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Mental health readmissions to hospital, 2018

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termMental health readmissions to hospital, 2018
METeOR identifier:Help on this term692976
Registration status:Help on this termHealth, Candidate 09/08/2018
Description:Help on this term

The percentage of in-scope overnight separations from state/territory acute admitted patient mental health care service unit(s) that are followed by readmission to the same or to another public sector acute admitted patient mental health care service unit within 28 days of separation.

NOTE: This specification has been adapted from the indicator Mental health readmissions to hospital, 2018– (Service level) using terminology consistent with the National Health Data Dictionary. 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 an acute admitted patient mental health care service unit following a recent discharge 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 admitted patient mental health care service unit.

Indicator set:Help on this termKey Performance Indicators for Australian Public Mental Health Services (Jurisdictional level version) (2018) Health, Candidate 09/08/2018

Collection and usage attributes

Computation description:Help on this term

Coverage/Scope:

State/territory public acute admitted patient mental health care service 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:

  • Reference period for 2018 performance reporting: 2016–17. 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 admitted patient mental health care service 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.
  • The categorisation of the admitted patient mental health care service unit is based on the principal purpose(s) of the admitted patient care program rather than the care type of the individual consumers.
  • The following Australian Classification of Health Interventions (ACHI) ECT procedure codes are relevant for the excluded separations specified above:
    • ACHI 5th edition use procedure codes 93340-02 and 93340-03.
    • ACHI 6th to 9th editions use procedure codes 93341-00 to 93341-99.
    • ACHI 10th edition use procedure codes 14224-00 to 14224-06.
    • ACHI 5th to 10th editions ECT Block 1907 may be selected to capture all data regardless of code changes over time.
  • No distinction is made between planned and unplanned readmissions.
Computation:Help on this term

(Numerator ÷ Denominator) x 100

Numerator:Help on this term

Number of readmissions to a state/territory public acute admitted patient mental health care service unit(s) occurring within the reference period.

Numerator data elements:Help on this term
Data Element / Data SetData Element

Number of readmissions to a public acute admitted patient mental health care service unit within 28 days

Data Source

State/territory admitted patient data


Guide for use

Determining whether there was a readmission for in-scope separations for the numerator requires data for the 28 days of the next financial year to be included in determining whether a readmission has occurred.


Denominator:Help on this term

Number of in-scope overnight separations from state/territory acute admitted patient mental health care service unit(s) occurring within the reference period.

Denominator data elements:Help on this term
Data Element / Data SetData Element

Number of separations from public acute admitted patient mental health care service unit(s)

Data Source

State/territory admitted patient data


Guide for use

In-scope separations for the denominator are identified prior to determining whether a readmission has occurred. The total number of in-scope separations is expected to comprise separations for the full 12 months of the data set year.


Disaggregation:Help on this term

Consumer attributes: age, sex, Socio-Economic Indexes for Areas (SEIFA), remoteness, Indigenous status. Disaggregated data excludes missing or not reported data.

All disaggregated data are to be calculated as at the admission for the first index separation, even if the value is null. The index separation refers to the separation data point included in the denominator data set. The data at admission for the index separation should be used for the associated numerator data pair, when present, and any subsequent denominator and data pairs for a uniquely identifiable person.

Disaggregation data elements:Help on this term
Data Element / Data SetData Element

Person—age

Data Source

State/territory admitted patient data


Guide for use

Data source type: Administrative by-product data


Data Element / Data SetData Element

Person—sex

Data Source

State/territory admitted patient data


Guide for use

Data source type: Administrative by-product data


Data Element / Data SetData Element

Person—area of usual residence

Data source

State/territory admitted patient data


Guide for use

Data source type: Administrative by-product data

Used for disaggregation by remoteness and SEIFA


Data Element / Data SetData Element

Person—Indigenous status

Data Source

State/territory admitted patient data


Guide for use

Data source type: Administrative by-product data


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

Reporting requirements:Help on this term

State/territory supplied data.

Benchmark:Help on this term

State/territory level

Further data development / collection required:Help on this term

This indicator cannot be accurately constructed using the Admitted Patient Care National Minimum Data Set (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, and the inability to identify patient transfers into and separations from acute admitted patient mental health care service units, 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.

When data for this indicator are requested, jurisdictions are required to answer whether a state-wide unique client identifier system is in place, or some comparable approach has been used in the data analysis to allow tracking of service utilisation by an individual consumer across all public specialised mental health services in the jurisdiction. Collection of this information is aimed at assessing the degree of consistency between jurisdictions in data reported, the result of which are explored in the data quality statement for this indicator.

 

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 02J – 28 day readmission rate, 2017 Health, Standard 14/06/2017

See also Mental health readmissions to hospital, 2018 Health, Candidate 09/08/2018

See also Specialised mental health service—admitted patient care program type, code N Health, Standard 08/12/2004, ACT Health, Final 17/08/2018

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