Developing a tool for collecting and costing activity data on psychiatric inpatient wards

Abstract

Background.Increasing therapeutic inpatient activities may improve the quality and outcomes of care. Evaluation of these interventions is necessary including assessment of cost-effectiveness. The aim of this paper is to describe the development and reliability of a tool to collect information on care contacts and therapeutic activities of patients on inpatient wards.Method.The development of the tool consisted of: 1) literature review, 2) interviews with staff, 3) expert consultation, 4) feasibility study, 5) focus groups with staff members, and 6) reliability tests. Service use data were collected with the tool and costs calculated.Results.Service users' reported more use of activities than that contained in case notes during a 7-day period. This resulted in a cost difference of £10 per person. Case notes had more one-to-one nursing contacts, with a cost difference of £4 per person. One-day data showed less nurse contact time reported by participants compared to observational data (p < 0.001) but similar use of activities. Costs were £46 for the tool and £67 for the observational data.Conclusions.This tool is a good source of information on the number of activities attended by service users and contacts with psychiatrists. There is some disagreement with other sources of information on interactions between service users and nurses, possibly reflecting different definitions of a ‘meaningful contact’. This does not have a major impact on cost given that for much of the care received there is reasonable agreement.

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

“…We used data compiled by Curtis 58 to cost these service contacts, assuming that each had an average duration of 30 minutes unless information from a comparable study was available to suggest otherwise. 85 Service use and costs were compared between baseline and follow-up. We compared baseline and follow-up cost of contacts and estimated the statistical significance of the change in the total over time using a non-parametric bootstrap approach with appropriate correction for clustered data.…”

“…Voted in last general election (n = 736) 144 (20) Has a bank/PO account (n = 735) 623 (85) Has charge of own finances (n = 736) 534 (73) Standardised outcome measures, mean (SD) GAF score (possible range 1-100) (n = 739) 54 (9) PO, post office. a Of whom 423 reported that they had been living with other inpatients, having been living in a hospital ward prior to current admission.…”

“…When possible, information from a study on inpatient care in the UK was used to estimate the mean duration of service use. 85 Otherwise, it was assumed that contacts lasted for 30 minutes on average. Average group size was also estimated from this same study, which investigated service use in inpatient psychiatric wards, 85 and unit costs for individual attendees at group sessions were divided by five.…”

Predicting psychiatric inpatient costs

“…(3) Functioning: global assessment of functioning (GAF) [ 2 ] scores were obtained for each service user. In addition, in order to explore the impact of service users’ perceptions on service use, a measure of their perceptions of the quality of acute inpatient care (VOICE) [ 3 ] was included. This 19-item self-report measure was developed using participatory methodology as part of the PERCEIVE programme.…”

Investigating the relationship between costs and outcomes for English mental health providers: a bi-variate multi-level regression analysis

“…We also dropped observations with inpatient days in the 99th percentile for clusters 1 (Common mental health problems, low severity) and 2 (Common mental health problems) (n=833). Admission thresholds have increased[28][29][30] to the extent that patients are being admitted under the Mental Health Act (MHA) in order to access inpatient treatment[31]. Therefore, we would not expect patients in clusters 1 and 2 to receive long periods of inpatient treatment due to demand pressures on inpatient beds.HoNOS is routinely collected as part of the MHMDS, both as part of the MHCT and as an outcome measure.…”