Implementing and Evaluating Outcome Indicators of Performance for Mental Health Agencies

Abstract

Regulation-based processes for evaluating the performance of mental health agencies are gradually changing to focus on measuring the effectiveness of mental health services in obtaining the best possible outcomes. The decreased availability of resources for serving people with mental health problems has led to an emphasis on effectiveness, which is often expressed in terms of accountability. Thus, a singular reliance on compliance with practice standards has shifted to the need to be able to demonstrate that funds appropriated for mental health services are being used in ways that result in valued outcomes. In Colorado, this shift has led to the development of performance indicators that provide information reflecting stakeholder values about the performance outcomes of the mental health system. This article describes these performance indicators and presents the data that led to a decision to award monetary incentives to two community agencies. Potential benefits and pitfalls of Colorado's performance indicator process are also discussed.

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

“…In addition to constructing outcome indicators, clinical data are needed for appropriate case mix adjustment [14,15,21-24]. When patient characteristics are strongly related to an outcome of interest and are unequally distributed among providers, comparisons of outcomes may favor providers who have a favorable case mix (i.e., a high number of patients who have “less severe” conditions or illness).…”

Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review

“…The included studies were classified according to the World Bank Country and Lending Groups 37 at the time of their publication. They were predominantly from high income countries (n = 23) of which 15 were Europe centric, 38 - 52 three each from the United States 53 - 55 and Canada 56 - 58 and one each from Australia 59 and New Zealand. 60 The few papers from upper-middle (n = 1) 61 or low- and middle-income countries (n = 4), were set in Asia and Africa including China, Nepal, Kenya and India.…”

“… 38 , 45 , 47 , 64 Half of the included papers were published in last six years from 2015 (n = 14), 38 - 40 , 42 , 45 , 49 - 52 , 54 , 56 , 62 , 63 , 65 with the oldest included paper published in 1998. 53 All themes described below form the results from the analysis.…”

“… 42 , 46 , 49 , 50 , 54 , 55 , 57 - 60 , 62 , 63 , 65 All those that did not explicitly use a literature review as part of their indicator selection process, relied heavily on adapting an existing framework into the relevant context (n = 10). 40 , 41 , 44 , 45 , 47 , 51 , 53 , 56 , 61 , 64 …”

The New Hampshire financing policy.

“…This process creates an incentive for programs to do "just enough" to be in compliance with practice standards, but no more. Furthermore, minimum standards are often little more than "professional guesses" about what constitutes effective mental health practice and are "not necessarily supported by research" (Barrett, Bartsch, Zahniser & Belanger, 1998).…”