Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment

Abstract

BackgroundOutcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally.MethodsRetrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry.ResultsSubscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence.ConclusionsThe RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.

Examining Non-Suicidal Self-Injury among Adolescents with Mental Health Needs, in Ontario, Canada

“…The RAI-MH is a standardized and comprehensive instrument administered to all inpatients admitted into adult mental health facilities in Ontario, Canada and consists of items and definitions that serve as a guide in designing clinical assessment with many of the items serving as specific triggers for care planning (Hirdes, Perez, CurtinTelegdi et al, 2005;Perlman, Hirdes, Barbaree et al, 2013). Participating facilities were determined by the Ministry of Health and Long Term Care (MOHLTC), Ontario and include approximately 4,500 mental health beds in general, provincial psychiatric, and specialty psychiatric facilities.…”

“…Participating facilities were determined by the Ministry of Health and Long Term Care (MOHLTC), Ontario and include approximately 4,500 mental health beds in general, provincial psychiatric, and specialty psychiatric facilities. The instrument takes about an hour to complete and is completed by trained clinical hospital staff by interviewing the patient, family, and friends, as well as using information from clinical chart notes and clinical observation (for a detailed description of the RAI-MH see Hirdes, Perez, Curtin-Telegdi et al, 2005;Perlman, Hirdes, Barbaree et al, 2013).…”

Indicadores qualitativos de satisfação em saúde mental

“…Os indicadores de resultados fornecem informações sobre a eficácia dos serviços de saúde, porém, apenas poucos estudos têm construído e utilizado indicadores de resultado para comparar e melhorar a qualidade entre esses serviços (PERLMAN ET AL., 2013).…”

Key performance indicators for mental health and substance use disorders: a literature review and discussion paper

“…One such example of this is the Resident Assessment Instrument for Mental Health (interRAI MH), which is an assessment system providing information on care planning, case-mix and outcomes, that has been used to derive mental health quality indicators (Perlman et al, 2013). Establishing a collaborative process is integral in the development of KPIs as MESUD academics, clinicians, consumers and decisionmakers will differ in their opinion of what KPIs are of most importance (Waraich et -11 -al., 2010).…”

“…Furthermore, differentiation of event-driven and paneldriven process indicators is important in order to glean corresponding information related to specific care events and management of a patient within the system. Continuing research into improvements in risk adjustment for process indicators, such as restraint use in mental health services, is adding to their robustness as KPIs (Perlman et al, 2013).…”