Mental Health and Addictions System Performance in Ontario
Mental Health and Addictions System Performance in Ontario Improving Quality of Care for Mental Health Patients through Funding Methodologies Using Health Administrative Data and Methods to Measure Performance and Costs Paul Kurdyak MD PhD
CAMH/ICES 3 4 5 Achieving a High Performing Mental Health & Addictions System for Ontario
Draft vision: A high performing mental health and addictions system that is appropriately resourced and accountable to the public ensures that services and supports are provided in a safe, effective, client-centred, timely, efficient and equitable manner. 6 Data Initiatives Underway in the Mental Health and Addictions Sector MHA Council
Data Strategy Mental Health and Addictions Quality Initiative (MHAQI) Considerations: Documentation burden Duplication &
redundancy Data infrastructure needs Impact of primary care reform E-Health 2.0 Ensuring Alignment DTFP Projects?
MCYS? Excellence through Quality Improvement Project (E-QIP) Health Quality Ontario Task Group Recommendations
The Performance Indicators for the Mental Health & Addictions System in Ontario scorecard be used to measure the outcomes of Ontarios Mental Health & Addictions System That all of the scorecard indicators be standardized across all parts of the Mental Health & Addictions System, including hospitals and community-based mental health and addictions organizations That common data tools that yield high quality, comparable data be standardized across all hospitals and community-based mental health and addictions organizations. We believe that the data sources identified in the scorecard are currently the most effective in yielding high quality, comparable data That a standardized definition of wait-times be established that can capture high quality,
comparable data consistently across multiple data sources such as OCAN, DATIS and ConnexOntario, as currently different definitions are being used by all three sources 8 Performance Indicators for the Mental Health & Addictions System in Ontario 9 Key Messages
High quality data is the foundation for developing service standards, best practices, benchmarks and system-level performance improvement opportunities Consistent, comparable data is needed to inform policy, system planning, investments and quality improvement The mental health and addiction sector is falling precipitously behind in its ability to measure and improve Due to the lack of centralized data oversight and governance, there is a proliferation of data collection and little meaningful information Significant improvements can be made to our data and
performance measurement capabilities in a short time frame What We Could Not Do with the MH&A Scorecard Understand the value of investments made in the system Compare the care and services received by different populations and in different regions Answer basic but important questions that include: What is the real time capacity and utilization for mental health and addictions services, both in hospital and in the community?
What are the wait times for clients? Where are clients living while accessing mental health and addictions services? Who is using services, when and which services, and for how long? How are clients transitioning from the youth system to the adult system? How are people transitioning from the hospital to community and vice versa? What combination of services are clients using? What are the outcomes of the services and how are the services impacting on clients? Which combination of services are most effective for clients? A Strategy Emerges:
Because a Scorecard is Not Enough A clear need for: Singular oversight for data and performance measurement A unique client identifier Data standards Ability to link data across the client journey Enabling and empowering community agencies to collect, report and use data When Comparing
Performance Important to compare apples to apples Examples: 30-day Readmission variation by volume 30-day Readmission by diagnosis 13 30-day Readmission by Volume
14 30-day Readmission by Diagnosis Mental Health High Cost Patients1 MH High Cost Patients account for 5% of all High Cost Patients and 7% of the total health care expenditure of high cost patients Avg per capita cost for MH High Cost Patient is $32K
(vs. $24K for non-MH High Cost Patient) Median age is 46 years (vs. 64 years for non-MH High Cost Patient) 1 DeOliveira et al., 2016; Health Affairs, 35(1):36-43 16 Mental Health High Cost Patients1
1 DeOliveira et al., 2016; Health Affairs, 35(1):36-43 17 SCZ Health Care Costs Across the Lifespan 18
Types of Costs by Age1 12000 10000 8000 16-25 26-45 46-65
65+ 6000 4000 2000 0 Medical Hospiatlizations Psych Hospitalizations
1 ED Visits Physician Services DeOliveira et al., 2016; J Ment Hlth Policy Econ; 19:181-92 LTC Summary
At system level, we have developed reasonable capacity to measure performance (including health care costs) in the past 5 years There are significant data gaps that prevent more accurate and comprehensive description of system and patient experience When reporting, VERY important to risk adjust Our early efforts to measure costs within patient populations have unearthed complex interactions with significant policy implications 20
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