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Mental Health Readmission % - 28 Day Acute Inpatient Readmission Rate

Basic Facts

Stage of development

Implemented

Potential or current usage

This measure can be used to identify potential ineffective or inefficient inpatient mental health services.

Brief overview of the measure

General description

A concise statement summarising specific aspects addressed by the measure including: • Broad subject area addressed: e.g. Diabetes management • Specific aspect of care, service or process support addressed: e.g. Identification of Microalbuminuria • Population of interest: e.g. Registered patients with diabetes • Setting: e.g. Primary care • Level of focus/unit of analysis: e.g. Practice

Rationale for selection

Inpatient mental health services aim to provide treatment that enables individuals to return to the community as soon as possible. Unplanned readmissions to a psychiatric facility following a recent discharge may indicate that inpatient treatment was either incomplete or ineffective, or that follow-up care was inadequate to maintain the person out of hospital. In this sense a high rate of readmissions potentially point to deficiencies in the functioning of the overall care system.

Type of measure

Outcomes

Domain(s) of quality

Effectiveness

Application and interpretation of the measure

Stated intent of the measure

To measure mental health readmission rates as a marker for deficiencies in the system.

Caveats - Considerations

Unable to distinguish between planned and unplanned readmissions in any national collection. If planned vs. unplanned readmission is seen as critical, then such data would need to be collected and it has validity only if the data is collected at the point of discharge rather than retrospectively constructing it at the point of readmission.

Level of health care delivery/setting

Secondary care.

Target population

This indicator is inclusive of all age ranges, ethnicities and genders.

Stratification by vulnerable populations

Stratification by ethnicity or socioeconomic status is useful.

Possible sources of bias or confounding

Includes practitioner, organisational and patient factors e.g. demography, case mix, compliance that need to be allowed for when interpreting results.

Calculation of the measure

Output of calculation

Percentage of overnight referral closures from the organisation’s acute inpatient unit that result in readmission to an acute inpatient unit within 28 days of discharge.

Numerator description

Total number of in-scope overnight referral closures (discharges) by the participant’s acute mental health and addiction services inpatient unit(s) during the reference period that are followed by a readmission within 28 days to the organisation’s acute mental health and addiction services inpatient unit(s)

Numerator exclusions

Broadly, the general rule is that you should include all referral closures from all the in scope acute mental health and addiction services units within your organisation that occurred in the reference period. They must also qualify for PRIMHD submission. Except where: • Same day discharges occur. For PRIMHD this is qualified as the referral incurred no overnight stays. The reasons for this are described below. • The PRIMHD referral closure does not meet the criteria outlined below.

Denominator description

Total number of in-scope overnight referral closures (discharges) by the participant’s acute mental health and addiction services inpatient unit(s) during the reference period.

Denominator exclusions

None

Time period

28 days

Criteria/standard for optimal performance

Patients should be readmitted within 28 days.

Data source

PRIMHD

Method of extraction

Note all data items are to be split by Ethnicity into Māori, Pacific and Other. See section 4.5 for the approach to ethnicity reporting. Total in-scope overnight referral closures Enter the total number of discharges as defined in the rules above. Total out-of-scope overnight referral closures Enter the number of overnight referral closures that are defined as out-of-scope by the rules above. Total same day referral closures Enter the total number of same day referral closures. Total out-of-scope overnight referral closures by type Enter the total number of out-of-scope overnight referral closures for each of the out-ofscope discharge types, e.g. death This supplementary information is collected for two purposes: • It allows benchmarking participants to review and compare the number of discharges that are being excluded from the analysis of 28-day readmission rates. The number of out-of-scope overnight discharges is carried forward to two related KPIs (8 and 19), to allow calculation of indicators based on all overnight discharges. Total overnight referral closures readmitted to this organisation’s acute psychiatric inpatient unit within 28 days of discharge Enter the number of in-scope discharges that are readmitted to an acute mental health and addiction service unit within 28 days of discharge. For counting purposes, 28 days is defined as (referral closure date) – (readmission date) ≤ 28 days. Total overnight referral closures readmitted to any organisation’s acute psychiatric inpatient unit within 28 days of referral closures Enter the number of in-scope discharges that are readmitted to an acute mental health and addiction services unit at any organisation within 28 days of discharge. For counting purposes, 28 days is defined as (referral closure date) – (readmission date) ≤ 28 days. This number may be difficult to collect. Submission is optional.

Key issues and challenges for data management

An individual service user may be counted more than once in the 28-day readmission indicator. This indicator is simple in concept: to track all referral closures from the participant’s acute inpatient units and count the number that led to readmission within 28 days. The complexity is in determining: • What closures should be counted, given that there are many different circumstances in which a person may be discharged from an acute mental health and addiction services unit and only some of these are meaningful for the 28-day readmission concept. What admissions should be counted as a readmission? Guidelines on each of these are given below.

Appraisal of the measure

Availability of evidence to support application of the measure

The measure has been developed or endorsed by an organization that promotes rigorous development and use of clinical performance measures (at an international, national, regional or local level).

Evidence of feasibility and reliability of implementation

Reliability - The measure has been demonstrated to be reliable (i.e. free from random error)., Interpretation - The measure allows unambiguous interpretation of better or worse performance., Data extraction - Data collection specifications for the measure are well defined., Data sources - Required data elements for the measure can be obtained from existing data sources., Availability of data - Required data elements for the measure can be gathered during routine practice activities, IT software - Existing IT software is sufficient for data collection., Validity - The measure has been demonstrated to be valid (i.e. it measures what it purports to).

Other items

Owner details

Reference number

884

Date of entry to library

2012-05-31 14:36:23

Owner (Organisation name)

Health Quality and Safety Commission, Indicators project team

Owner (Email contact)

richard.hamblin@hqsc.govt.nz

Creator (Organisation name)

Health Quality and Safety Commission, Indicators project team

Creator (Email contact)

richard.hamblin@hqsc.govt.nz