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INFORMATIONPAPER
PRIMARYMENTALHEALTHCAREMINIMUMDATASET
Overviewofpurpose,design,scopeandkeydecisionissues
16SEPTEMBER2016
FordetailsonthePMHCMDSgoto:https://www.pmhc-mds.com/
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VersionHistory
Date Details17June2016 VersionpreparedforinitialconsultationwithPHNPMHCMDSReference
Group8July2016 VersionreleasedforPHNconsultation
16September VersionpreparedtoaccompanyreleaseofV1.0ofPMHCMDSspecifications
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TABLEOFCONTENTS1. PURPOSE.............................................................................................1
2. BACKGROUND......................................................................................1
2.1 Primarymentalhealthcarereforms.........................................................................12.2 Keyperformanceindicators......................................................................................22.3 Minimumdatasetspecifiedasrequirementoffundingschedules..........................3
3. OVERVIEWOFTHEPMHCMINIMUMDATASET..............................................3
3.1 Designprinciples........................................................................................................33.1.1 Minimumdatasettomeetarangeofpurposes...............................................33.1.2 Scope–activitiesincludedandexcluded...........................................................43.1.3 BuiltonexistingATAPSfoundation....................................................................53.1.4 Flexibilitytoincorporateemergingrequirements............................................5
3.2 Thedatatobecollected...........................................................................................53.3 Datamodel................................................................................................................63.4 ComparisontocurrentATAPSsystem.......................................................................83.5 WhatthenewarrangementsmeanforPHNsandcommissionedserviceproviders 93.6 Timelines...................................................................................................................93.7 Consultationprocess...............................................................................................10
4. KEYDESIGNISSUES...............................................................................11
4.1 Definingepisodes....................................................................................................114.2 Identifyingandclassifyingcommissionedepisodesofcaretoenablemonitoringof
policyimplementation.............................................................................................124.3 Howsuicidepreventionactivitywillbemanagedinthecollection........................164.4 Determiningwhatactivitiesareinscopeforreportingasservicecontacts............164.5 Classifyingtypesofservicesdeliveredateachservicecontact...............................184.6 Diagnosiscoding......................................................................................................194.7 Selectingcoreoutcomemeasures...........................................................................22
ATTACHMENTA:PRIMARYMENTALHEALTHCAREMINIMUMDATASET–DATA
ELEMENTSSUMMARY..................................................................................25
ATTACHMENTB:DRAFTDEFINITIONSFORSERVICETYPE.......................................28
ATTACHMENTC:DIAGNOSISLISTUSEDINPMHCMDS.......................................31
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1. PURPOSEThispaperoutlinestheapproachtakentothedesignofthePrimaryMentalHealthCareMinimumDataSet(PMHCMDS)andassociatedreportingarrangementstobeimplementedacrossallPrimaryHealthNetworks(PHNs).ThePMHCMDSarrangementswillprovidethebasisformonitoringandevaluationofprimarymentalhealthcareservicescommissionedthroughthePHNsflexiblefundingpool.Theywilldothisby:
• definingthecommondatatobecollectedinrelationtoallmentalhealthservicescommissionedbyPHNs;
• settingstandardsforhowthevariousdataitemsaredefined;and• specifyingtherequirementsfornationalreporting.
ThePMHCMDSdatareportedthroughPHNswillformthebasisforproductionofkeyperformanceindicatorsusedtomonitorservicesdeliveredacrossthe31PHNregionscoveredbyPHNs.Summarydetailsoftheseindicatorsareincludedinthecurrentpaperandhavebeenmorefullydocumentedinaseparatepaper.1
ThispaperprovidesanoutlineofwhatthePMHCdatasetandreportingarrangementswillentail.ThefinalsectionofthepaperdescribescriticaldecisionpointsinthedesignofthecollectiononwhichfeedbackwillbesoughtfromPHNsviathePMHCMDSReferenceGroup.
2. BACKGROUND2.1Primarymentalhealthcarereforms
FundinghasbeenprovidedtoPrimaryHealthNetworks(PHNs)throughaPrimaryMentalHealthCareFundingPooltosupportcommissioningofmentalhealthandsuicidepreventionservicesinsixkeyservicedeliveryareas:
• lowintensitypsychologicalinterventionsforpeoplewith,oratriskof,mildmentalillness;
• psychologicaltherapiesdeliveredbymentalhealthprofessionalstounderservicedgroups;
• earlyinterventionservicesforchildrenandyoungpeoplewith,oratriskofmentalillness;
• servicesforpeoplewithsevereandcomplexmentalillnesswhoarebeingmanagedinaprimarycaresetting;
• enhancedAboriginalandTorresStraitIslandermentalhealthservices;and
1PerformanceindicatorsforPrimaryHealthNetwork-ledmentalhealthreform:DraftspecificationsforreportingbyPrimaryHealthNetworks.MentalHealthReformTaskForce,DepartmentofHealth
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• aregionalapproachtosuicidepreventionactivitieswithafocusonimprovedfollow-upforpeoplewhohaveattemptedsuicideorareathighriskofsuicide.
ThePMHCMDSisdesignedtocaptureservicedeliveryacrossallsixareas.
2.2Keyperformanceindicators
Asetof11keyservicedeliveryperformanceindicators(KPIs)hasbeenspecifiedformonitoringoveralldeliveryofservicescommissionedbyPHNs,coveringfourperformancedomains–access,efficiency,appropriatenessandeffectiveness(Figure1).
Figure1:Servicedeliveryperformanceindicatorsandassociatedperformancedomains
PERFORMANCEINDICATORNumberofperformanceindicators
PERFORMANCEDOMAIN
Access
Efficiency
Approp
riatene
ss
Effectiven
ess
ProportionofregionalpopulationreceivingPHNcommissionedmentalhealthservices:
• Lowintensitypsychologicalinterventions• Psychologicaltherapiesdeliveredbymentalhealth
professionals• Clinicalcarecoordinationforpeoplewithsevereand
complexmentalillness
3 ▲
AveragecostofPHNcommissionedmentalhealthservices:
• Lowintensitypsychologicalinterventions• Psychologicaltherapiesdeliveredbymentalhealth
professionals• Clinicalcarecoordinationforpeoplewithsevereand
complexmentalillness
3 ▲
ProportionofregionalyouthpopulationreceivingPHNcommissionedyouth-specificmentalhealthservices 1 ♦ ▲
ProportionofPHNcommissionedmentalhealthservicesdeliveredtotheregionalIndigenouspeoplewheretheserviceswereculturallyappropriate
1 ♦ ▲
ProportionofpeoplereferredtoPHNcommissionedservicesduetoarecentsuicideattemptorbecausetheyareatriskofsuicidefollowedupwithin7daysofreferral
1 ♦ ▲
ClinicaloutcomesforregionalpopulationreceivingPHNcommissionedmentalhealthservices:
• Lowintensitypsychologicalinterventions• Psychologicaltherapiesdeliveredbymentalhealth
professionals
2 ▲
▲ Primarydomain ♦Secondarydomain
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TheperformanceindicatorshavebeenspecifiedonthepremisethatacomprehensiveprimarymentalhealthcaredatasetisdevelopedandreportedbyallPHNcommissionedservices.
2.3Minimumdatasetspecifiedasrequirementoffundingschedules
FundingschedulesdevelopedtoprovidementalhealthfundingtoPHNsstipulatethereciprocalobligationsoftheDepartmentandPHNorganisationsinthedevelopmentandreportingofthenewPMHCMDS.Theschedulesrequire:
• theDepartmenttodevelopspecificationsforthePMHCMDSandestablisharrangementsforreportingofdatabyPHNsbyDecember2016,usingasafoundationthepreviousdatacollectionandreportingarrangementsestablishedfortheATAPSandMHSRRAprograms;
• theDepartmenttoundertakethisworkinconsultationwithPHNstoensurethatallmandatorydataarebothrelevanttomonitoringachievementofkeyobjectivesandfeasibleforreporting;and
• PHNstoensureallmandatorydataarereportedtothePMHCMDS,achievingfullcompliancewithreportingby30June2017.
3. OVERVIEWOFTHEPMHCMINIMUMDATASET
3.1Designprinciples
3.1.1 Minimumdatasettomeetarangeofpurposes
ThePMHCMDSisdesignedtomeetanumberofregionalandnationalpurposes.Attheregionallevel,thecollectionisaimedatsupportingtheroleofPHNsby:
• providingthebasisformonitoringservicedeliverybycommissionedorganisationsacrossthekeyperformancedomainsandinformingjudgementsaboutoutcomesandvalueformoney;
• supportingongoingregionalneedsanalysisandplanningbyidentifyingservicecoverageandpotentialgaps;
• providingmeaningfuldataforbenchmarkingbothwithinacrossregionstosupporttargetedregionalservicequalityimprovementinitiatives;
• establishingabasecollectionforlocalprogramevaluationsthatcanbeaugmentedbyadditionalpurpose-specificdata;and
• informingcommunicationwithregionalstakeholderandthebroadercommunitybasedoninformationthatiscomparabletootherregions.
ThePMHCMDSdoesnotconfinePHNstothedataspecified.Rather,itsetstheminimumandcommongroundforwhatdataaretobecollectedandreportedforservices
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commissionedbyPHNs.ItisanticipatedthatmanyPHNswillseektocollectanenhancedsetofdatatomeetlocalneeds,howeverthisdatawillnotbesubmittedtotheMDS.
Atthenationallevel,thecollectionwill:
• providethebasisformonitoringtheimplementationofGovernmentprimarymentalhealthcarereforms;
• beusedasafoundationforaccountabilityarrangementswithPHNsandinformregularreviewandupdatingofannualactivityworkplans;
• serveasthecoredataforuseinnationalevaluationsofmentalhealthreforms;and• supportongoingnationalplanningandpolicydevelopmentforprimarymental
healthcare.
3.1.2 Scope–activitiesincludedandexcluded
ThenewarrangementsaredesignedtocapturedataonPHN-commissionedmentalhealthservicesdeliveredtoindividualclients,includinggroup-baseddeliverytoindividualclients.Initiallythiswillinclude,butnotrestrictedto:
• psychologicaltherapiesdeliveredbymentalhealthprofessionals(asperpreviousATAPS/MHSRRAprograms);
• servicesdeliveredbymentalhealthnurses,formerlycapturedthroughtheMentalHealthNurseIncentiveProgram(MHNIP)sessionclaimprocessmaintainedbytheDepartmentofHumanServices;
• mentalhealthinterventionsdeliveredbyanew‘lowintensity’workforce;• carecoordinationtargetedatpeoplewithsevereandcomplexmentalillness;• suicidepreventionservicesdeliveredtoindividuals;and• servicesdeliveredtoAboriginalandTorresStraitIslanderpeople.
TheintentistoensurethatthePMHCMDShascapacitytocollectandreportonabroaderrangeofservicesthanthecurrentATAPS/MHSRRAminimumdataset,coveringthefullspectrumofindividualclient-centredservicesexpectedtobedevelopedthroughPHNcommissioningprocesses.
Thescopeofcoveragedoesnotextendtoservicestargetedatcommunities,suchasthecommunitycapacitybuildingactivitiespreviouslyfundedunderprojectssourcedfromNationalSuicidePreventionProgramfunding.Collectionandreportingofactivitiesofthistyperequiresadifferentapproachto‘counting’andidentificationofthe‘client’.PHNscommissioningactivitiesofthistypewillhaveflexibilitytoestablishlocaldatareportingarrangementsthatsuitrequirements.
Firststagedevelopmentwillfocusontheaboveareasandnotincludeexistingyouth-specificservices(headspace,EarlyPsychosisYouthServices)thatcurrentlycollectandreportastandardiseddatasettoheadspaceNationalOffice.Pendingthefutureofthesearrangements,andaccesstodatabyPHNs,thePMHCminimumdatasetcanbeexpanded
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atafuturestagetoallowincorporationofheadspaceandEarlyPsychosisYouthServicesshouldthisberequired.
3.1.3 BuiltonexistingATAPSfoundation
ThePMHCMDSdoesnotrepresentagroundupdevelopmentbutratherisbuiltonthefoundationestablishedbythecurrentATAPS/MHSRRAminimumdataset.Establishedin2003tocoverthethennewATAPSprimarymentalhealthprogram,thissystemhasbeenusedsuccessfullybyDivisionsofGeneralPractice,andlater,MedicareLocalstocollectandreportunitrecorddatatotheDepartment.In2015-16,thesystemwasbroadenedtocovertheMHSRRAprogram.InJuly2015PHNstookoverresponsibilityfortheATAPSandMHSRRAprogramsandwithitcollectionoftheminimumdataset.Currently,allPHNshaveaccesstothesystemandarereportingdatatotheDepartment.
ThisATAPS/MHSRRAdatacollectioncomprisessocio-demographicandclinicalinformationcollectedbythegeneralpractitionerorreferrerandservice-levelinformationcollectedbythementalhealthprofessionalateachsession,whichisenteredoruploadedfromlocalsystemsintoaweb-basedportal.
3.1.4 Flexibilitytoincorporateemergingrequirements
ChangestothePMHCMDSareexpectedtobemadefollowingtheestablishmentphase,andinresponsetoexpansionbyPHNsandtheirexperienceofthedatacollection.Thedesignofthedatamodelisaimedtobesufficientlycomprehensivetoallowfuturemodifications.
ChangestorequirementswillbeundertakeninconsultationwithPHNs.
3.2 Thedatatobecollected
ThecontentofthePMHCdataisdesignedtoanswerthecomplexmulti-partquestion:“Whoreceives,whatservices,deliveredbywhom,atwhatcost,andwithwhateffect?”CollectionofdatatoanswereachelementofthisquestionisequallyimportanttoPHNsintheircommissioningroleasitistoGovernmentinmonitoringtheimplementationofmentalhealthpolicyreforms.
ThedatabroadlycoversthesamecontentascapturedintheATAPS/MHSRRAsystem,coveringperson-level(demographics,clinical)andserviceevent-levelinformation(e.g.,sessiondetailssuchasduration,placeofdeliveryetc).Figure2summarisesthetypeofdatatobecollected.
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Figure2:Summaryofinformationtobecollected
Question Whatdatawillinformthisquestion?
Whoreceives… Demographicandclinicalcharacteristicsofserviceconsumers,collectedatepisodelevelbyserviceproviders
Whatservices… Rangeofdatacollectedbyserviceproviderforeachindividualserviceevent(e.g.,dateandtypeofservice,duration)
Fromwhom… Serviceproviderandorganisationdetailscharacteristics
Detailsoforganisationandmentalhealthworkforcedeliveringservices,reportedbyprovider
Atwhatcost… CostdatatobederivedfromannualfinancialstatementsmaintainedbyPHN,supplementedbyoutofpocketcoststoconsumercollectedandreportedbyprovidersforeachserviceevent
Withwhateffect Clientoutcomedata,maintainedbyproviderusingstandardinstruments
SummarydetailsoftheitemstobecollectedareprovidedatAttachmentA.Fulldetailsofallitemsincludingdefinitions,datadomainsandformatsareavailableon-lineathttps://www.pmhc-mds.com/.
3.3 Datamodel
ThebasicmodelfollowsthestructuralconceptsthathavebeensuccessfullyappliedforATAPS/MHSRRA.TheseconceptshavebroadapplicabilityandarenottiedexclusivelytothetypesofservicesdeliveredthroughATAPSandMHSRAA.ThedatamodelissummarisedinFigure3.
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Figure3:Thedatamodelanddatatobecollectedateachlevel
Datacollectedateachlevel(indicativeonly)Socio-demographicdataUniqueidentifier
ReferralsourceReferraldateDiagnosisPrevioustreatmenthistory
Datacollectedforeachservice:DateofserviceTypeofservicedeliveredServicemodality(face-face,phone,web)
Organisation ServicedurationProvidercategory Providerinformation
Copaymentdetails
Client
ServiceEpisode
'Sessions'(services)
Aclientmayhaveoneormorereferrals/episodes
Outcome
Outcomeassessedbycomparing pre- and
post-treatmentscoresonstandardised
scales
Providers
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3.4 ComparisontocurrentATAPSsystem
InadditiontocontinuationofmuchofthedatacontentcapturedinthecurrentATAPS/MHSRRAarrangements,thePMHCMDSretainsmanyofthepreviousdesignfeatures.Theseincludethebasicdataflow(Figure4)andfollowingfeatures:
• datamanagedviaanationaldatawarehouse• datasubmittedbyserviceprovidersthroughasecureweb-basedportal,ortoPHNs
tocollate/aggregateandsubmitthroughtheweb-basedportal,withoptiontobatchuploadfromlocalsystemsordirectdataentryviawebinterfaceforproviderswithoutsuitablesystems
• standardreportstobedesignedtomeetPHNanddepartmentalrequirements• capacityforPHNstodownloaddataforfurtherdetailedanalytics• automatedreceiptingandvalidationofdata.
Figure4:Dataflowsinexistingarrangementsthatwillbemaintained
Changestotheexistingarrangementshavefocusedon,butlimitedto:
• additionofnewdataitems,oramendmentstoexistingitems,necessarytoaccommodatethebroaderrangeofprimarymentalhealthcareservicesbeingcommissionedbyPHNs;
• anenhancedapproachtodefiningepisodes;• introductionofaprocessforallocationofregion-wideuniqueclientidentifiers;• improvementstothetypeofdatacapturedonthementalhealthworkforce
deliveringPHN-commissionedmentalhealthservices;• alignmentofdataitemswithnationalstandardsthathaveemergedsince2003;and• retirementofpreviousdataitemsthathavenotdemonstratedtheirworth,to
reducedatacollectionburdentothemaximumextentpossible.
National datawarehouse
PHNs
Contractedproviders
Optionsexistsforproviderstosubmitdatadirectlyusingwebinterface,orbatchupload
fromlocalsystems
Referrers
TwooptionsforPHNsubmission:1.Directdataentrytowebinterface2.Batchuploadfromlocalinformationsystems
StandardreportstoDOH
StandardreportstoPHNs
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3.5 WhatthenewarrangementsmeanforPHNsandcommissionedserviceproviders
ThePMHCMDSsetstherequirementsfordatacollectionandreportingthatareexpectedbyallPHNs.PHNsthereforeneedtoensurethattherequirementsaremetbyallcontractedprovidersofindividualclientmentalhealthservices.
DecisionsabouthowthedataarecollectedandreportedacrosstheregionwillbeatthediscretionofeachPHN.
3.6 Timelines
ThePMHCMDSisprogressinginstages,commencingwithdevelopmentofdataspecificationsandfollowedbyprogressiveupgradingoftheexistingweb-baseddatasubmissionandreportingarrangements.Theprocessentailsasetofshort-term,interimarrangementsforreportingofdatacoveringnewservicesthatwillrunalongsidetheexistingATAPS/MHSRRAsystem.
Thetimetableforrolloutofthenewarrangementisoutlinedbelow.
11July2016 ReleaseoffirstdraftofdataspecificationsdevelopedfollowingfeedbackfromPHNMDSReferenceGroup.
ThesewerereleasedtoforeshadowtoallPHNstheindicativecontentofmandatorydatatobereportedandinvitecommentpriortofinalisation.
21September)2016
FullminimumdatasetspecificationsreleasedforusebyPHNsindevelopinglocalsystemsandsettingreportingrequirementsofcommissionedproviders.
ByendOct2016
STAGE1ofnewdatasubmissionarrangements
Interimweb-baseddatasubmissionprocessreleasedforreportingbyPHNsonallaspectsofclientservicedeliveryincludingthosenotcurrentlycapturedintheATAPS/MHSRRAsystem.
Theinterimprocessincorporatesallnewdataitemsandexcludesthose‘retired’fromtheformerATAPS/MHSRRAminimumdataset.
Stage1requiresPHNsandtheirserviceproviderstoeither:
• exportdatafromtheirclientsystemsanduploadtotheMDS;or• manuallycreatespreadsheetsthatcanthenbeuploaded.
ItalsoincludesausermanagementinterfacetoallowPHNstomanagetheirserviceprovidersandacoresetofreportsrelatingtodepartmentalreporting.However,theinterimdatasubmissionprocesshassignificantlylessfunctionalitythantheATAPSsystem,includingweb-baseddataentryandediting.
TheATAPS/MHSSRAsystemwillbemaintainedandrunalongsidetheseinterimarrangementsforPHNsthatarereliantonthissystemfordatacaptureorchosetomaintainparallelsystems.However,newdata
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itemsbeingintroducedtothePMHCMDSarenotincluded.
TheATAPS/MHSRRAsystemwillbemaintaineduntilanewintegrateddataentryinterfaceisavailableinstagetwo.
Byfinalquarter2016-17
STAGE2–integrateddatasubmissionarrangement
Thisstagewillbringtogetherallreportingintoasingledatasubmissionprocess.Itwillincludeare-designeddataentryuserinterfacethatallowsonlineeditingofthedataintheMDS,amasterpatientindextoallowserviceproviderstomanageclientidentifiersacrossPHNsandotherreportingfunctionality.
TheexpectedimplementationtimetableforPHNs,includingdecisionstobemaderegionallyis:
From1July2016
HaveinplacedatacollectionarrangementstocoverservicesthatfallinscopeofpreviousATAPS/MHSRRAprogramsandthenewrangeofservicesbeingcommissioned.
Basedonregionalrequirements,decidewhetherto:
• maintaintheexistingATAPS/MHSSRAdatacollectionandsubmissionarrangementsinparallelwithinterimarrangementsfornewservices,or
• tomoveacrosstoasingleapproachtocollectionthatwillusetheinterimdatasubmissionprocessfrom1November2016
From1Nov2016
Commenceprocessesrequiredforreporting/uploadingofnewserviceactivityusinginterimreportingsystem.
MaintainexistingATAPS/MHSRRAreportinginparallelifthePHNdecidedtomaintainthisarrangementpendingintegratedStage2developments.
Byfinalquarter2016-17
BeginadoptionofStage2integratedPMHCdatacollectionandsubmissionarrangements.
30June2017 Fullcompliancewithintegratedreporting.
3.7 Consultationprocess
TheDepartmentiscommittedtoengagingwithPHNsinundertakingthedevelopmentworkandestablishedaReferenceGrouptooverseetheredesignoftheMDS.ExpressionsofinterestwerecalledinAprilandmetwithsignificantinterest.Atotalof16ofthe31PHNsnominatedforReferenceGroupmembership.Aninitialmeetingofthegroupwasheldon21June2016.
TheDepartmentappreciatesthatPHNsneedtobeawareofthespecificdataitemstheywouldneedtoreportontoensurethatthecommissionedservicesarecollectingand
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reportingonsuchdataitems.TothisenditmadeavailabletoallPHNsallmaterialspreparedfortheReferenceGroupconsiderationandrequestedcommentstobesubmittedbythosePHNswhoarenotReferenceGroupmembers.CommentsandsuggestionssubmittedbyPHNshavebeenusedtodevelopthefinalversionofthespecifications.
4. KEYDESIGNISSUESLikeallminimumdatasets,designofthePMHCMDShasentailedanumberofcriticaldecisionsaboutwhattocollect,whentocollectandhowtocollecttherequireddata.ThissectionofthepaperdescribesthekeydecisionissuesconsideredbytheDepartmentandhowthesewereresolved.
4.1 Definingepisodes
AcentralfeatureofthePMHCMDSdesignisthattheunitofservicedeliveryistheepisodeofcare.Episodesinturncompriseaseriesofoneormoreservicecontacts.Thisstructureallowsfordeterminingalogicaldatacollectionprotocolthatspecifieswhatdataarecollectedwhen,andbywhom.DifferentsetsofPMHCMDSitemsarecollectedatvariouspointsintheclient’sengagementwiththeproviderorganisation.Someitemsareonlycollectedonceattheepisodelevel,whileothersarere-collectedateachservicecontact.
Conceptsofepisodesareusedwidelythroughoutthehealthsystemasamethodtodescribetheactivitiesofhealthservicesandtoorganisedatacollection,reportingandanalysis.Ingeneral,anepisodeofcareisusedtorefertoaperiodofcarewithdiscretestartandendpoints.Mostworkondefiningepisodeshasbeentiedtoacutehospitalsettings,wheretheprincipleisrelativelysimple–oneepisodeperpatientperhospitalatanyonetime,withtheepisodebeginningatadmissionandendingatdischarge.
Thereareseveralissuesthatmakethedefinitionofanepisodeinprimarycaresettingsparticularlydifficult.First,whilsttheinitiationofprimarymentalhealthcareisusuallyaccompaniedbyformal,well-definedprocesses,itsterminationoftenismoredifficulttodefine,eitherclinicallyoradministratively.Second,manyclientsmayundergotreatmentoverextendedperiods.Finally,multipleorganisationsorpractitionerswithinorganisationsmaybeinvolvedinprovidingcareduringaparticularperiod,witheachprovideragencyorpractitionerregardingtheirinterventionasadiscreteepisode.
ApproachtakeninPMHCMDS
• ForthepurposesofthePMHCMDS,andepisodeofcareisdefinedasamoreorlesscontinuousperiodofcontactbetweenaclientandaPHN-commissionedproviderorganisationthatstartsatthepointoffirstcontact,andconcludesatdischarge.
• Threebusinessrulesapplytoepisodesofmentalhealthcare:
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1. Oneepisodeatatimeforeachclient,definedattheleveloftheproviderorganisationWhileanindividualmayhavemultipleepisodesofmentalhealthcareoverthecourseoftheirillness,theymaybeconsideredasbeinginonlyoneepisodeatanygivenpointoftimeforanyparticularPHN-commissionedproviderorganisation.Thepracticalimplicationisthatthecareprovidedbytheorganisationtoanindividualclientatanypointintimeissubjecttoonlyonesetofreportingrequirements.
2. Episodescommenceatthepointoffirstcontact3. Dischargefromcareconcludestheepisode
Dischargemayoccurclinicallyoradministrativelyininstanceswherecontacthasbeenlostwiththeclient.Anewepisodeisdeemedtocommenceifthepersonre-presentstotheorganisation.
4.2 Identifyingandclassifyingcommissionedepisodesofcaretoenablemonitoringofpolicyimplementation
Monitoringofservicedeliveryneedstohavecapacitytogroupepisodesofcareintohighlevelcategoriesthatalignwithpolicyprioritiesforprimarymentalhealthcarereform–thesehavebeenthebasisfortheKPIssetforPHNs.OfparticularimportancearethesixkeyservicedeliveryareasrequiredofPHNsidentifiedinfundingschedulesdescribedinbriefas:
• lowintensitypsychologicalinterventions• psychologicaltherapiesdeliveredbymentalhealthprofessionals• earlyinterventionservicesforchildrenandyoungpeople• servicesforpeoplewithsevereandcomplexmentalillness• enhancedAboriginalandTorresStraitIslandermentalhealthservices;and• regionalapproachtosuicidepreventionactivitiesfocusedonimprovedfollow-upfor
peoplewhohaveattemptedsuicideorareathighriskofsuicide
GovernmentrequiresareliablemechanismtomonitorservicedeliveryacrosstheseareasjustasPHNsrequireameanstomonitorregionalservicedelivery.
AnuancedsolutiontothisissuehasbeenadoptedintheproposedPMHCMDS.Thisisbasedonthefollowingconsiderations:
• Principalcategorytobereportedbytheserviceprovider
o Whileallkeyserviceareascouldbe‘carvedout’post-factofromactivitydatabyspecificdataanalysisrules(e.g.,onlyclassifyanepisodeaslowintensityifthemajorityofservicesaredelivered‘lowintensity’workers),thereisanover-ridingrequirementtoensurethedatacollectionandreportingsystem
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allowsPHNstomonitorservicedeliveryagainstitscommissioningtargetsinanongoingmanner.
o Thisshouldbebasedondatareportedbyprovidersratherthancomplexmanipulationsofdataafterthefact.Theimplicationisthatepisodesofcaredeliveredneedtoincludeaspecificmarker,reportedbytheserviceprovider,ofthemaincategoryofservicestobeprovidedandforthesetobealignedwherepracticaltothekeyareasofservicedelivery.
• Categoriesneedtobemeaningfulandmutuallyexclusiveo Robustdefinitionsarerequiredthatallowtheprovidertomakeajudgement
aboutcomplexfacts.Servicecategoriesneedtobeasmutuallyexclusiveaspossibletominimiseproviderconfusionabouthowtoassignepisodes.
• Monitoringdeliveryacrossallsixkeyserviceareaswillrequireamixofmethodso Thesixpriorityareascompriseamixofconcepts–rangingfromafocuson
specificsub-populations(e.g.,children)tospecifictypesofservices(e.g.,lowintensity).Asingleapproachtocapturingalloftheseisnotconsideredfeasible.
ApproachtakeninPMHCMDS
• Serviceprovidersarerequiredtoreportonthe‘Principalfocusoftreatmentplan’forallacceptedreferrals.
• Thisrequiresajudgementtobemadeaboutthemainfocusoftheservicestobedeliveredtotheclientforthecurrentepisodeofcare,madefollowinginitialassessmentandmodifiableatalaterstage.
• Operationally,theconceptof‘principalfocus’willbedefinedastherangeofactivitiesthatbestdescribestheoverallservicesintendedtobedeliveredtotheclientacrossthecourseoftheepisode.Formostclients,thiswillequatetotheactivitiesthataccountformosttimespentbytheserviceprovider.
• Principalfocusoftreatmentplanisnecessarilyajudgementmadebytheproviderattheoutsetofservicedeliverybutconsistentwithgoodpractice,wouldbemadeonthebasisofatreatmentplandevelopedincollaborationwiththeclient.Itmaybemodifiedthroughoutthecourseoftreatmentiftheinitialassessmentprovedincorrect.
• Itischosenfromadefinedlistofcategories,withtheproviderrequiredtoselectthecategorythatbestfitsthetreatmentplandesignedfortheclient
Expandeddefinitionsforthe‘principalfocusoftreatmentplan’concepthavebeendeveloped.Thecategoriesandmainfeaturesofeachcategoryaredescribedbelow.
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Category Principalfocusoftreatmentplan
• Psychologicaltherapy
Thetreatmentplanfortheclientisprimarilybasedaroundthedeliveryofpsychologicaltherapybyoneormorementalhealthprofessionals.ThiscategorymostcloselymatchestherangeofservicesdeliveredunderthepreviousATAPSprogram.
Theconceptof‘mentalhealthprofessionals’hasaspecificmeaningdefinedintheguidancedocumentationpreparedtosupportPHNsinimplementationofreforms.2Itreferstoserviceproviderswhomeettherequirementsforregistration,credentialingorrecognitionasaqualifiedmentalhealthprofessionalandincludes:
• Psychiatrists• RegisteredPsychologists• ClinicalPsychologists• MentalHealthNurses;• OccupationalTherapists;• SocialWorkers• AboriginalandTorresStraitIslanderhealthworkers.
• Lowintensitypsychologicalintervention
Thetreatmentplanfortheclientisprimarilybasedarounddeliveryoftime-limited,structuredpsychologicalinterventionsthatareaimedatprovidingalesscostlyinterventionalternativeto‘standard’psychologicaltherapy.Theessenceoflowintensityinterventionsisthattheyutilisenilorrelativelylittlequalifiedmentalhealthprofessionaltimeperclient3andaretargetedatpeoplewith,oratriskof,mildmentalillness.
Lowintensityepisodescanbedeliveredthrougharangeofmechanismsincludinguseofindividualswithappropriatecompetenciesbutwhodonotmeettherequirementsforregistration,credentialingorrecognitionasamentalhealthprofessional;deliveryofservicesprincipallythroughgroup-basedprograms;anddeliveryofbrieforlowcostformsoftreatmentbymentalhealthprofessionals.
• Clinicalcarecoordination
Thetreatmentplanfortheclientisprimarilybasedarounddeliveryofarangeofserviceswheretheoverarchingaimistocoordinateandbetterintegratecarefortheindividualacrossmultipleproviderswiththeaimofimprovingclinicaloutcomes.Consultationandliaisonmayoccurwithprimaryhealthcare
2DepartmentofHealth,PHNprimarymentalhealthcareflexiblefundingpoolimplementationguidance:Psychologicaltherapiesprovidedbymentalhealthprofessionalstounderservicedgroups.August2016.http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Tools3BasedonBennet-LevyJ,RichardsD,FarrandPetal.OxfordGuidetoLowIntensityCBTInterventions.OxfordUniversityPress,2010.www.oup.com.au/titles/academic/psychology/9780199590117
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providers,acutehealth,emergencyservices,rehabilitationandsupportservicesorotheragenciesthathavesomelevelofresponsibilityfortheclient’sclinicaloutcomes.Theseclinicalcarecoordinationandliaisonactivitiesareexpectedtoaccountforasignificantproportionofservicecontactsdeliveredthroughouttheseepisodes.
• Complexcarepackage
Thetreatmentplanfortheclientisprimarilybasedaroundthedeliveryofanindividuallytailored‘package’ofservicesforaclientwithsevereandcomplexmentalillnesswhoisbeingmanagedprincipallywithinaprimarycaresetting.Theoverarchingrequirementisthattheclientreceivesanindividuallytailored‘package’ofservicesthatbundlesarangeofservicesthatextendsbeyond‘standard’servicedeliveryandwhichisfundedthroughinnovative,non-standardfundingmodels.Note:Asoutlinedintherelevantguidancedocumentation,onlythethreeselectedPHNLeadSiteswithresponsibilitiesfortriallingworkinthisareaareexpectedtodelivercomplexcarepackages.4Awiderroll-outmaybeundertakeninthefuturependingresultsofthetrial.
• Childandyouth-specificmentalhealthservices
Thetreatmentplanfortheclientisprimarilybasedaroundthedeliveryofarangeofservicesforchildren(0-11years)oryouth(aged12-24years)whopresentwithamentalillness,orareatriskofmentalillness.Theseepisodesarecharacterisedbyservicesthataredesignedspecificallyforchildrenandyoungpeople,includeabroaderrangeofbothclinicalandnon-clinicalservicesandmayincludeasignificantcomponentofclinicalcarecoordinationandliaison.Childandyouth-specificmentalhealthepisodeshavesubstantialflexibilityintypesofservicesactuallydelivered.
• Indigenous-specificservices
ThetreatmentplanfortheclientisprimarilybasedarounddeliveryofmentalhealthservicesthatarespecificallydesignedtoprovideculturallyappropriateservicesforAboriginalandTorresStraitIslanderpeoples.
• Other Thetreatmentplanfortheclientisprimarilybasedaroundservicesthatcannotbedescribedbyothercategories.
ThecategoriesdonotspecificallyaddressoneofthesixkeyservicedeliveryareasrequiredofPHNs(Suicidepreventionactivitiesfocusedonimprovedfollow-upforpeoplewhohave
4DepartmentofHealth,PHNprimarymentalhealthcareflexiblefundingpoolimplementationguidance:Primarymentalhealthcareservicesforpeoplewithseverementalillness,August2016.http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Tools
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attemptedsuicideorareathighriskofsuicide)becausetodosowouldcreateambiguityindatareportingandcompromisethemutualexclusivityrequirement.
Adifferentapproachisrequiredtoidentifypeoplereferredforepisodeswheresuicideriskwasanissue.Thisisdescribedbelow.
4.3 Howsuicidepreventionactivitywillbemanagedinthecollection
Initialconsiderationwasgiventoincludingsuicidepreventionasaseparate‘principalfocus’episodetype.Thiswasnotconsideredaworkableoptionbecauseitwouldconfusethemutuallyexclusiveboundariesthatneedtobecreated.Servicesdeliveredtoindividualswhohaverecentlyattemptedsuicideorareatriskofsuchmaybeafeatureofalloftheother‘principalfocus’categories.
Aspecificmarkerofsuicideprevention-orientedservicestoindividualsisessentialhowever,giventhatPHNKPIsincludeonethatisfocusedontimelyfollowupofpeoplereferredfollowingarecentsuicideattemptorbecausetheyareatriskofsuicide.
ApproachtakeninPMHCMDS
• ThePMHCMDSincludesanew‘suicidereferralflag’inthedataset,recordedbytheserviceproviderattheoutsetoftheepisode.Thisitemisdefinedtoidentifythoseindividualswherearecenthistoryofsuicideattempt,orsuiciderisk,wasafactornotedinthereferral.
4.4 Determiningwhatactivitiesareinscopeforreportingasservicecontacts
ServicecontactsrepresentthebasicunitforcountinganddescribingactivitiesinthePMHCMDS.Aneffective,reliableapproachtodefiningandcountingservicecontactsisessentialforPHNstomonitorservicevolumes,unitcostsandoverallservicecoverageoftheregionalpopulation.Relianceonameasureofservicecontact(or‘occasionofservice’)tomonitorservicedeliveryisconsistentwithallequivalentdatacollectionsinthehealthfield,includingthosecoveringstateandterritorycommunitymentalhealthservices,communityhealthcentresand‘non-admitted’servicesdeliveredthroughpublichospitals.
UnderpreviousATAPS/MHSRRAarrangements,theconceptwasreferredtoasa‘session’.However,withsomeexceptions,sessionscouldonlyberecordedwhentherewasadirectinteractionbetweenaserviceproviderandtheclient,whetheritwasfacetofaceorthroughanothermedium(telephone,internet).Thisapproachexcludedarangeofclient-relatedactivitiesthatwereundertakenonbehalfoftheclient,suchasinteractionwithsignificantothers,carecoordinationactivitiesentailingengagementwithotheragenciesandsoforth.
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AmodifiedapproachisembeddedinthePMHCMDSthatisbasedonthefollowingconsiderations:
• Multiplestudieshavedemonstratedthatasignificantcomponentoftheworkoftreatmentclinicianswhoworkwithpeoplewithmentalillnessentailsengagingwithindividualsotherthantheclient.Typically,theseincludeotherhealthorsocialserviceproviders,familymembersorothersignificantothersintheclient’ssupportnetwork.
• TheincreasedflexibilitygiventoPHNsincommissioningservicestomeetindividualclientneedsrequiresthatabroaderrangeofservicesthantheconstrictedATAPS‘session’concept.
• Statesandterritorieshavegrappledwiththeissueandresolvedmanyyearsagotoallowservicedeliveredonbehalfofclients–wheretheclientwasnotpresent–toberecordedandcountedasservicecontactsinthecommunitymentalhealthinformationcollections,endorsedalsointhenationaldata.Thesemakeupabout30%oftotalcontactsrecorded.
• Theprimarycarereformemphasisinimprovedcarecoordinationforpeoplewithseverementalillnesswhoarebeingprincipallymanagedbyprimaryhealthcareservicesnecessitatesawiderdefinitionofcontacttoallowthefullextentofserviceprovisiontothistargetgrouptobegauged.
• AnybroadeningofwhatcanbereportedasaServiceContactneedstoconfinethescopetoclientrelated,clinicallyrelevantactivity.ThisisnecessarytopreventthePMHCMDSbeingdesignedasanall-encompassing‘timeandmotion’recordofallactivitiesengagedinbymentalhealthserviceproviders.
ApproachtakeninPMHCMDS
• Servicecontactsaredefinedusinganapproachbasedonthatestablishedforstateandterritorymentalhealthcommunitymentalhealthservices,withappropriatemodifications.Theessenceofthedefinitionisbelow:
o ServicecontactsaredefinedastheprovisionofaservicebyaPHNcommissionedmentalhealthserviceproviderforaclientwherethenatureoftheservicewouldnormallywarrantadatedentryintheclinicalrecordoftheclient.
o Aservicecontactmustinvolveatleasttwopersons,oneofwhommustbeamentalhealthserviceprovider.
o Servicecontactscanbeeitherwiththeclientorwithathirdparty,suchasacarerorfamilymember,and/orotherprofessionalormentalhealthworker,orotherserviceprovider.
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o Servicecontactsarenotrestrictedtoface‑to‑facecommunicationbutcanincludetelephone,internet,videolinkorotherformsofdirectcommunication.
o Serviceprovisionisonlyregardedasaservicecontactifitisrelevanttotheclinicalconditionoftheclient.Thismeansthatitdoesnotincludeservicesofanadministrativenature(e.g.telephonecontacttoscheduleanappointment).
AnimplicationofthisapproachisthatthedatacollectionrequiresaflagagainsteachrecordedServiceContacttoindicatewhethertheclientparticipated,andifnot,whowastherecipientofthecontact.Twoitemshavebeenaddedtothecollectiontocapturetheseaspects-seethedataitems:
• Mentalhealthservicecontact-clientparticipationindicator• Serviceparticipants
4.5 Classifyingtypesofservicesdeliveredateachservicecontact
Inadditiontobasicdetailsabouteachservicecontact(e.g.,date,duration,locationetc),theMDSalsoshouldincludecaptureofinformationaboutthetypeofservicesdelivered.Thisisnecessarytounderstandthemixofservicesprovidedwithinandacrossepisodesofcare.Thekeyrequirementsaretodesignalistofservicetypesthatis:
• policyrelevant;• meaningfultobothconsumers,practitionersandPHNs;and• minimalistbutcomprehensive
Meetingalltheserequirementsisachallenge.Informationsystemdevelopersinthehealthfieldhavevariouslyapproachedthetask.Acommonapproachistodevelopalistofinterventionsfromwhichtheproviderisrequiredtoselectoneormoreoptionsthatdescribeswhatwasdeliveredateachtreatmentencounter.Typically,thelistsareextensive,aimedatcomprehensivelycoveringalloptions,andoverwhelmserviceproviderswithchoice.Dataqualityisoftenpoorasaresult.
ThepreviousATAPSdatacollectioncollectsinformationabouttypesofservicesdeliveredbasedaroundspecificpsychologicalinterventionsbutthisistoonarrowforthebroaderrangeofservicestobeofferedunderthenewprimarymentalhealthcarearrangements.Dataqualityhasalsobeenproblematicasthecodelistofferedtoclinicianslacksdefinitionalspecificityandisoverinclusive.
ApproachtakeninPMHCMDS
• TheapproachadoptedforthePMHCMDSincludesanitemtitled‘Servicecontact–Type’thatrequiresserviceproviderstoreportonthemainservicedeliveredateachservicecontact.Thisisselectedfromasmalllistofoptions,andbasedonthe
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activitythataccountedformostprovidertime.Thecategoriesforselectionofmainservicetypeare:
1 Assessment2 Structuredpsychologicalintervention3 Otherpsychologicalintervention4 Clinicalcarecoordination/liaison5 Clinicalnursingservices6 ChildoryouthspecificassistanceNEC57 SuicidepreventionspecificassistanceNEC8 CulturalspecificassistanceNEC
• DefinitionsareprovidedatAttachmentB.
• ServiceContact–Typediffersfromthedataitem‘Principalfocusoftreatmentplan’becauseitrequiresinformationabouteachservicecontact.‘Principalfocusoftreatmentplan’requiresajudgementabouttheoverallepisodeofcare,madeatthepointofdevelopingtheclientstreatmentplan(butcanbemodifiedlater).Classifyinganepisodeofcareintoa‘Principalfocusoftreatmentplan’categorydoesnotrestrictwhatisrecordedateachservicecontact.Forexample,anepisodewithaPrincipalFocusof‘ClinicalCareCoordination’mayincludecontactsofanytype.
4.6 Diagnosiscoding
CollectionoftheprincipaldiagnosisofclientsreceivingservicesisessentialtounderstandthetypesofmentalhealthproblemsanddisordersmanagedthroughPHN-commissionedservices.Diagnosisistobereportedatoverallepisodelevel,withdiagnosis(PrincipalandAdditional)assignedbythetreatingorsupervisingclinicalpractitioner.
Thekeyissuetoberesolvedconcernedthelevelofdiagnosiscodingthatshouldbesetastheminimumandwhatclassificationsystemistobeused.ThepreviousATAPSspecificationfordiagnosisreportingrepresenteda‘mixedbag’.ItwassetasasmallnumberofcategoriestorecordhighlevelcodesforanxietyanddepressivedisordersbutamendedovertheyearstoincorporatethevariousrequirementsofspecialTier2fundinglevelsastheywereadded.Wherediagnosiswasrecorded,anxiety-relatedanddepressiveconditionstogetheraccountedforaround80%.Diagnosesenteredasun-codedfreetextaccountfor19%.Mostimportantly,diagnosiswasnotrecordedforjustunderathird(28%)ofallclients,likelyduetoanumberofproblemsincludingpoorcompliancewithrequirementsandinadequaciesofthecodingoptionsprovidedtoclinicians.
MultipleoptionsareavailableforuseinthePMHCMDS.Theseinclude:
5NECrefersto‘notelsewhereclassified’–thatis,theactivitycannotbedescribedbytheavailablecategories.
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• IncorporationofthefullICD-10AMcodinglistformentaldisorders.Thiswouldentailallowingmanyhundredsofdiagnosticcodesmostofwhichareveryrarelyseeninprimarymentalhealthcare,ifatall.
• BasethecodingaroundthehighlevelmentaldisorderchaptersoftheICD-10.Thisapproachhastheadvantageofsimplicitybutispoorlytargetedtoreportonthemostcommondisordersseeninprimarymentalhealthcare.Forexample,around80%ofclientstreatedwouldfallwithintwocategories.(F30-F39andF40-48).Amorefine-grainedapproachisrequiredthatallowsbetterclinicalprofilingofclientsbutdoesnotcause‘diagnosisclutter’.
• BasethecodingonthefullsetofcodesdevelopedfortheICPC-2primarycaresystemtodescribepsychologicalproblems,asusedforexampleinthereportingofBEACHstudiesofGeneralPractitioneractivities.Whileintuitivelyappealing,thisapproachmorereflectsanextensivelistofpresentingproblemsthanformaldiagnosticcodes.Itisalsoregardedasunhelpfulbymanymentalhealthclinicians.
• DevelopacustomisedlistofdiagnosiscodesthatarebasedonthemostprevalentconditionsincludedinAustralianNationalSurveysofMentalHealthandWellbeingconductedacrossadultandchildandadolescentpopulationsoverthepasttwodecades(seeFigure5andFigure6).AlthoughbasedonDSM-IVclinicaldiagnosesanddescriptionsratherthanICD-10,thesemorecloselyalignwithdiagnosticapproachesusedbyAustralianmentalhealthclinicians.
• AnadditionalconsiderationconcernstheneedtodesigntheapproachtodiagnosisreportingtoreflectthatPHN-ledreformsrequireextendingservicedeliveryto‘lowintensity’clientswhoareatriskofdevelopingamentalillness.Manyinthisgroupareanticipatedtopresentwithsignificantmentalhealthproblemsthataresubsyndromalanddonotcurrentlymeetformaldiagnosticcriteria.
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Figure5:Diagnosisrangeusedinthe2007NationalSurveyofMentalHealthandWellbeing–Adults16-856
Figure6:Diagnosisrangeusedinthe2013-14SecondAustralianChildandAdolescentSurveyofMentalHealthandWellbeing-4-17yearolds7
%population
%population
Anxietydisorders
Anxietydisorders PanicDisorder 2.6 Socialphobia 2.3Agoraphobia 2.8 Separationanxiety 4.3SocialPhobia 4.7 Generalisedanxiety 2.2GeneralisedAnxietyDisorder 2.7 Obsessive-compulsive 0.8Obsessive-CompulsiveDisorder 1.9 Anyanxietydisorder 6.9Post-TraumaticStressDisorder 6.4 Majordepressivedisorder 2.8
AnyAnxietydisorder 14.4AttentionDeficitHyperactivityDisorder(ADHD) 7.4
Affectivedisorders
Conductdisorder 2.1DepressiveEpisode 4.1 Any12-monthmentaldisorder 13.9Dysthymia 1.3
BipolarAffectiveDisorder 1.8
AnyAffectivedisorder 6.2SubstanceUsedisorders
AlcoholHarmfulUse 2.9
AlcoholDependence 1.4
DrugUsedisorders 1.4
AnySubstanceUsedisorder 5.1
Any12-monthmentaldisorder 20.0
ApproachtakeninPMHCMDS
• ThesolutionadoptedforthePMHCMDSusesa‘picklist’ofdiagnosiscodingoptionsdevelopedtobalancecomprehensivenessandbrevity.TheycompriseamixofthemostprevalentmentaldisordersintheAustralianadult,childandadolescentpopulation,supplementedbylessprevalentconditionsthatmaybeexperiencedbyclientsofPHN-commissionedmentalhealthservices.
• ThediagnosisoptionsarebasedonanabbreviatedsetofclinicaltermsandgroupingsspecifiedintheDiagnosticandStatisticalManualofMentalDisordersFourthEdition(DSM-IV-TR).Thecodelistsummarisestheapproximate300uniquementalhealthdisordercodesinthefullDSM-IVtoasetto9majorcategories,and37individualcodes.Diagnosesaregroupedunderhigherlevelcategories,basedontheDSM-IV.CodenumbershavebeenassignedspecificallyforthePMHCMDStocreate
6Sladeetal(2009),ThementalhealthofAustralians2:Reportonthe2007NationalSurveyofMentalHealthandWellbeing.DepartmentofHealthandAgeing,Canberra.7Lawrenceetal(2015),Thementalhealthofchildrenandadolescents:ReportonthesecondAustralianchildandadolescentSurveyofMentalHealthandWellbeing.DepartmentofHealth,Canberra
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alogicalorderingbutarecapableofbeingmappedtobothDSM-IVandICD-10codes.
• Additionalcodeshavebeenaddedtoreflectsubsyndromalconditionstoaccommodatereportingonclientswhodonotmeetdiagnosticcriteria.
• ThediagnosislistisprovidedatAttachmentC.
4.7 Selectingcoreoutcomemeasures
Reportingonclientoutcomesisafundamentalrequirementandcomprisestwoofthe11servicedeliveryKPIssetforPHNs.Beyondthis,ongoingmonitoringbyserviceprovidersofclientprogressusingstandardisedmeasuresiscriticaltoinformingtreatmentdecisionsandongoingdialoguebetweenserviceprovidersandtheirclients.
Therearemanyhundredsofstandardisedmeasuresdevelopedandavailableforinuseinthedeliveryofmentalhealthcare.Whilesomearetargetedatspecificconditions,ordevelopedforuseinspecifictreatmentsettings,othershavebeendevelopedasbroadspectrummeasuresforapplicationacrossthefullrangeofclientswhopresentforassistance.
Australia’sexperienceinintroducingoutcomemeasuresintoroutineclinicalpracticeisunmatchedinternationally.Commencingin2003,routineuseofoutcomemeasureswasintroducedintostateandterritoryspecialisedmentalhealthservices,progressedthroughafundingpartnershipbetweenstateandterritoryandtheCommonwealthGovernments.ThatyeartheAustralianMentalHealthOutcomesandClassificationNetwork(http://www.amhocn.org/)wasestablishedbytheDepartmenttoleadthenationaldevelopmentsandprovidesupportthroughreportingandanalytictools.
Whileregularuseofoutcomemeasureshealthservicesbeenarequirementofspecificmentalhealthfundedprimarycareactivity,includingtheMBSBetterAccessprogramandATAPS,ithasbeensubjecttolessdevelopmentalwork.ThepreviousATAPSallowedanextensivelistofoptionsthatwasselectedattheclinician’sdiscretionbutthesehadrelativelypoorcompliance.
TheapproachtoselectingoutcomemeasuresincorporatedinthePMHCMDSshouldbebasedonthefollowingconsiderations.
• Acore(mandatory)setofstandardoutcomemeasuresshouldbesetforreportingwithanyadditionalmeasuresusedatthediscretionoftheprovider.Theprinciplesof‘lessisbest’,andminimisationofreportingburdenareparamount.
• Thecoremeasuresshouldbemeaningfulandapplicableacrossallclientgroupsandbecapableofbeingusedbyallserviceproviders.
• Coremeasuresshouldreflecttheclient’sperspective–thatis,bebasedonself-report.
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• Coremeasuresshouldbebriefandtakenomorethan10minutestobecompletedbytheclient.
• Coremeasuresshouldhavesoundpsychometricpropertiesandbesensitivetochangeintheclient’scondition.
• Australianpopulationleveldatashouldbeavailableonallcoremeasurestoenablecomparison,andparticularlythecapacitytoassessclientrecovery–i.e.movementintothe‘normal’scorerange.
ApproachtakeninPMHCMDS
• Asmallnumberofoutcomemeasureshasbeensetasmandatoryforallepisodesofcare.
• Foradultclients:
o themandatorymeasureistheKessler-10(K10+version).ThisisthemostwidelyusedmeasureusedinAustralia,hascomprehensivenormativedataandhasdemonstratedutilityinmeasuringclientprogress(ordeterioration).Itisalsohasaveryhighcorrelationwithalternativemeasuresalsowidelyused(e.g.,PHQ-9,GAD-7).
o forAboriginalandTorresStraitIslanderclients,theK5maybeusesasanalternativetotheK10.
• Forchildandadolescentclients:
o themandatorymeasureistheStrengthsandDifficultiesQuestionnaire(SDQ).TheSDQisusedwithsignificantutilityinbyallstateandterritorychildandadolescentmentalhealthservicesandalsohasrecentpopulationlevelgatheredthroughthe201314SecondAustralianChildandAdolescentSurveyofMentalHealthandWellbeing.
o MultipleversionsoftheSDQareavailableandvaryaccordingtowhenthemeasureisused(baselinevsfollowup),age(4-10year,11-17years)andwhoprovidestheinformation(parentvschildselfreport).TheversionsspecifiedforPMHCMDSreportingare:
§ PC1-ParentReportMeasureforChildrenaged4-10,Baselineversion;§ PC2-ParentReportMeasureforChildrenandAdolescentsaged4-10,
Followupversion;§ PY1-ParentReportMeasureforYouthaged11-17,Baselineversion;§ PY2-ParentReportMeasureforYouthaged11-17,Followupversion;§ YR1-Youthselfreportmeasure(11-17),Baselineversion;and§ YR2-Youthselfreportmeasure(11-17),Followupversion.
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o Foradolescents,thecliniciansmayusetheK10+(orK5forIndigenousclients)asanalternativetotheSDQisthisisconsideredappropriatetotheclient’ssituation.TheK10hasbeenusedsuccessfullyinanumberofstudiesofadolescentsinAustraliae.g.,thenationalevaluationofheadspace;thesecondAustralianchildandadolescentSurveyofMentalHealthandWellbeing.
• EachPHNhasthecapacitytoaddadditionaloutcomemeasurestotheirownregionaldatacollectionsystemstomeetlocalrequirementsbutthesearenotnecessaryforreportingthenationaldataPMHCminimumdataset.
• Forthemandatorymeasures,theconceptof‘CollectionOccasion’isdefinedasanoccasionduringanEpisodeofCarewhentherequiredoutcomemeasureistobecollected.Ataminimum,collectionofoutcomedataisrequiredatbothEpisodeStartandEpisodeEnd,butmaybemorefrequentifclinicallyindicatedandagreedbytheclient.ThisdiffersfromtheATAPScollectionthatdidnotallowoutcomemeasurestobereportedbeyondEpisodeStartandEnd.
• Individualitemscoresmaybereportedforallscalesandwilleventuallyberequiredoncethesystemhasbeenimplemented.Intheshortterm,acknowledgingthatreportingindividualitemscoresmaynotbepossibleforallproviders,reportingoverallscores/subscalesisallowed.Therefore:
o FortheK10+,providerscaneitherreportall14itemscoresorreporttheK10totalscoreaswellasitemscoresforthe4extraitemsintheK10+.
o FortheK5,providerscaneitherreportall5itemscoresorreporttheK5totalscore.
o FortheSDQ,providerscaneitherreportall42itemscoresorreporttheSDQsubscalescores.
• Detailsofalloutcomemeasures,includingscoringrules,areavailableonthePMHCMDSwebsite(https://docs.pmhc-mds.com/index.html).
=============================end========================================
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ATTACHMENTA:PRIMARYMENTALHEALTHCAREMINIMUMDATASET–DATAELEMENTSSUMMARYProviderOrganisation
• ProviderOrganisationKey• ProviderOrganisationName• ProviderOrganisationCode• ProviderOrganisationABN• ProviderOrganisationType• ProviderOrganisationState
Practitioner
• OrganisationPath• PractitionerKey• PractitionerCategory• ATSICulturalTrainingFlag• PractitionerYearofBirth• Gender• AboriginalandTorresStraitIslanderStatus• PractitionerActive
Client
• OrganisationPath• ClientKey• StatisticalLinkageKey• DateofBirth• EstimatedDateofBirthFlag• Gender• AboriginalandTorresStraitIslanderStatus• CountryofBirth• MainLanguageOtherThanEnglishSpokenatHome• ProficiencyinSpokenEnglish
Episode
• OrganisationPath• EpisodeKey• ClientKey• ClientConsenttoAnonymisedData• EpisodeStartDate• EpisodeEndDate
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• EpisodeCompletionStatus• EpisodeReferralDate• ReferrerProfession• ReferrerOrganisationType• SuicideReferralFlag• GPMentalHealthTreatmentPlanFlag• PrincipalFocusofTreatmentPlan• Homelessnessflag• AreaofUsualResidence,Postcode• LabourForceStatus• EmploymentParticipation• SourceofCashIncome• HealthCareCard• NDISParticipant• MaritalStatus• PrincipalDiagnosis• AdditionalDiagnosis• Medication-Antipsychotics(N05A)• Medication-Anxiolytics(N05B)• Medication-Hypnoticsandsedatives(N05C)• Medication-Antidepressants(N06A)• Medication-Psychostimulantsandnootropics(N06B)
ServiceContact
• OrganisationPath• ServiceContactKey• ClientKey• EpisodeKey• PractitionerKey• ServiceContactDate• ServiceContactType• ServiceContactPostcode• ServiceContactModality• ServiceContactParticipants• ServiceContactVenue• ServiceContactDuration• ServiceContactCopayment• ServiceContactClientParticipationIndicator• ServiceContactInterpretedUsed• ServiceContactFinal
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• ServiceContactNoShow
OutcomeCollectionOccasion(summarylist-separatefieldsforK10+,K5,SDQ)
• OrganisationPath• CollectionOccasionKey• EpisodeKey• CollectionOccasionMeasureName• CollectionOccasionMeasureDate• CollectionOccasionReason• CollectionOccasionItemScores(individualitemsortotalsandsubscalescores)
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ATTACHMENTB:DRAFTDEFINITIONSFORSERVICETYPE
ServiceType
Themaintypeofserviceprovidedintheservicecontact,asrepresentedbytheservicetypethataccountedformostprovidertime.
1 Assessment2 Structuredpsychologicalintervention3 Otherpsychologicalintervention4 Clinicalcarecoordination/liaison5 Clinicalnursingservices6 ChildoryouthspecificassistanceNEC7 SuicidepreventionspecificassistanceNEC8 CulturalspecificassistanceNEC
Notes:
Describesthemaintypeofservicedeliveredinthecontact,selectedfromadefinedlistofcategories.Wheremorethanservicetypewasprovidedselectthatwhichaccountedformostprovidertime.ServiceprovidersarerequiredtoreportonServiceTypeforallServiceContacts.
1 AssessmentDeterminationofaperson‘smentalhealthstatusandneedformentalhealthservices,madebyasuitablytrainedmentalhealthprofessional,basedonthecollectionandevaluationofdataobtainedthroughinterviewandobservation,ofaperson‘shistoryandpresentingproblem(s).Assessmentmayincludeconsultationwiththeperson‘sfamilyandconcludeswithformationofproblems/issues,documentationofapreliminarydiagnosis,andatreatmentplan.
2 StructuredpsychologicalinterventionThoseinterventionswhichincludeastructuredinteractionbetweenaclientandaserviceproviderusingarecognised,psychologicalmethod,forexample,cognitivebehaviouraltechniques,familytherapyorpsychoeducationcounselling.Thesearerecognised,structuredorpublishedtechniquesforthetreatmentofmentalill-health.Structuredpsychologicalinterventionsaredesignedtoalleviatepsychologicaldistressoremotionaldisturbance,changemaladaptivebehaviourandfostermentalhealth.Structuredpsychologicaltherapiescanbedeliveredoneitheranindividualorgroupbasis,typicallyinanofficeorcommunitysetting.Theymaybedeliveredbytrainedmentalhealthprofessionalsorotherindividualswithappropriatecompetenciesbutwhodonotmeettherequirementsforregistration,credentialingorrecognitionasamentalhealthprofessional.
StructuredPsychologicalTherapiesincludebutarenotlimitedto:
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• Psycho-education(includingmotivationalinterviewing)• Cognitive-behaviouraltherapies• Relaxationstrategies• Skillstraining• Interpersonaltherapy
3 OtherpsychologicalinterventionPsychologicalinterventionsthatdomeetcriteriaforstructuredpsychologicalintervention.
4 Clinicalcarecoordination/liaisonActivitiesfocusedonworkinginpartnershipandliaisonwithotherhealthcareandserviceprovidersandotherindividualstocoordinateandintegrateservicedeliverytotheclientwiththeaimofimprovingtheirclinicaloutcomes.Consultationandliaisonmayoccurwithprimaryhealthcareproviders,acutehealth,emergencyservices,rehabilitationandsupportservices,family,friends,othersupportpeopleandcarersandotheragenciesthathavesomelevelofresponsibilityfortheclient’streatmentand/orwellbeing.
5 ClinicalnursingservicesServicesdeliveredbymentalhealthnursesthatcannotbedescribedelsewhere.Typically,theseaimtoprovideclinicalsupporttoclientstoeffectivelymanagetheirsymptomsandavoidunnecessaryhospitalisation.Clinicalnursingservicesinclude:
• monitoringaclient’smentalstate;• liaisingcloselywithfamilyandcarersasappropriate;• administeringandmonitoringcompliancewithmedication;• providinginformationonphysicalhealthcare,asrequiredand,where
appropriate,assistinaddressingthephysicalhealthinequitiesofpeoplewithmentalillness;and
• improvinglinkstootherhealthprofessionals/clinicalserviceproviders.
6 Childoryouth-specificassistanceNECServicesdeliveredto,oronbehalf,ofachildoryoungpersonthatcannotbedescribedelsewhere.Thesecaninclude,forexample,workingwithachild’steachertoprovideadviceonassistingthechildintheireducationalenvironment;workingwithayoungperson’semployertoassisttheyoungpersontotheirworkenvironment.
Note:ThiscodeshouldonlybeusedforServiceContactsthatcannotbedescribedbyanyotherServiceType.ItisexpectedthatthemajorityofServiceContactsdeliveredtochildrenandyoungpeoplecanbeassignedtoothercategories.
7 SuicidepreventionspecificassistanceNECServicesdeliveredto,oronbehalf,ofaclientwhopresentswithriskofsuicidethatcannotbedescribedelsewhere.Thesecaninclude,forexample,workingwiththeperson’semployerstoadviseonchangesintheworkplace;workingwithayoungperson’steacherto
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assistthechildintheirschoolenvironment;orworkingwithrelevantcommunity-basedgroupstoassisttheclienttoparticipateintheiractivities.
Note:ThiscodeshouldonlybeusedforServiceContactsthatcannotbedescribedbyanyotherServiceType.ItisexpectedthatthemajorityofServiceContactsdeliveredtoclient’swhohaveariskofsuicidecanbeassignedtoothercategories.
8 CulturalspecificassistanceNECCulturallyappropriateservicesdeliveredto,oronbehalf,ofanAboriginalorTorresStraitIslanderclientthatcannotbedescribedelsewhere.Thesecaninclude,forexample,workingwiththeclient’scommunitysupportnetworkincludingfamilyandcarers,men’sandwomen’sgroups,traditionalhealers,interpretersandsocialandemotionalwellbeingcounsellors.
Note:ThiscodeshouldonlybeusedforServiceContactsthatcannotbedescribedbyanyotherServiceType.ItisexpectedthatmanyServiceContactsdeliveredtoAboriginalorTorresStraitIslanderclientscanbeassignedtoothercategories.
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ATTACHMENTC:DIAGNOSISLISTUSEDINPMHCMDSAnxietydisorders
101 Panicdisorder102 Agoraphobia103 Socialphobia104 Generalisedanxietydisorder105 Obsessive-compulsivedisorder106 Post-traumaticstressdisorder107 Acutestressdisorder108 Otheranxietydisorder
Affective(Mood)disorders
201 Majordepressivedisorder202 Dysthymia203 DepressivedisorderNOS204 Bipolardisorder205 Cyclothymicdisorder206 Otheraffectivedisorder
Substanceusedisorders
301 Alcoholharmfuluse302 Alcoholdependence303 Otherdrugharmfuluse304 Otherdrugdependence305 Othersubstanceusedisorder
Psychoticdisorder
401 Schizophrenia402 Schizoaffectivedisorder403 Briefpsychoticdisorder404 Otherpsychoticdisorder
Disorderswithonsetusuallyoccurringinchildhoodandadolescencenotlistedelsewhere
501 Separationanxietydisorder502 Attentiondeficithyperactivitydisorder(ADHD)503 Conductdisorder504 Oppositionaldefiantdisorder505 Pervasivedevelopmentaldisorder506 Otherdisorderofchildhoodandadolescence
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Othermentaldisorder
601 Adjustmentdisorder602 Eatingdisorder603 Somatoformdisorder604 Personalitydisorder605 Othermentaldisorder
Noformalmentaldisorderbutsubsyndromalproblem
901 Anxietysymptoms902 Depressivesymptoms903 Mixedanxietyanddepressivesymptoms904 Stressrelated905 Other