups. Consultation questions Are there other factors that should be considered in determining the study sample? Please indicate potential sources for the data needed to inform consideration of any other suggested factors. Independent Hospital Pricing Authority Page 10

18 4 Scope of the mental health costing study This Chapter presents the definition of mental health care type and the proposed scope of services to be included in the mental health costing study. 4.1 MENTAL HEALTH CARE TYPE DEFINITION IHPA has also specified that the scope of the mental health costing study will be consistent with the mental health care type definition approved by the Pricing Authority, which is: Mental health care is care in which the primary clinical purpose or treatment goal is improvement in the symptoms and/or psychosocial, environmental and physical functioning related to a patient s mental disorder. Mental health care: is delivered under the management of, or regularly informed by, a clinician with specialised expertise in mental health; is evidenced by an individualised formal mental health assessment and the implementation of a documented mental health plan; and may include significant psychosocial components including family and carer support. Psychogeriatric care is considered within scope of the costing study as it is covered by this definition. Given that the mental health care type is not currently used in routine data collections, clinicians at study sites will need to determine prospectively in the data collection period from July to December, 2014 whether the services provided meet the definition of the mental health care type. All the services where this determination is positive will then be within the mental health costing study scope. 4.2 DEFINITION OF A STUDY SITE For the purposes of this study, a study site will be considered to be a service or connected range of services delivering mental health care. A site may include outreach services or satellite locations but all services will typically have a common point of responsibility for administrative governance. Study sites will also typically participate in common data collections and use the same or interfacing computer systems for patient management, clinical, financial and workforce data. The participation of a study site in the mental health costing study will be able to be managed by a single study site coordinator and the training and support activities relating to the study will be able to be conducted at one physical location. However, it should be noted that this definition is flexible and nominated sites will be assessed on a case by case basis, in consultation with the relevant jurisdiction. 4.3 SERVICES INCLUDED AT STUDY SITES In order for a mental health service to be included in the national mental health costing study, it must deliver services which meet the mental health care type definition. Since specialised mental health services will meet delivered under the management of, or regularly informed by, a clinician with specialised expertise in Independent Hospital Pricing Authority Page 11

19 mental health their services are without question in scope of the national mental health costing study. However there are a number of mental health services provided outside the specialist mental health services sector that meet the mental health care type definition. Specifically, in the admitted patient setting, it is likely that there will be some study sites where patients/clients that meet the definition of the mental health care type have their episodes: wholly within the specialist mental health service; or wholly within the non-mental health services; or spread across both (i.e. partially within the specialist mental health service and partially within the non-mental health services). When patients/clients have their episodes wholly within the specialist mental health service identifying these patients/clients at the study sites and hence collecting the required data, including the clinical rating data (e.g. HoNOS) is not problematic. Where patients have their episodes partially within the specialist mental health service, it should be possible to collect all the data required for the mental health costing study. It is acknowledged that there may be some difficulties in gathering data that relate to that part of the episode provided outside the specialist mental health services, but it is expected that there will be significant numbers of these patients/clients and the problem needs to be managed. However for those patients/clients who have their episodes wholly within the non-mental health services, for example, as a result of lack of bed availability within the mental health ward, identifying them and collecting the required mental health costing study data is likely to be problematic. Study sites will need to first, identify these patients/clients, second ensure that the services provided meet the definition of the mental health care type, and third, collect the full mental health costing study dataset (including the clinical rating scales). Where the full dataset cannot be collected, it is considered that the study cannot generate extra value from the costing relative to what is already available through the NHCDC, hence costing study resources should be directed to mental health patient/client services where all data can be obtained. This issue only applies to study sites that have both specialist and nonspecialist mental health services providing mental health care. Consultation questions How can study sites best collect data relating to mental health patients/clients whose episodes are wholly within the non-mental health services? The other key scope issue is the inclusion of Consultation Liaison (CL) services provided by specialist mental health clinicians. CL services can be defined as the diagnosis, treatment, study and prevention of morbidity among physically ill patients and those who somatise, and the provision of psychiatric consultation, liaison and teaching for non-psychiatric health workers in all types of health care settings, but especially in the general hospital 1. Based on this definition, for the purposes of this study CL services are taken to include: consultation services provided by specialist mental health services clinician (i.e. from the admitted mental health unit or a community mental health team) seeing a patient/client in a non-mental health service (who may or may not meet the definition of the mental health care type) and providing an opinion to the patient s/client s primary clinician; and liaison services provided by specialist mental health services clinician discussing the case of a patient/client in a non-mental health service (who may or may not meet the definition of the mental health care type) with the patient s/client s primary clinician. 1 Royal Australian and New Zealand College of Psychiatrists accessed on 29 th April, 2014 at Independent Hospital Pricing Authority Page 12

20 It is noted that in the NHCDC, CL services costs are typically not measured directly but attributed as either indirect or overhead costs. Hence, CL services are not counted, but their costs are included. This study is different, because it is proposed to include CL services provided by specialist mental health clinicians (in both the consultation and liaison categories) as a distinct service contact to be counted and costed. To include CL in the national mental health costing study, study sites will need to be able to identify CL services provided by specialist mental health clinicians and determine a method for capturing data on the relevant patient/client or, at the very least, counting or estimating the number of CL services provided in the study period. Consultation questions Is it reasonable to attempt to count and cost all CL services provided by specialist mental health clinicians for the purposes of the study? Will inclusion of CL services be practical from a mental health service point of view? Independent Hospital Pricing Authority Page 13

21 5 Data collection and management arrangements This Chapter presents the issues that have been considered and the solutions offered in terms of ethics approval, data collection, data management and data quality assurance. 5.1 ETHICS APPROVAL IHPA and HealthConsult have recognised that, consistent with good practice when dealing with studies handling sensitive data about individuals, an ethics approval from a properly constituted Human Research Ethics Committee (HREC) should be obtained. The intention is to use the collected data for research purposes by developing an Australian classification system specific to mental health services. Accordingly, HealthConsult is working with IHPA to obtain that ethics approval, which will be in place before the study data collection starts on 1 st July, DATA COLLECTION Issues that have been considered, together with the solution options are: Data to be collected: the key objective of the study is to collect and consolidate robust unit record (patient/client service event level) data that describe the nature of the service and associated cost for services meeting the mental health care type definition. Study sites (mental health service providers) will need to collect and contribute a mix of data categorised as either primary (data collected specifically for the purpose of the study) or secondary (data currently collected for some other purpose). Sites will need to undertake patient level costing to generate the data on the costs of each patient/client service contact. The capability of sites to provide data according to the Data Request Specification (DRS) will vary and it will be the role of FMTs to assist and support sites to achieve valid and complete datasets. Costing methodology: the national mental health costing study will reflect rigorous adherence to the Australian Hospital Patient Costing Standards (AHPCS) Version 3.0 (which will be released by IHPA for use from 1 st July, 2014). The emphasis will be on applying as many of the standards as possible at each site, with a particular focus on achieving accurate matching of production (service volumes) with costs at all stages of the patient level costing process. FMTs will work closely with study sites to achieve the best possible costing process. Mental Health Costing Guidelines (MHCG): the study will extend the AHPCS, which describe what to do in costing into the MHCG document which will set out how to do the costing. Production of this material and on-site training by FMTs at study sites in the use of the MHCG for prospective application will result in good quality data on the costs of mental health services. Data Request Specification (DRS): a DRS in a format consistent with the IHPA approach for other ABF data collections is under development. The DRS will be developed largely by using agreed existing data definitions (primarily the National Health Data Dictionary (NHDD)). There will be at least three new data elements (i.e. phase of mental health care, first recent episode of mental health care and mental health intervention as recommended by UQ) that are not currently collected in any system. Draft definitions have been proposed (see chapter 6). Assisting study sites to develop an understanding the DRS will be part of the onsite training provided by the FMTs. Independent Hospital Pricing Authority Page 14

22 Variation in systems: it is recognised that the systems utilised by sites will vary and the DRS will maximise the use of existing common data elements regardless of the system(s) used by sites. There will be no need for sites to use a standard IT platform, only to supply data according to the DRS. Variations in systems will be evaluated by analysing the feasibility assessment questionnaire, and FMTs will make local arrangements with each site to minimise data collection burden. Variation in data element definitions: it will be vital for data integrity to ensure that data are collected according to standardised data collection guidelines and associated definitions. The FMTs will work with each site to establish that data are (or can be) collected according to the agreed definitions. Variations in data element definitions will also be evaluated by analysing the feasibility assessment questionnaire, and FMTs will make local arrangements with each site to minimise data collection burden. Primary data collection methods: there will be a requirement for study sites to provide at least three data elements that are not currently collected. The impact of this data collection burden will be minimised. The first preference will be to incorporate collection of primary data into existing processes (some existing IT systems may enable the collection of extra data elements with little additional effort). At the other end of the spectrum, manual (paper-based) data collection may be required. Study sites will need to provide de-identified data to HealthConsult electronically. As necessary, a simple database system will be provided to sites for storage and transfer of such data. The alternatives of using data entry bureaus or optical character recognition (OCR) for manually collecting data will be considered but are not preferred. The FMTs will work with sites individually to determine the most appropriate approach to collecting any primary data. Data matching: there will be a requirement for study sites to collate the data from all their source systems, according to the DRS, and provide a single unit record file with all DRS data elements for each patient/client service in scope to HealthConsult. It will be an expectation that study sites will de-identify the data using their own local algorithms so that the data are not identifiable to HealthConsult or IHPA or their local jurisdictional health authority (i.e. data matching is done at and by the study sites). In addition, for episodes that are already in progress as at 1 st July 2014, it will be strongly preferred to for study sites to match the retrospective data for those episodes (i.e. that part of the episode that took place prior to 1 st July, 2014) with the prospective data, so that details of the complete episode can be provided to HealthConsult. Consultation questions Are there any other data collection issues which should be considered? 5.3 DATA MANAGEMENT The HealthConsult consortium team has carefully considered data management issues. The sensitive nature of some of the data being handled demands that strict protocols be used in data collection, transfer and storage. Issues that have been considered, together with the solution options are: Data security: although it will not be necessary to collect or transfer information that identifies an individual client/patient by name, it is recognised that the data are highly sensitive. As mentioned, an expectation of that study sites will be that they de-identify the matched data using their own local algorithms so that the data is not identifiable to HealthConsult or IHPA or their local jurisdictional health authority. This means that study sites will provide HealthConsult with a single unit record file with all DRS data elements for each client/patient. The provision of a single unit record file with all DRS data elements for each client/patient that is identifiable to only the mental Independent Hospital Pricing Authority Page 15

23 health service provider will ensure privacy of the data, but allow for the testing of the bundling of service events for classification and possibly payment purposes. Data integrity: the FMTs will be working with study sites throughout the project to ensure that the data being delivered is consistent with the DRS. A data integrity checking process will also be developed that validates the data upon receipt as well as ensuring accurate cataloguing and secure storage of the data to correctly identify the data with the site. The DRS will contain the edit rules, and error reports will be produced and sent to sites so that data can be resubmitted where required. Ease and security of data transfer: the DRS will provide sites with a detailed specification and process for uploading data to HealthConsult. The process is likely to use Dropbox as the mechanism for uploading data, as it provides an easy way of transferring large data files across the internet within a secure environment. The arrangements for data transfer will confirm with the Australian Government Information Security Manual Controls. Consultation questions Are there any other data management issues which should be considered? 5.4 DATA QUALITY ASSURANCE The HealthConsult consortium team understands that it will not be possible (because of the differences in systems, and staff capacity and capability) to have completely homogenous approaches to the study at each study site. This situation does not present a problem so long as the costing data that are generated at each site are fit for purpose. We will assess fitness for purpose by application of a formal data quality assurance framework. The framework will be developed to allow a data quality score to be calculated at each site, thus providing a tool for the FMTs to work with the sites to ensure that they attain a minimum threshold score (i.e. if the data quality score at each site exceeds the threshold score then the resultant data are deemed fit-for-purpose). Logically, fitness for purpose will be assessed, in a large part, by assessing the extent to which the AHPCS have been applied at each site to produce the costing data. Accordingly, we will start the detailed work on the data quality assurance framework by using an approach that was developed more general application to the NHCDC, and refining it so that it is mental health costing study specific. Consistent with that approach, points will be assigned for the extent to which each standard in the AHPCS is met. There will be a strong emphasis in the scoring on allocating points for getting the matching of production and cost right at Steps 1, 2 and 3 of the costing process (see Figure 8.1). The work on the data quality assurance framework will commence in parallel with the development of the detailed costing methodology. Our aim will be to ensure that the two pieces of work are complementary, and provide staff at study sites with points of reference that allow them to undertake the costing in such a way that the resultant data exceed the threshold data quality score. Both the detailed costing methodology and the data quality assurance framework will form part of the MHCG. The consortium team acknowledges that the FMTs will also have a crucial role in supporting staff at study sites to achieve the threshold data quality score. Consultation questions Are there any other data quality assurance issues which should be considered? Independent Hospital Pricing Authority Page 16

24 6 Proposed data definitions - New items This chapter presents proposed definitions and data domains for the three new data elements recommended by the UQ mental health cost drivers study: phase of mental health care, first recent episode of mental health care, and mental health intervention. 6.1 PHASE OF MENTAL HEALTH CARE This section first presents the concept behind phase of mental health care and then proposes the draft definition and data domain Concept of phase of mental health care The UQ report proposed a new activity unit mental health phase as a unit of counting within an episode of care. The concept is represented in Figure 6.1 at Level 4. Figure 6.1: Proposed mental health information architecture Source: Final report for Stage B of the Definition and Cost Drivers for Mental Health Services Projects, Volume 1. Page 43 Level 1 is the patient or consumer. During their life a patient may have one or more episodes of illness. A patient who meets the criteria for the Mental Health Care Type is at Level 2. Concurrent with their mental health episode, a patient may have other Level 2 episodes. For example the patient may break their leg and have an orthopaedic episode in parallel with their mood disorder. At the next level Level 3 is the Episode of Care. Episodes of care are defined by setting (admitted, non-admitted) and by turnstile event such as hospital discharges and transfers. UQ proposed that the Mental Health Phases replace or complement the current Focus of Care data element (defined in National Outcome and Casemix Collection (NOCC)) and are an alternative to Mental Health Subtypes that are currently in place in some jurisdictions. UQ stated that there are several important differences between mental health care phase, focus of care and mental health subtypes: Independent Hospital Pricing Authority Page 17

25 as currently defined, Focus of Care applies to a whole Episode of Care (Level 3 in diagram) and is captured retrospectively. Any change in Focus of Care within an Episode of Care is not captured. Similarly, a change in Focus of Care does not currently trigger a review of the patient s clinical status. Mental Health Phase is both a data item and an activity unit. A patient may have one or more Mental Health Phases within the one Episode of Care. Each change of Mental Health Phase triggers a new NOCC collection and, in the ABF context, a new ABF payment. Mental Health Phase needs to be captured prospectively and defined by patient characteristics and associated goals of care ( patient journey ) rather than solely by physical location of treatment (e.g. acute unit, rehabilitation unit) or the treating clinical team (e.g. acute team, rehabilitation team) Proposed definition of phase of mental health care The HealthConsult consortium is proposing that the phase of care data element to be used in the mental health costing study is based on a modification of the existing Focus of Care (FoC) data element (as defined in NOCC). The advantage of this option is that the limitations of FoC are known (e.g. currently only collected at episode level and collected retrospectively); and that clinicians contributing to NOCC are already familiar with the concept. The disadvantage is that some stakeholders have expressed the view that they want a more patient focused data element. Definition: The phase of care identifies the primary goal of care that is reflected in the client s mental health treatment plan at the time of collection. Consultation questions Is the suggested phase of mental health care definition appropriate? Does it need further refinement? How does/should phase of mental health care impact on the current NOCC data collection? Data domain for phase of mental health care The suggested draft data domain for phase of care presented in Table 6.1 incorporates the four FoC categories (i.e. acute, functional gain, intensive extended care and maintenance). The HealthConsult consortium team did consider modifying the categories (e.g. change maintenance to ongoing care, etc.) for the purposes of the costing study but, as clinicians from sites which participate in the NOCC will be familiar with the existing terminology, making modifications in the limited time available is considered problematic. However, in addition to the existing four categories, some stakeholders have argued that it is important to add another category with the working title of initial assessment/brief intervention, which is also included in Table 6.1 (a definition will need to be developed with clinician input). While the differences between initial assessment and brief intervention are recognised, it is considered appropriate to group them together for the purposes of the study, noting the circumstances in which the new category in the data domain is intended to be used. Independent Hospital Pricing Authority Page 18

26 Table 6.1: Data domain for phase of mental health care Code Code descriptive term Code definition 1 Acute The primary goal is the short term reduction in severity of symptoms and/or personal distress associated with the recent onset or exacerbation of a psychiatric disorder. 2 Functional gain The primary goal is to improve personal, social or occupational functioning or promote psychosocial adaptation in a patient with impairment arising from a psychiatric disorder. 3 Intensive extended The primary goal is prevention or minimisation of further deterioration, and reduction of risk of harm in a patient who has a stable pattern of severe symptoms, frequent relapses or severe inability to function independently and is judged to require care over an indefinite period. 4 Maintenance The primary goal is to maintain the level of functioning, or improving functioning during a period of recovery, minimise deterioration or prevent relapse where the patient has stabilised and functions relatively independently. 5 Initial assessment/brief Intervention To be drafted with clinical input. It is thought that the definition needs to include assessment as well as any brief intervention. 9 Not stated / Missing It is also recognised that, for example, an acute phase in the inpatient setting will be different from an acute phase in the community setting. As the service setting will be collected through existing mental health minimum data sets, in the analysis stage of the work, it will be possible to look at the differences in the reported phases of care by setting (i.e. although the definitions will be the same analysis will be undertaken at the setting level). Using this consistent process will minimise burden at the participating sites and prevent confusion for clinicians working across settings. Consultation questions Are the suggested categories in the data domain appropriate? Do the definitions need further work? How should the additional category in the data domain initial assessment/brief intervention be described and defined? Are there any other suggested refinements? Collection point for phase of mental health care After consultation, the HealthConsult consortium has formed the view that many of the limitations of the existing FoC data element can be addressed by having the data element collected (only for the purposes of the mental health costing study) at each point of service delivery in the community setting, and at regular intervals in the inpatient setting. Thus, it is proposed that the point at which phase of care should be collected will differ based on the setting. The following collection points based on setting are proposed: Inpatient setting: Collected on day of admission, then every subsequent two weeks post admission, then at discharge. If there is a phase of care change during the admission (e.g. a change from acute to maintenance) then there will be a requirement to submit other specified data such as clinical ratings (e.g. HoNOS, or RUG-ADL for older persons etc.). Two weeks has been chosen so as to provide some updated clinical data for the longer term episodes (i.e. to allow the UQ idea that the phase of care changes within episodes to be assessed), while at the same time minimising data collection burden (the vast majority of inpatient episodes are less than two weeks duration). Community /Non-admitted setting: The proposition is that sites will report phase of care for all contacts/service events provided by mental health services. The clinician decides the phase of care at each contact/service event. As is currently the case, the clinical rating data (e.g. HoNOS) will only need to be submitted every 91 days (as the minimum requirement) or when there is a significant change (e.g. change of care team). Although it is considered desirable to collect the clinical rating data more regularly, it is recognised that more frequent collection (e.g. at every service contact) would be too onerous for mental health services and hence would not get completed. Independent Hospital Pricing Authority Page 19

27 Consistent with the UQ idea, an episode of mental health care may consist of a single phase or multiple phases, depending on changes in the client s condition. Phases are not sequential and a client may move back and forth between phases within the one episode of mental health care. Collecting phase of mental health care at the lowest possible level of aggregation (i.e. at the suggested data collection points) will allow the classification developers opportunities to consider options for how phase of care should be defined post the national costing study. Consultation questions Are the proposed points of data collection for phase of care and the clinical rating data reasonable and practical? Are there any other suggested refinements? 6.2 FIRST RECENT EPISODE OF MENTAL HEALTH CARE This variable has been identified as a cost driver in multiple studies. It is a patient-level data element collected at the level of the Episode of Care. For example, a patient may have a history of treatment for schizophrenia and subsequently presents for treatment for depression. Under the proposed definition, the initial treatment for schizophrenia is the patient s first recent episode of mental health care. The treatment for the depression is not the patient s first recent episode of mental health care (unless it occurs five years after completion of the schizophrenia episode). The proposed definition is: whether a client/patient has presented to this mental health service organisation in the last five years for care that meets the definition of the mental health care type (i.e. if a client has been previously provided with care by the same mental health service organisation, within the last five years, that meets the definition of the mental health care type, it is not the clients /patients first recent episode of mental health care). The proposed data domain is presented in Table 6.2. Table 6.2: Data domain for first episode of mental health care Code Code descriptive term 1 Patient has never received care/treatment by this mental health service organisation 2 Patient has received care/treatment from this mental health service organisation, but not in the preceding five years 3 Patient has received care/treatment from this mental health service organisation in the preceding five years Note: mental health services organisation has the same meaning as it does in the Mental Health Establishments National Minimum Data Set. Consultation questions Is the title of the data element appropriate and clear? Is the suggested definition appropriate and clear? Is the suggested time limit (i.e. five years) included in the definition appropriate? Are there any other suggested refinements? Independent Hospital Pricing Authority Page 20

28 6.3 MENTAL HEALTH INTERVENTION This section presents a brief overview of the development of the Mental Health Intervention Classification (MHIC) and a description of the interventions included in the classification. Due to the extensive work already undertaken by the Australian Institute of Health and Welfare (AIHW) in the development of the MHIC, the HealthConsult consortium is proposing to use this work to collect data on the mental health interventions Development of the MHIC At its April 2005 meeting, the Australian Health Ministers Advisory Council National Mental Health Working Group Information Strategy Committee (ISC) agreed that the AIHW would be the lead agency to progress the MHIC project, with the assistance of ISC representatives from New South Wales (NSW), Queensland (Qld) and Western Australia (WA). The development of a MHIC has been an iterative process, extending over several years (Figure 6.2). During this period, development has been guided by the Mental Health Information Standards Subcommittee (MHISS). The full paper on the development of MHIC Version 1.0 can be found at Figure 6.2: Brief history of the MHIC Mental Health Intervention Classification version 1.0 Definition: Activities carried out during a service contact to improve, maintain or assess the health of a person. If not therapeutic or diagnostic, an intervention will nevertheless contribute materially to the improvement of a client s health, alter the course of a health condition or promote wellness. Interventions include invasive and non-invasive procedures, cognitive interventions and other interventions (including psychosocial interventions). 2 Table 6.3 presents the data domain for MHIC version 1.0 as shown in the AIHW paper Development of a prototype Australian Mental Health Intervention Classification: a working paper AIHW (2012). Development of a prototype Australian Mental Health Intervention Classification: a working paper 2013.pg 3. Independent Hospital Pricing Authority Page 21