How integrated clinical data can drive continuous quality improvement in youth mental health services.
The 2014 Report of the National Review of Mental Health Programmes and Services by the National Mental Health Commission (NMHC) revealed fundamental shortcomings for mental health services across the lifespan.
Numerous other reports over the past 25 years have concluded that the quality of mental health care nationally and internationally is poor. Service quality is an overarching concept that includes eight interrelated and internationally adopted domains including:
- clinical safety (eg, how suicide risk is assessed and mitigated at service entry);
- accessibility and equity (eg, ease of access for high risk sub-populations);
- effectiveness and outcomes (eg, proportion of users who return to work or education);
- acceptability and satisfaction;
- efficiency, expenditure and cost;
- appropriateness (eg, matching service provision to clinical stage, which is an adjunct to mental health diagnosis that incorporates illness severity and risk of progression to facilitate appropriate treatment matching);
- continuity and coordination (eg, successful transitions from primary to secondary care); and
- workforce competence and capability (eg, assignment of skilled staff to specific interventions)
In recent years, there have been concerted attempts to collect and report consumer outcomes in Australian public sector mental health services. The National Mental Health Performance Framework outlines clinical data capture across nine domains including effectiveness, efficiency, appropriateness, access, continuity,
responsiveness, capability, safety and sustainability.
At present, there are major gaps in the data available (highlighted in an independent evaluation by headspace, Australia’s Youth Mental Health Foundation); 13 of the 24 identified National Mental Health Performance Framework data indicators remain undefined and require further development.
More recently, Primary Health Networks have been charged with commissioning regionally appropriate, community-based mental health services and have reported substantial challenges in accessing clinical data to assist them to fulfil their responsibilities.
These challenges arise in part from limitations associated with electronic medical record and minimum dataset systems, which are typically divorced from the clinical data generated at the consumer-health professional level.
Instead they rely heavily on measures of health system activity (in the case of minimum datasets) or have limited data extraction capability (in the case of electronic medical records). Neither are suitable for enabling continuous and real-time quality improvements in health care.
The mental health system trails behind the general health system in collecting and analysing standard health information for use at an individual treatment planning level and subsequently as aggregated data for quality monitoring at the service level.
Our approach has been to propose that co- designed, real-time and integrated health information technologies collecting and processing clinical data may prove to be the most powerful enabler of mental health services reform.
Through Phase 2 of Project Synergy, an online platform is now being further developed and trialled within face-to-face and online mental health services, with a focus on enabling quality improvements in service delivery.
The further development of the online platform has been guided by three health system re-design principles outlined in two United States Institute of Medicine service quality reports.
These principles are:
- care should be data-driven by utilising health information technologies to make the best scientific and clinical information available at the point of use (ie, real-time);
- care should be person-centred in that it respects the diversity of individuals and puts consumers in control of their own health; and
- care at the consumer level should also be service-minded, whereby broader coordination, integration and efficiency are key considerations.
Importantly, our online platform aligns with the National Mental Health Performance Framework and Institute of Medicine service quality domains and captures associated performance indicators in real time.
From a clinical data perspective, any consumer using the online platform is considered to be the foundational level, and their clinical data are obtained, with consent, at the time of collection, shared with their health professional(s), then integrated at the service level (eg, headspace) and potentially more broadly at the regional (e.g. lead agency, Primary Health Network) or national (e.g. government) level.
This integrated approach to service quality monitoring uses the rich quantitative and transactional data obtained from users interacting with the online platform.
For example, the online platform supports routine outcome monitoring at the consumer–health professional level (ie, both the consumer and their health professional can track and monitor clinical outcomes and change treatment as needed) to improve treatment outcomes.
This same clinical data is then de-identified and collated with many others at the local, regional and national levels to allow analysis of between-service and between-region variation.
There is also evidence that such information can guide evidence-based practice, performance management, accountability, clinical safety monitoring and resource allocation, as well as overall quality improvement.
Indeed, high quality health services tend to employ management practices that focus on quality and use service metrics to set quality targets.
To find out more, download our supplement ‘Potential of real-time and integrated clinical data to drive continuous quality improvement in youth mental health services‘ from the peer-reviewed Medical Journal of Australia.