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KPIs for Australian Public Mental Health Services: PI 02 – 28 day mental health readmissions, 2018 (Service level)

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termMHS PI 02: Mental health readmissions to hospital, 2018 (Service level)
METeOR identifier:Help on this term633017
Registration status:Help on this termHealth, Standardisation pending 26/11/2020
Description:Help on this term

The percentage of in-scope overnight separations from the mental health service organisation’s acute psychiatric inpatient unit that are followed by readmission to the same or to another public sector acute psychiatric inpatient unit within 28 days of discharge.

NOTE: This indicator is related to Mental health readmissions to hospital (Jurisdictional level). There are no technical differences in the calculation methodologies between the Service level version and the Jurisdictional level version of this indicator.

Rationale:Help on this term

Readmissions to a psychiatric facility following a recent separation may indicate that inpatient treatment was incomplete or ineffective, or that follow-up care was inadequate to maintain the person’s treatment out of hospital. In this sense, rapid readmissions may point to deficiencies in the functioning of the overall care system.

Avoidable rapid readmissions place pressure on finite beds and may reduce access to care for other consumers in need.

International literature identifies one month as an appropriate defined time period for the measurement of unplanned readmissions following separation from an acute psychiatric inpatient service.

Indicator set:Help on this termKey Performance Indicators for Australian Public Mental Health Services (Service level version) (2018) Health, Standardisation pending 26/11/2020

Collection and usage attributes

Computation description:Help on this term

Coverage/Scope:

All public mental health service organisations acute psychiatric inpatient units.

The following readmissions are excluded when calculating the numerator:

  • same-day separations
  • separations where the length of stay is one night only and a procedure code for Electroconvulsive therapy (ECT) is recorded.

The following separations are excluded when calculating the denominator:

  • same-day separations
  • separations where the length of stay is one night only and a procedure code for Electroconvulsive therapy (ECT) is recorded.
  • statistical and change of care type separations
  • separations that end in death or left against medical advice/discharge at own risk
  • separations that end by transfer to another acute or psychiatric hospital.

Methodology:

  • Readmissions where the initial separation occurred within the reference period are in scope.
  • Readmission is considered to have occurred if the person is admitted to any public acute psychiatric inpatient unit within the state/territory. Consequently, a state-wide unique patient identifier is required for accurate construction of this indicator.
  • Readmissions where the person is separated and readmitted on the same day are included.
  • For the purpose of this indicator, when a mental health service organisation has more than one unit of a particular admitted patient care program, those units should be combined.
  • All acute admitted mental health service units are in scope for this indicator, including short-stay units and emergency acute mental health admitted units.
  • The categorisation of the admitted patient unit is based on the principal purpose(s) of the admitted patient care program rather than the care type of individual consumers.
  • The following ECT procedure codes are relevant for the excluded separations specified above:
    • ACHI 5th edition (2006–2008) uses ICD-10 procedure codes 93340-02 and 93340-03.
    • ACHI 6th to 9th editions (2008 to 2015) use ICD-10 procedure codes 93341-00 to 93341-99.
    • ACHI 10th (2015 to current) edition uses procedure codes 14224-0 to 14224-06.
    • ACHI 5th to 10th editions (2006 to current) Electroconvulsive therapy Block 1907 may be selected to capture all data regardless of code changes over time.
Computation:Help on this term

(Numerator ÷ Denominator) x 100

Numerator:Help on this term

Number of in-scope overnight separations from the mental health service organisation’s acute admitted patient mental health care service unit(s) occurring within the reference period, that are followed by a readmission to the same or another acute psychiatric inpatient unit within 28 days.

Denominator:Help on this term

Number of in-scope overnight separations from the mental health service organisation’s acute psychiatric inpatient unit(s) occurring within the reference period.

Disaggregation:Help on this term

Service variables: target population.

Consumer attributes: diagnosis, age, Socio-Economic Indexes for Areas (SEIFA), remoteness, Indigenous status, involuntary status.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termService event
Format:Help on this term

N[NN].N

Indicator conceptual framework

Framework and dimensions:Help on this termEffective

Continuous

Accountability attributes

Benchmark:Help on this term

Levels at which the indicator can be useful for benchmarking:

  • service unit
  • mental health service organisation
  • regional group of services
  • state/territory.
Further data development / collection required:Help on this term

This indicator cannot be accurately constructed using the Admitted Patient Care NMDS. While the data set comprehensively provides a collection of separations from Australian public hospitals; its inability to uniquely identify a patient across episodes and across hospitals limits its capacity to count readmissions.

There is no proxy solution available. In order to report this indicator at a national level, states and territories are required to individually provide separate indicator data.

A reliable system of patient identifiers within the Admitted Patient Care NMDS is required to enable unique identification of individual consumers across multiple years, multiple admitted episodes and multiple hospitals.

Other issues caveats:Help on this term

Due to data limitations this indicator cannot differentiate between planned and unplanned readmissions.

This indicator does not track readmissions across state and territory boundaries or track movement between public and private hospitals.

Source and reference attributes

Submitting organisation:Help on this term

Australian Institute of Health and Welfare on behalf of the National Mental Health Performance Subcommittee

Reference documents:Help on this term

National Mental Health Performance Subcommittee (NMHPSC) 2013. Key Performance Indicators for Australian Public Mental Health Services, 3rd edn. Canberra: NMHPSC.

Relational attributes

Related metadata references:Help on this term

Supersedes KPIs for Australian Public Mental Health Services: PI 02 – 28 day readmission rate, 2015– Health, Standard 19/11/2015

Has been superseded by KPIs for Australian Public Mental Health Services: PI 02 – Mental health readmissions to hospital, 2019 (Service level) Health, Standardisation pending 26/11/2020

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