Activity Based Funding Mental Health Care Data Set Specifications Independent Hospital Pricing Authority

Transcription

1 Independent Hospital Pricing Authority Activity Based Funding Mental Health Care Data Set Specifications Technical specifications for reporting

2 Activity Based Funding Mental Health Care Data Set Specifications Technical specifications for reporting requirements Copyright Statements: Internet sites Commonwealth of Australia 2015 This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from Independent Hospital Pricing Authority to do so.

3 Table of Contents Abbreviations Background Purpose and Scope of document Overview of the DSS structure Scope of the ABF MHC DSS Definition of in-scope public hospital services Definition of specialised mental health services Definition of a non-government organisation Key concepts underpinning the ABF MHC DSS Episode of care Service setting Admitted Ambulatory Residential Age group Unique identification of consumers Reporting unit of count Episode of care Mental health service contact Non-admitted patient service event Data items Clinical data Clinical data specific to children and adolescents Clinical data specific to adults Clinical data specific to older people Other clinical data common to all groups Principal and additional diagnosis First episode of mental health care Mental Health Intervention Classification (MHIC) Mental health phase of care Collection Protocol Reporting occasions Rating Period Cluster Specific Information... 24

4 8.1 Admitted Data Model Reporting of mental health phase Reporting of MHIC codes Ambulatory Data Model Episode of Care - Derived Reporting of mental health phase of care Reporting of MHIC codes Residential Data Model Reporting of mental health phase Reporting of MHIC codes Frequently Asked Questions Episode of care Mental health phase of care Mental Health Intervention Classification Setting... 32

5 Abbreviations ABF Activity Based Funding ABF MHC DSS ACHI ACS AIHW AMHCC APC NMDS CGAS CMHC NMDS FIHS HoNOS Activity based funding mental health care data set specifications Australian Classification of Health Interventions Australian Coding Standards Australian Institute of Health and Welfare Australian Mental Health Care Classification Admitted patient care national minimum data set Children s Global Assessment Scale Community mental health care national minimum data set Factors Influencing Health Status Health of the Nation Outcome Scale HoNOS 65+ Health of the Nation Outcome Scale 65+ HoNOSCA ICD-10 ICD-10-AM IHPA LSP-16 METeOR MH-CASC MHIC MHPI DRS MHPoC MHWG NHRA NMDS NOCC Health of the Nation Outcome Scale Child and Adolescent International Statistical Classification of Diseases and Health Related Problems, Tenth revision International Statistical Classification of Diseases and Health Related Problems, Tenth revision, Australian Modification Independent Hospital Pricing Authority Life Skills Profile (Abbreviated) Metadata Online Registry Mental Health Classification and Service Costs Mental Health Intervention Classification Mental health phase item data request specification Mental Health Phase of Care Mental Health Working Group National Health Reform Agreement National minimum data set National Outcomes and Casemix Collection

6 NAP DSS RMHC NMDS RUG-ADL UQ Non-admitted patient data set specification Residential mental health care national minimum data set Resource Utilisation Groups Activities of Daily Living University of Queensland

7 1. Background In December 2012, the Pricing Authority approved the development of a new mental health classification for mental health services in Australia for the purposes of activity based funding (ABF). The development of the Australian Mental Health Care Classification (AMHCC) will significantly improve the clinical meaningfulness of the classification of mental health services, which will improve cost predictiveness and strengthen the implementation of new models of care. There are a number of steps that need to be followed in designing the AMHCC such as defining the services provided, identifying cost drivers, conducting a patient level costing study, developing a classification system and associated infrastructure (for example, data set specifications and grouping software) and collecting ongoing activity and cost data. In 2012, the Independent Hospital Pricing Authority (IHPA) engaged the University of Queensland (UQ) to develop a definition of mental health care for ABF purposes and to define the cost drivers associated with these services. The UQ Final Report proposed the creation of a separate care type for mental health services, an associated draft definition for classification purposes and the identification of possible cost drivers. UQ proposed a care type definition which has been modified slightly, endorsed by IHPA s working and advisory groups and approved by the Pricing Authority on 31 May The care type definition approved by the Pricing Authority 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 function relating 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. Whilst not specifically stated, "assessment only" activities are considered in scope for the classification. In 2014, IHPA engaged a consortium to undertake a six month costing study in 25 hospitals across Australia including both public and private hospitals, and community mental health services. Data from the costing study is being used to build the first version of the new AMHCC. Further information on the AMHCC development project is contained within the AMHCC Project Plan, which is available on IHPA s website.

8 In order to support the development of the AMHCC, IHPA has developed the Activity Based Funding Mental Health Care Data Set Specification (ABF MHC DSS) for data collection in The intention of the ABF MHC DSS is to use existing data collections and definitions where feasible, being mindful of the single provision, multiple use data principle. The development of the ABF MHC DSS was undertaken during 2014 with extensive consultation through IHPA s working and advisory groups, the National Health Information Standards and Statistics Committee (NHISSC) and the Mental Health Information Strategy Standing Committee (MHISSC). The ABF MHC DSS, and all associated reference documents, will be reviewed on an annual basis with stakeholder engagement and consultation.

9 2. Purpose and Scope of document The purpose of this document is to outline the reporting requirements for the provision of data against the ABF MHC DSS by state and territory governments. This document provides details about the: content and key concepts included in the ABF MHC DSS business rules relating to the reporting of the data items frequently asked questions relating to the ABF MHC DSS. This document is based on information in existing technical specifications, handbooks, manuals and the Australian Institute of Health and Welfare s (AIHW) Metadata Online Registry (METeOR). The scope of this document is limited to the above and does not cover discussion or issues relating to the provision of data that is a result of, or can be resolved through, system management and design at a state and territory level. Similarly, this document does not address the analysis and interpretation of the data gathered through this data set specification. The reporting requirements outlined in this document represent a minimum requirement for ABF reporting purposes, and are not intended to limit the scope of data collections maintained by individual service agencies or state and territory government.

10 3. Overview of the DSS structure The ABF MHC DSS is comprised of three clusters: Admitted, Ambulatory and Residential. The Ambulatory cluster is further divided into specialised or non-specialised mental health services. The ABF MHC DSS has utilised existing data collections where possible, such as existing AIHW activity data collections, national minimum data sets (NMDS) and the Mental Health National Outcomes and Casemix Collection (NOCC). Whilst there are some similarities in concepts between the clusters, specific detail relating to the data to be collected is outlined further in the document. ABF MHC DSS Admitted Ambulatory Residential Specialised Non-specialised Each cluster collects activity, clinical and episode specific data at the patient level. Specific data that is collected in relation to these three components are dependent on the setting and age of the consumer. In the following chapters, the data items and key concepts contained with the ABF MHC DSS are discussed, followed by further discussion in relation to cluster specific information.

11 4. Scope of the ABF MHC DSS The purpose of the ABF MHC DSS is to collect information about consumers receiving mental health care, funded by the Commonwealth, state and territory government that is associated with Australian public hospitals. 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. The scope of the ABF MHC DSS is primarily mental health care provided by services that are in-scope public hospital services under the National Health Reform Agreement 2011 (NHRA). This includes care delivered by specialised mental health services, public hospitals, Local Hospital Networks and non-government organisations (NGO) managed or funded by state and territory health authorities. The scope of the ABF MHC DSS is broader than specialised mental health service and includes patient s receiving mental health care in non-specialised settings as well. The ABF MHC DSS has been created in the context of activity based funding, and as such its primary scope is related to those hospital services considered in-scope under the NHRA. However, as the Australian Mental Health Care Classification will have a scope that is broader than the NHRA, any mental health care services which are not in-scope public hospital services under the NHRA are encouraged to report their activity. 4.1 Definition of in-scope public hospital services In-scope public hospital services refer to the General List of In-Scope Public Hospital Services (General List) which, in accordance with Section 131(f) of the National Health Reform Act 2011 (the Act) and Clauses A9 A17 of the NHRA, defines public hospital services eligible for Commonwealth funding to be: all admitted programs, including hospital in the home programs; all emergency department services, and non-admitted services that meet the criteria for inclusion on the General List as published in the Pricing Framework. 4.2 Definition of specialised mental health services Specialised mental health services are those with a primary function to provide treatment or community health support targeted towards people with a mental disorder or psychiatric disability. These activities are delivered from a service or facility that is readily identifiable as both specialised and serving a mental health care function.

12 The concept of a specialised mental health service is not dependent on the inclusion of the service within the state or territory mental health budget. A service is not defined as a specialised mental health service solely because its clients include people affected by a mental illness or psychiatric disability. The definition excludes specialist drug and alcohol services for people with intellectual disabilities, except where they are established to assist people affected by a mental disorder who also have drug and alcohol related disorders or intellectual disability. These services can be a sub-unit of a hospital even where the hospital is not a specialised mental health establishment itself (e.g. designated psychiatric units and wards, outpatient clinics). Specialised mental health services include: public psychiatric hospitals and designated psychiatric units in general hospitals; community-based residential services, and ambulatory care mental health services. 4.3 Definition of a non-government organisation An NGO is a private organisation that receives Australian government and/or state or territory funding specifically for the provision of community health and related support and information services for people with a mental disorder or psychiatric disability, their carers or the broader community. These services can include accommodation, advocacy, community awareness, health promotion, counselling, independent living skills, psychosocial, recreation, residential, respite and self-help services.

13 5. Key concepts underpinning the ABF MHC DSS In the ABF MHC DSS, the underlying statistical unit of count is an episode of care. The type and number of items reported are dependent on the age group of the consumer, the service setting and, whether it was the commencement or completion of the consumer s episode of care. The key concepts contained within the ABF MHC DSS are: episode of care, service setting and age group. These are defined and discussed further below: 5.1 Episode of care For the purposes of the ABF MHC DSS, an episode of care is defined as a more or less continuous period of contact between a consumer and a health service organisation that occurs within the one service setting. Depending on the service setting and the health service organisation, there may be variations regarding what is a continuous period of contact. For example, an episode of care may vary slightly in definition between an admitted episode of care, an ambulatory psychiatric episode, and a residential episode of care. Three broad episode types are identified which are based on the Episode Service Setting Admitted, Ambulatory and Residential. Admitted episodes refers to the period of care provided to a consumer who is admitted for care to a specialised psychiatric inpatient service or to a general public hospital for the purposes of receiving mental health care (i.e. the consumer would have a mental health care type). The period of care is commenced when the consumer has an admission and ceases with a discharge. The admission and/or discharge may be formal or statistical. Ambulatory episodes refers to the care provided to consumers in a non-admitted setting which can be defined by exclusion i.e. the service does not take place in an admitted or residential setting. The service providing the care may be a specialised community-based ambulatory mental health service or it may be a non-specialised non-admitted public hospital service. The commencement of an ambulatory episode may be signalled by a new referral to community care or if the consumer has previously been treated by the ambulatory team; the start of an episode may be the recommencement of care for a specified purpose or goal. The episode of care may cease when the consumer s case has been closed by the mental health care team who are responsible for the development of the specialised mental health plan. Residential episodes refers to the period of care provided to a consumer who is admitted for care to a specialised community-based residential service. This period of care commences with a statistical admission, and ceases with a statistical discharge. Depending on the services that a consumer is engaged with, there may be more than one episode occurring at a time. An overlap in episodes will occur when an admitted episode of care occurs concurrently with an existing episode of care provided in the residential or ambulatory- specialised setting. It is recognised that this does not align with the current NOCC protocols, however is allowed under certain circumstances under existing NMDS.

14 5.2 Service setting In the ABF MHC DSS there are three different service settings: Admitted, Ambulatory and Residential. The service setting is defined by the service setting in which the consumer s episode of mental health care takes place. The different service settings are defined further below Admitted The Admitted setting includes consumers admitted for care. This may be a ward or designated psychiatric unit in a general hospital or a psychiatric hospital. All activity reported will have a mental health care type for the admitted patient episode, regardless of mental health specialisation status of the provider Ambulatory The Ambulatory setting includes specialised and non-specialised mental health care services delivered to consumer who are not admitted or reside in a residential mental health care facility. Specialised mental health services are defined in section 4.2, and may include activity which is currently reported under the Ambulatory care mental health service setting in the NOCC or the Community mental health care national minimum data set (CMHC NMDS). Non-specialised mental health services are those services provided to consumers which meet the definition of the mental health care type, however are not provided by specialised mental health services as defined in section Residential The Residential setting refers to care provided in residential units that are staffed on a 24- hour basis by health professionals with specialist mental health qualifications or training and established in a community setting which provides specialised treatment or care for people affected by a mental illness or psychiatric disability (psychogeriatric hostels and psychogeriatric nursing homes are included). 5.3 Age group The outcome measures associated with the ABF MHC DSS are dependent on the age group of the consumer, be that child and adolescent, adult or older person. Generally, adults are defined as persons between the age of 18 and 64 years inclusive, older persons are defined as persons aged 65 years and older, and children and adolescents are defined as persons under the age of 18 years. State and territory governments will be responsible for determining whether age group, and the associated clinical measures, is determined on the basis of the actual age, condition and care needs of the consumer or on the type of service providing the treatment and care, or a mixture of both.

15 5.4 Unique identification of consumers Unique identification of the consumer is an essential requirement in clinical information systems, both for ensuring that local information collections support continuity of care, as well as analysis at a state or territory and national level. State and territory governments vary in the extent to which different mental health service units share a unique identifier for consumers under care. However, where these are not in place, state and territory governments are taking steps to establish such arrangements. The unique patient identifier reported to the ABF MHC DSS should be in encrypted form and meet two fundamental requirements: The identifier should be identical to the identifier used in supplying unit record data in respect of the individual consumer in the corresponding NMDS/ DSS and NOCC dataset. The encrypted identifier used to supply data should be stable over time that is, it should allow the consumer s data to be linked across reporting years. 5.5 Reporting unit of count The underlying unit of activity is episode of care, however the individual reporting unit of count is dependent on the service setting. In the Admitted and Residential settings the reporting unit of count is an episode of care, however in the Ambulatory settings the reporting unit of count is either a mental health service contact or a non-admitted patient service event Episode of care The reporting unit of count for the Admitted and Residential cluster is an episode of care. An episode of care may commence with an admission to a facility or in the case of the residential setting it may be signalled by the start of a new reference period 1. The end of the episode occurs when a consumer is discharged from the facility, at the end of a reference period or for any other reason as stated in the relevant activity data set specifications Mental health service contact The reporting unit of count for the Ambulatory-specialised cluster is the mental health service contact. The mental health service contact is defined in the CMHC NMDS as the provision of a clinically significant service by a specialised mental health service provider(s) for consumers, other than those consumers admitted to psychiatric hospitals or designated psychiatric units in acute care hospitals, and those resident in 24 hour staffed specialised residential mental health services, where the nature of the service would normally warrant a dated entry in the clinical record of the consumer in question. 1 Refer to the data request specifications for the Residential mental health care national minimum data set for further information relating to reference period.

16 The mental health service contact may coincide with a NOCC collection occasion 2 for an admission or a discharge, and these contacts will contain the corresponding outcome measures. The episode of care is derived using these service contacts as the flag for an admission or discharge from an ambulatory service. There may be occasions where a service contact occurs outside of an active episode of care 3, or if the consumer has been admitted to an acute facility, or there may be multiple service contacts in one day. These service contacts should still be reported in accordance with the specifications for the CMHC NMDS Non-admitted patient service event The reporting unit of count for the Ambulatory- non-specialised cluster is the non-admitted patient service event. The non-admitted patient service event is defined in the NAP DSS as an interaction between one or more healthcare provider(s) with one non-admitted patient, which must contain therapeutic/clinical content and result in a dated entry in the patient's medical record. The non-admitted patient service event may coincide with a NOCC collection occasion for an admission or a discharge, and these service events will contain the corresponding outcome measures. The episode of care is derived using these service events as the flag for an admission or discharge from an ambulatory service. There may be occasions where a service event occurs outside of an episode of active care. These service events should still be reported in accordance with the specifications for the NAP DSS. 2 Refer to the Mental Health National Outcomes and Casemix Collection Technical Specifications V1.80 for further information relating to collection occasion. 3 Refer to the Mental Health National Outcomes and Casemix Collection Technical Specifications V1.80 for further information relating to active care.

17 6. Data items 6.1 Clinical data Clinical data specific to children and adolescents Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) The HoNOSCA is a 15 item clinician-rated measure modelled on the HoNOS and designed specifically for use in the assessment of child and adolescent consumer outcomes in mental health services. Ratings are made by clinicians based on their assessment of the consumer. In completing their ratings, the clinician makes use of a specific glossary which details the meaning of each point on the scale being rated. Key references: Gowers S, Harrington R, Whitton A, Lelliott P, Beevor A, Wing J, Jezzard R (1999a) Brief scale for measuring the outcomes of emotional and behavioural disorders in children: Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). British Journal of Psychiatry, 174, Gowers S, Harrington R, Whitton A, Beevor A, Lelliott P, Jezzard R, Wing J (1999b) Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): Glossary for HoNOSCA score sheet. British Journal of Psychiatry, 174, Children s Global Assessment Scale (CGAS) The CGAS was developed by Schaffer and colleagues at the Department of Psychiatry, Columbia University to provide a global measure of severity of disturbance in children and adolescents. Similar to the HoNOSCA, it is designed to reflect the lowest level of functioning for a child or adolescent during a specified period. The measure provides a single global rating only, on a scale of Key reference: Schaffer D, Gould MS, Brasic J, et al (1983) A children s global assessment scale (CGAS). Archives of General Psychiatry, 40, Factors Influencing Heath Status (FIHS) The FIHS measure is a checklist of seven psychosocial complications based on the problems and issues identified in the Factors Influencing Health Status chapter in International Statistical Classification of Diseases and Health Related Problems, Tenth revision (ICD-10). It is a simple checklist of the ICD factors which was originally developed for the Mental Health Classification and Service Costs (MH-CASC) project. Key Reference: Buckingham W, Burgess P, Solomon S, Pirkis J, Eagar K (1998) Developing a Casemix Classification for Mental Health Services. Volume 2: Resource Materials. Canberra: Commonwealth Department of Health and Family Services.

18 6.1.2 Clinical data specific to adults Health of the Nation Outcome Scales (HoNOS) The HoNOS is a 12 item clinician-rated measure designed by the Royal College of Psychiatrists specifically for use in the assessment of consumer outcomes in mental health services. Ratings are made by clinicians based on their assessment of the consumer. In completing their ratings, the clinician makes use of a glossary which details the meaning of each point on the scale being rated. Key references: Wing J, Beevor A, Curtis R, Park S, Hadden S, Burns A (1998) Health of the Nation Outcome Scales (HoNOS). Research and development. British Journal of Psychiatry, 172, Wing J, Curtis R, Beevor A (1999) Health of the Nation Outcome Scales (HoNOS): Glossary for HoNOS score sheet. British Journal of Psychiatry, 174, Abbreviated Life Skills Profile (LSP-16) The original LSP was developed by a team of clinical researchers in Sydney (Rosen et al 1989, Parker et al 1991) and, prior to the introduction of the NOCC collection, was in fairly wide use in Australia as well as several other countries. It was designed to be a brief, specific and jargon free scale to assess a consumer s abilities with respect to basic life skills. It is capable of being completed by family members and community housing members as well as professional staff. The original form of the LSP consists of 39 items. Work undertaken as part of the Australian MH-CASC study saw the 39 items reduced to 16 items by the original designers in consultation with the MH-CASC research team. This reduction in item number aimed to minimise the rating burden on clinicians when the measure is used in conjunction with the HoNOS. The abbreviated 16-item instrument is the version to be reported for the NOCC. Key references: Original 39 item version of the LSP: Rosen A, Hadzi-Pavlovic D, Parker G (1989) The Life Skills Profile: A measure assessing function and disability in schizophrenia. Schizophrenia Bulletin, 1989, Parker G, Rosen A, Emdur N, Hadzi-Pavlov D (1991) The Life Skills Profile: Psychometric properties of a measure assessing function and disability in schizophrenia. Acta Psychiatrica Scandinavica, Trauer T, Duckmanton RA, Chiu E (1995) The Life Skills Profile: A study of its psychometric properties. Australian and New Zealand Journal of Psychiatry, 29, Abbreviated 16 item version of the LSP-16: Buckingham W, Burgess P, Solomon S, Pirkis J, Eagar K (1998) Developing a Casemix Classification for Mental Health Services. Volume 2: Resource Materials. Canberra: Commonwealth Department of Health and Family Services.

19 6.1.3 Clinical data specific to older people Health of the Nation Outcome Scale 65+ (HoNOS 65+) The 65+ variant of the HoNOS has been designed for use with adults aged older than 65 years. It consists of the same item set and is scored in the same way, however the accompanying glossary has been modified to better reflect the problems and symptoms likely to be encountered when rating older persons. Key References: Burns A, Beevor A, Lelliott P, Wing J, Blakey A, Orrell M, Mulinga J, Hadden S (1999) Health of the Nation Outcome Scales for Elderly People (HoNOS 65+). British Journal of Psychiatry, 174, Burns A, Beevor A, Lelliott P, Wing J, Blakey A, Orrell M, Mulinga J, Hadden S (1999) Health of the Nation Outcome Scales for Elderly People (HoNOS 65+): Glossary for HoNOS 65+ score sheet. British Journal of Psychiatry, 174, Abbreviated Life Skills Profile (LSP-16) The original LSP was developed by a team of clinical researchers in Sydney (Rosen et al 1989, Parker et al 1991) and, prior to the introduction of the NOCC collection, was in fairly wide use in Australia as well as several other countries. It was designed to be a brief, specific and jargon free scale to assess a consumer s abilities with respect to basic life skills. It is capable of being completed by family members and community housing members as well as professional staff. The original form of the LSP consists of 39 items. Work undertaken as part of the Australian MH-CASC study saw the 39 items reduced to 16 items by the original designers in consultation with the MH-CASC research team. This reduction in item number aimed to minimise the rating burden on clinicians when the measure is used in conjunction with the HoNOS. The abbreviated 16-item instrument is the version to be reported for the NOCC. Key references: Original 39 item version of the LSP: Rosen A, Hadzi-Pavlovic D, Parker G (1989) The Life Skills Profile: A measure assessing function and disability in schizophrenia. Schizophrenia Bulletin, 1989, Parker G, Rosen A, Emdur N, Hadzi-Pavlov D (1991) The Life Skills Profile: Psychometric properties of a measure assessing function and disability in schizophrenia. Acta Psychiatrica Scandinavica, Trauer T, Duckmanton RA, Chiu E (1995) The Life Skills Profile: A study of its psychometric properties. Australian and New Zealand Journal of Psychiatry, 29, Abbreviated 16 item version of the LSP-16: Buckingham W, Burgess P, Solomon S, Pirkis J, Eagar K (1998) Developing a Casemix Classification for Mental Health Services. Volume 2: Resource Materials. Canberra: Commonwealth Department of Health and Family Services.

20 Resources Utilisation Groups Activities of Daily Living (RUG-ADL) Developed by Fries et al for the measurement of nursing dependency in skilled nursing facilities in the United States of America, the RUG-ADL measures ability with respect to late loss activities those activities that are likely to be lost last in life (e.g. eating, bed mobility, transferring and toileting). Early loss activities (such as managing finances, social relationships, grooming) are included in the LSP. The RUG-ADL is widely used in Australian nursing homes and other aged care residential settings. The RUG-ADL comprises four items only and is usually completed by nursing staff. Key reference: Fries BE, Schneider DP, et al (1994) Refining a casemix measure for nursing homes. Resource Utilisation Groups (RUG-III). Medical Care, 32, Other clinical data common to all groups Principal and additional diagnosis The principal diagnosis is the diagnosis established to be chiefly responsible for occasioning the consumer s episode of care or presentation at a health service. In the Admitted Patient Care National Minimum Data Set, principal diagnosis is determined in accordance with the Australian Coding Standards. Principal diagnosis is reported for an episode of care that occurs in the Admitted, Ambulatory- specialised and residential settings. Additional diagnosis identifies secondary or other diagnoses that affected the person s care during the period in terms of requiring therapeutic intervention, clinical evaluation, extended management or increased care or monitoring. Additional diagnosis is reported for an episode of care that occurs in the admitted or residential setting. In the admitted and residential settings, the principal and additional diagnoses are coded at the end of the episode in accordance with the Australian Coding Standards. In the ambulatory-specialised setting the principal diagnosis is coded at each service contact First episode of mental health care The first episode descriptor is used to identify an initial or recent presentation at a mental health service organisation. In the UQ Final report, it was suggested that there was evidence that showed that the first presentation of a consumer with psychosis is different from subsequent presentations both in terms of costs and outcomes, and has been supported as a cost driver in many studies 4. 4 For further information refer to University of Queensland (2013) Cost Drivers and a Recommended Framework for Mental Health Classification Development Independent Hospital Pricing Authority, Sydney.

21 During development of the ABF MHC DSS, it was determined that identifying the first episode of psychosis would be very difficult, however it would be possible to identify if the episode of care was the first, or if there was a recent episode of care at a health service organisation. As an alternative, the data item first episode of mental health care at a mental health care organisation was created. This was due to the possibility of identifying if the presenting episode was the first episode of mental health care at the organisation, or if the consumer had been treated within the preceding five years. In the ABF MHC DSS, the first episode descriptor is used to identify those episodes of care where the consumer has/ has never received care or treatment from a specific mental health service organisation. The information for this data item may be derived from a variety of means, such as information contained in electronic patient administration systems, consumer s medical notes or the consumer themselves Mental Health Intervention Classification (MHIC) The MHIC is a multi-axial intervention scheme that is designed to capture significant mental health interventions. Interventions that have been included in the classification are evidence based, highly valued by consumers, carers or clinicians, have the potential for high impact or risk, are evidence of significant variation in practice or are high cost. The classification is grouped into four broad categories of interventions: assessment and review therapeutic emergency service coordination Within each of these four categories, further subdivision occurs to provide a detailed list of selected mental health interventions Mental health phase of care Mental health phase of care (MHPoC) is a prospective description of the primary goal of care in the client s mental health treatment plan at the point in time when the data is being reported, and refers to the next stage in the consumer s care. MHPoC should be considered a subset of episode of care, meaning that for each episode there can be multiple MHPoC. MHPoC is independent of both the treatment setting and the designation of the treating service, and does not reflect service unit type. For example, an admitted episode of care does not always have to have an acute MHPoC.

22 There are five MHPoC which are described in the following table: Code descriptive term Acute Functional gain Intensive extended Consolidating gain (also known as maintenance) Code definition 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. The primary goal is to improve personal, social or occupational functioning or promote psychosocial adaptation in a consumer with impairment arising from a psychiatric disorder. The primary goal is prevention or minimisation of further deterioration, and reduction of risk of harm in a consumer 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. 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 consumer has stabilised and functions relatively independently. Initial assessment The primary goal is to obtain information, including collateral information where possible, in order to determine the intervention/treatment needs and to arrange for this to occur (includes brief history, risk assessment, referral to treating team or other service). Whilst it is recognised that there may be aspects of each MHPoC represented in the consumer s mental health plan, the MHPoC is intended to identify the main goal or aim that will underpin the next period of care. The MHPoC should be based on the goal of the consumer s mental health care plan, and as such should be agreed upon by the treating mental health team. This may mean that the MHPoC is recorded by a case manager, who may belong to any health professional discipline. However, there may be local business rules and guidelines which refer to how MHPoC is determined and who may report it.

23 7. Collection Protocol This manual outlines the minimum requirements for the ABF MHC DSS, and should not confine state and territory governments. The NOCC collection protocol contains assessment measures which are reported at admission, review and discharge collection occasions. In comparison, the ABF MHC DSS only requires the assessment measures to be reported in relation to an episode admission and discharge. In the NOCC collection protocol, the data requirements at discharge from ambulatory care are dependent on the reason for collection as based on two broad requirements: Whether the care of the consumer is transferred from the ambulatory service to an inpatient or residential service of the same Mental Health Service Organisation, or Whether the duration of the ambulatory episode of mental health care was brief, as defined as an episode of care 14 days or less in duration (i.e. the number of days from admission to and discharge from the NOCC Ambulatory episode). When these two types of discharge from an ambulatory episode occur, the outcome measures (HoNOS/CA/65+, LSP-16, FIHS and CGAS) are not required to be collected at discharge. In the case of those that are transferred from the ambulatory service to an inpatient or residential service, the outcome measures collected at the admission of the inpatient/ residential service should be applicable for those usually reported at the discharge of the ambulatory episode. For the purposes of the ABF MHC DSS the outcome measures are required at the admission and discharge of each episode of care, regardless of setting. If a unique identifier is available that facilitates episodes in different settings to be linked, and the admission into one episode is concurrent with the discharge from the initial episode then the outcome measures can be linked. However, if this is not possible, the outcome measures for both episodes of care are required to be reported.

24 7.1 Reporting occasions The following table shows when the assessment measures are collected and reported in the ABF MHC DSS. Service Setting Admitted Ambulatory Residential Assessment/ Item Admission Discharge Admission Discharge Admission Discharge Child and HoNOSCA Adolescent CGAS FIHS Adult HoNOS LSP-16 Older person First episode of Mental Health Care HoNOS 65+ LSP-16 RUG-ADL Further information on how the MHIC is reported is discussed in section 8 with regard to cluster specific information. 7.2 Rating Period The rating period for the outcome measures is the same as for the NOCC protocols. In summary they are: Outcome measure Usual rating period Exceptions HoNOS/ HoNOS 65+/ HoNOSCA Previous two weeks Discharge from admitted carebased on previous 72 hours including day of discharge. CGAS Previous two weeks No exceptions to rating period FIHS Period of care bound by No exceptions to rating period current collection occasion and the preceding collection occasion as per the NOCC specifications LSP-16 Previous three months No exceptions to rating period RUG-ADL Current status No exceptions to rating period The clinician may draw on direct observation and information from other individuals that have been in contact with the consumer during the rating period. This may include family, friends, carers and health professionals.

25 8. Cluster Specific Information 8.1 Admitted Figure: Data model underlying admitted cluster: Service Provider (for example): Australian State/Territory identifier Establishment organisation identifier (Australian) Establishment Local Hospital Network identifier Establishment region identifier Establishment region name Establishment sector Establishment service unit cluster identifier Establishment service unit cluster name Hospital hospital identifier Hospital hospital name, text Specialised mental health service organisation organisation identifier Specialised mental health service organisation organisation name Specialised mental health service admitted patient service unit identifier Specialised mental health service admitted patient service unit name Specialised mental health service ambulatory service unit identifier Specialised mental health service ambulatory service unit name Specialised mental health service residential service unit identifier Specialised mental health service residential service unit name Person (non-variable) (for example): Person identifier Service provider identifier Sex Date of birth Country of birth Indigenous status Episode of Admitted Mental Health Care Service provider identifier Person identifiers State Record Identifier Admitted Patient Care NMDS specific items Admitted Patient Mental Health Care NMDS specific items First episode of MHC at a MHSO Mental Health Phase linking key FIHS HoNOS HoNOS 65+ Mental health intervention Classification CGAS RUG-ADL HoNOSCA Mental Health Phase Item DRS Mental Health Phase Linking Key Mental Health Phase of care start date Mental Health Phase of care end date Mental Health Phase Type Mental health Phase leave days Data Model In the admitted cluster, each health service organisation can report records for multiple persons. Each person can potentially be associated with multiple episodes of care. Within each episode of care there are specific clinical assessment measures, and one or more MHIC codes representing the interventions that have been undertaken. Each episode of care will have one or more MHPoC; therefore each episode of care will also have one or more mental health phase linking keys. The mental health phase linking keys are associated with a mental health phase item data request specifications (MHPI DRS). The MHPI DRS contains the details of the phases of care that occurred during the episode of care such as start and end dates, the phase types and any leave days.

26 8.1.2 Reporting of mental health phase It is anticipated that there may be more than one MHPoC reported for each admitted episode of care. As a consumer s mental health plan is reviewed, and the main goal of care is changed, then the MHPoC should be reviewed and adjusted accordingly. As there is the possibility of multiple MHPoC during an episode, these are reported in a separate file, and are linked to the main ABF MHC DSS by using a mental health phase linking key. The multiple phases within an episode are associated with a linking key, which is reported in the ABF MHC DSS. Each MHPoC should have associated start and end dates, as well the number of any leave dates which were taken during the episode of care Reporting of MHIC codes Each episode of care should contain the associated MHIC codes which reflect the interventions that have been carried out. For the purposes of the ABF MHC DSS, each episode of care can have up to 100 MHIC codes reported. Each MHIC code should represent an intervention which has distinct clinical and/or therapeutic content and results in specific documentation in the consumer s medical record. The intervention must occur as a dedicated and discrete event. For example, routine observation of an admitted consumer and/ or assistance provided to them for daily activities such as showering, meals, taking medication etc. does not constitute a dedicated and discrete intervention. The intervention may occur as a one-on-one event between a clinician, an event with a group of clinicians and the consumer, or as an event as part of a group of consumers with one or more clinicians. If the consumer participates in an event (as described above) which can be described by or contains more than one intervention, the code which represents the most dominant assessment and/or therapeutic intervention provided during the event should be selected. An intervention does not necessarily need to occur with the direct participation of the consumer (i.e. case conferencing), however it must result in a distinct and specific documentation in the consumer s medical record. In the ABF MHC DSS each intervention should only be reported once.

27 8.2 Ambulatory Figure: Data model underlying ambulatory cluster Service Provider (for example) Australian State/Territory identifier Establishment organisation identifier (Australian) Establishment Local Hospital Network identifier Establishment region identifier Establishment region name Establishment sector Establishment service unit cluster identifier Establishment service unit cluster name Hospital hospital identifier Hospital hospital name, text Specialised mental health service organisation organisation identifier Specialised mental health service organisation organisation name Specialised mental health service admitted patient service unit identifier Specialised mental health service admitted patient service unit name Specialised mental health service ambulatory service unit identifier Specialised mental health service ambulatory service unit name Specialised mental health service residential service unit identifier Specialised mental health service residential service unit name Person (non-variable) (for example) Service provider identifier Person identifier Sex Date of birth Country of birth Indigenous status Episode of Community Mental Health Care (derived) Person Identifier Service provider identifiers State Record identifiers Service Contact in a NOCC Episode of Care Service provider identifier Person identifier State Record Identifier Community Mental Health NMDS specific items OR Non-Admitted Patient DSS specific items First episode of MHC at a MHSO Mental Health Phase linking key FIHS HoNOS HoNOS 65+ Mental Health Intervention Classification array CGAS HoNOSCA LSP-16 Mental Health Phase Item DRS Mental Health Phase Linking Key Mental Health Phase of care start date Mental Health Phase of care end date Mental Health Phase Type Data Model In the Ambulatory cluster, each health service organisation can report records for multiple persons, with each person potentially associated with multiple mental health service contacts or non-admitted patient service events. The mental health service contacts or non-admitted patient service events are used to derive the ambulatory episode of care. There may also be service contacts or events that occur outside of an associated episode of care and these should also be reported. The service contacts or events that are for the admission or discharge of an episode of care must contain the clinical assessment measures that are associated with the age group and collection occasion (admission or discharge), in addition to any interventions (MHIC codes) that were undertaken during the episode of care. The service contact or events may also contain a linking key for an associated MHPI DRS. The MHPI DRS contains the details of the phases of care that occurred during the episode of care such as start and end dates and the phase types.