Index <<

Utility

• Consumer and Carer Involvement
• The Clinician's Perspective
• The Service Provider Perspective
• The Planning Perspective

Consumer and Carer Involvement

The benefits of outcome measurement to the consumer are significant. Routine outcome measurement ratings can assist in the following areas:

• Assessment is holistic
  completing the HoNOS rating requires the clinician to take into account issues such as the consumer's relationships and accommodation.
• The Individual Service Plan is realistic
  increasing severity of symptoms or deterioration in 'life skills' may signal need for review.
• Review occurs regularly
  a missing HoNOS rating can be picked up on the Client Management Interface (CMI) and may signal that a review has not occurred.

Individual HoNOS scores will only be accessible by anyone who currently has access to the client file-that is, only those professionals who need to access the information for the purposes of treatment. The Department will only receive de-identified data downloaded from the agency's CMI.

Consumers may choose to complete a self-rating instrument such as the Mental Health Inventory (MHI), which can be compared with the clinician's score. This introduces another opportunity for consumers to participate in case planning and review.

In addition to the opportunity to be actively involved in the health status ratings, consumers will retain the capacity to provide comment upon the various aspects of the mental health service provided by completing the Consumer Satisfaction Questionnaire. The questionnaire information constitutes the second strand of consumer outcome information collected. Effective service provision implies that consumers are engaged effectively by the service and are satisfied with the service provided (at a number of levels including access, information, responsiveness and so on). These various components of user satisfaction are covered by the questionnaire and will be fed back to Mental Health Branch in aggregated form, where the service can be identified but not the consumer.

An 'Outcome Measurement Helpline' will be established to support the early implementation of outcome measurement by responding to queries from consumers, carers, raters and other stakeholders in relation to the implementation of the consumer outcome measures.

The Clinician's Perspective

The use of non diagnosis-specific tools means that an instrument's appeal to clinicians will be derived from its brevity and convenience.

If outcome measurement is to be integrated into routine clinical practice, it is imperative that ratings are made at moments which make sense from a clinical and consumer perspective. Natural points of transition during episodes of care are

It is proposed to add value to the health status assessment in two ways. In the first place the HoNOS rating will be enriched by the inclusion in the suite of other data types, ranging from the consumer's self-rating to service activity data. Secondly the introduction of RAPID's CMI will mean that all outcome measurement data generated by the service will be available for aggregation and analysis locally as soon as they are entered.

This will provide clinicians with instant access to outcome measurement data. Some strategies for using outcome measurement data in the clinical context are:

• Histograms
  HoNOS ratings on the client file or CMI provide a readily accessible summary of case severity as well as an overview of change over time.
  
  
• Second Opinion
  The clinician's assessment can be compared to the consumer's self-assessment or to ratings made by peers.
  
  
• Plan Caseload
  Team leaders can use aggregated HoNOS and LSP scores to compare severity, dependence levels or outcomes by team member, diagnostic group, and other parameters. Used in this way, the HoNOS/LSP combination may play a role in both caseload management and in the review of individual clinical performance.
  
  
• Flag Cases for Review
  Very high or very low scores on HoNOS items or groups of items can be used to 'flag' cases for monitoring or review (for example, in terms of safety, urgency, treatment options or discharge).
  
  
• Case Review
  HoNOS, LSP and consumer ratings can be used to inform case review. For example, the various consumer outcome measures can be used in conjunction with the Focus of Care rating in order to review clinical decision making.
  
  
• Monitor Impact of Transitions
  The HoNOS rating undertaken following referral to a different service or service element provides a way of monitoring and quantifying the impact of such transitions.
  
  
• Identify Training Needs
  Clinicians may use aggregated HoNOS scores of their clients to analyse their clinical effectiveness from a number of perspectives (for example, outcomes by client group) and to identify training needs.

The Service Provider Perspective

The Mental Health Branch will continue to work with service providers to minimise the need for additional data entry and to avoid all duplication. To this end, the Mental Health Outcomes Project is working in close collaboration with RAPID.

At the service level, clinical data, including outcome measurement data, will be entered into the CMI. This system is available for area mental health service providers to use as a local clinical management system while also providing an interface to other RAPID components.

For most data collected as part of the proposed suite, no additional 'measurement' effort is required. Instead, clinical data entered into the CMI as part of routine service provision will be analysed from the perspective of outcome measurement. There are some exceptions to this, namely the consumer outcome measures (which will require repeated ratings over time) and the measures which rely for data collection on the existing Quality Incentive and Satisfaction Questionnaire processes.

Data entry arrangements will be piloted in the first stage of implementation to ensure that the practical feasibility of introducing outcome measurement is addressed at the same time as its relevance from other perspectives. The training needs of data entry staff in relation to outcome measurement will be addressed as part of RAPID implementation training.

Possible use of outcome measurement data for service provider purposes includes:

Service Outcome Data
will allow an agency to review its own performance primarily in terms of throughput, outputs and linkages and to compare itself to other providers in terms of efficiency and responsiveness. The agency will have access to its own data and RAPID development is likely to include provision for access to statewide data for comparison.

Consumer Outcome Data
will allow an agency to review its own performance in terms of user satisfaction and service effectiveness. For example, agencies can use aggregated HoNOS and LSP scores to compare severity, dependence levels or outcomes by program, subcentre, campus, service type or other parameters (for example, length of stay).

Service responsiveness to the needs of client groups with special needs can be gauged to some extent through the responses to the satisfaction questionnaires and through quantitative data documenting utilisation levels.

Framework for the Analysis of Outcome Measurement Data
It is acknowledged that not all service providers may have access to sufficient expertise in statistical analysis to make optimal use of the complex array of data collected as part of routine outcome measurement. In order to assist agencies with the analysis of local outcome measurement data, consultants will develop a framework for combining and interrogating subsets of outcome measurement data. The focus will be upon developing practical products such as sample standard reports or query tools which will allow agencies to integrate outcome measurement data into routine clinical practice.

The Planning Perspective

Once outcome measurement is implemented, de-identified client data will be forwarded on a monthly basis from each provider's CMI to the statewide Health Data Warehouse. The Mental Health Branch will have access to outcome measurement data forwarded to the warehouse and will have the capacity to perform further analysis upon these data.

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