Skip to main content Accessibility help
×
Home

Monitoring service utilization of persons with mental disorders – a case for mapping pathways of care

  • H. Katschnig (a1)

Abstract

Routinely collected and reported indicators for health service utilization have traditionally been event/episode related and hospital centered. This is also the case for service utilization by persons with mental disorders, for whom national and international databases usually report rates of hospital discharges, mean length of stay for hospital episode and the like. Such event/episode-related indicators are of limited use for planning and improving services for persons with mental disorders. It is argued that new reporting systems are needed that allow the monitoring of the pathways of persons with mental disorders through the service system. It is shown how – owing to recent developments in techniques of ‘pseudonymization’ and the ever-increasing computer power for dealing with large volumes of patient data – such a system can be established and how it can contribute to analyzing empirically such mental health-care issues as ‘heavy utilizers’, ‘revolving door psychiatry’, ‘continuity of care’, ‘de-institutionalization’ and the like. Results of a record linkage study for the total population of a federal state of Austria monitoring both psychiatric and non-psychiatric health service utilization are reported. Some unexpected findings include the high utilization of non-psychiatric services by patients discharged from a psychiatric hospital bed, results which could not have been found by psychiatric case registers which usually only monitor utilization of psychiatric services.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Monitoring service utilization of persons with mental disorders – a case for mapping pathways of care
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Monitoring service utilization of persons with mental disorders – a case for mapping pathways of care
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Monitoring service utilization of persons with mental disorders – a case for mapping pathways of care
      Available formats
      ×

Copyright

Corresponding author

*Address for correspondence: Heinz Katschnig, MD, Professor of Psychiatry, Medical University of Vienna, Director, Ludwig Boltzmann Institute for Social Psychiatry, Lazarettgasse 14A-912, A-1090 Vienna, Austria. (Email: heinz.katschnig@meduniwien.ac.at)

References

Hide All
Amaddeo, F, Zambello, F, Tansella, M, Thornicroft, G (2001). Accessibility and pathways to psychiatric care in a community-based mental health care. Social Psychiatry and Psychiatric Epidemiology 36, 500507.
Ansseau, M, Dierick, M, Buntinkx, F, Cnockaert, P, De Smedt, J, Van Den Haute, M, Vander Mijnsbrugge, D (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders 78, 4955.
Botha, UA, Koen, L, Joska, JA, Parker, JS, Horn, N, Hering, LM, Oosthuizen, PP (2010). The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country. Social Psychiatry and Psychiatric Epidemiology 45, 461468.
Burns, T, Catty, J, White, S, Clement, S, Ellis, G, Jones, IR, Lissouba, P, Mclaren, S, Rose, D, Wykes, T (2009). Continuity of care in mental health: understanding and measuring a complex phenomenon. Psychological Medicine 39, 313323.
Byrne, SL, Hooke, GR, Page, AC (2010). Readmission: a useful indicator of the quality of inpatient psychiatric care. Journal of Affective Disorders 126, 206213.
Durbin, J, Lin, E, Layne, C, Teed, M (2007). Is readmission a valid indicator of the quality of inpatient psychiatric care? Journal of Behavioral Health Services and Research 34, 137150.
EC (European Commission) (October 2010). Special Eurobarometer 345, Mental Health (http://ec.europa.eu/health/eurobarometers/index_en.htm). Accessed November 2010.
Frick, U, Frick, H (2010). ‘The psychiatric revolving door’: facts from the national discharge statistics of Switzerland. In: Third European Public Health Congress, 2010 Amsterdam. European Journal of Public Health 26, Volume 20 (Suppl 1), p. 26.
Garcia Armesto, S, Madeiros, H, Wei, L (2008). Information availability for measuring and comparing quality of mental health care across OECD countries. OECD Health Technical Papers No. 20. OECD: Paris.
Goldberg, D, Huxley, P (1980). Mental Illness in the Community: The Pathway to Psychiatric Care. Taylor and Francis: London.
Healy, D, Savage, M, Michael, P, Harris, M, Hirst, D, Carter, M, Cattell, D, Mcmonagle, T, Sohler, N, Susser, E (2001). Psychiatric bed utilization: 1896 and 1996 compared. Psychological Medicine 31, 779790.
Jacobs, R, Mcdaid, D (2009). Performance assessment in mental health services. In Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects (ed. Smith, P. M. E., Leatherman, S. and Papanicolas, I.), pp. 426472, Cambridge University Press: Cambridge.
Jones, IR, Ahmed, N, Catty, J, Mclaren, S, Rose, D, Wykes, T, Burns, T (2009). Illness careers and continuity of care in mental health services: a qualitative study of service users and carers. Social Science and Medicine 69, 632639.
Jorm, AF, Angermeyer, M, Katschnig, H (2000). Public knowledge of and attitudes to mental disorders: a limiting factor in the optimal use of treatment services. In Unmet Need in Psychiatry: Problems, Resources, Responses (ed. Andrews, G. and Henderson, S.), pp. 399413, Cambridge University Press: Cambridge.
Katschnig, H (2010). Are psychiatrists an endangered species? Observations on internal and external challenges to the profession. World Psychiatry 9, 2128.
Katschnig, H, Breier, P, Constantopoulos, A, Dragomirecka, E, Rancans, E, Reneses, B, Angerer, K, Obernosterer, E (2006). Monitoring service utilisation. In Improving Mental Health Information in Europe – Proposal of the MINDFUL project (ed. Lavikainen, J., Fryers, T. and Lehtinen, V.), pp. 6677, STAKES: Helsinki.
Katschnig, H, Eichberger, G, Schimek, M, Seidl, L (1986). The role of the genera practitioner in the care of discharged psychiatric patients – a pilot study in a rural area. In Mental Illness Inprimary Care Settings (ed. Shepherd, M., Wilkinson, G. and Williams, P.), pp. 226232, Tavistock Publications: London and New York.
Katschnig, H, Endel, G (2010). Identifying psychiatric patients’ pathways through the health care system by record linkage and pseudonymisation 1: linking inpatient and outpatient data of a large health insurer in Austria. Poster presentation, 26th PCSI Conference, 2010 Munich (http://pcstest.x-coop.de/index.php?option=com_content&view=article&id=70&Itemid=79).
Katschnig, H, Endel, G, Endel, F, Filzmoser, P, Weibold, B (2010 b). Identifying psychiatric patients’ pathways through the health care system by record linkage after pseudonymisation 2: linking inpatient and outpatient data for the total population of a province of Austria. Poster presentation, 26th PCSI Conference, 2010 Munich. (http://pcstest.x-coop.de/index.php?option=com_content&view=article&id=70&Itemid=79).
Katschnig, H, Endel, G, Endel, F, Weibold, B (2010 a). Inanspruchnahme-Pfade von Patienten mit Psychiatrischen Diagnosen durch das Gesundheitsversorgungssystem: Aus dem Krankenhausbett in die ambulante Versorgung und zurück 2.Teil (‘Psypfade 2 – PP2’). Federal Ministry of Health: Vienna.
Krautgartner, M, Alexandrowicz, R, Benda, N, Wancata, J (2006). Need and utilization of psychiatric consultation services among general hospital inpatients. Social Psychiatry and Psychiatric Epidemiology 41, 294301.
Krautgartner, M, Scherer, M, Katschnig, H (2002). Psychiatrische Krankenhaustage: Wer konsumiert die meisten? – Eine Record Linkage Studie über fünf Jahre in einem österreichischen Bundesland. [Days in psychiatric hospitals: who consumes most of them? A five-year record linkage study of ‘Heavy Users’ in an Austrian province]. Psychiatrische Praxis 29, 355363.
Kutzin, J (2001). A descriptive framework for country-level analysis of health care financing arrangements. Health Policy 56, 171204.
Lave, JR (2003). Developing a Medicare prospective payment system for inpatient psychiatric care. Health Affairs (Millwood), 22, 97109.
Morgan, VA, Jablensky, AV (2010). From inventory to benchmark: quality of psychiatric case registers in research. British Journal of Psychiatry: The Journal of Mental Science 197, 810.
Munk-Jorgensen, P, Mortensen, PB (1997). The Danish Psychiatric Central Register. Danish Medical Bulletin 44, 8284.
OECD (2010). Health at a Glance: Europe 2010. OECD Publishing: Paris.
Perera, G, Soremekun, M, Breen, G, Stewart, R (2009). The psychiatric case register: noble past, challenging present, but exciting future. British Journal of Psychiatry 195, 191193.
Petersen, S (2010). Hospital reimbursement and readmissions. Norway 2002, 2005 and 2008. BMC Health Services Research 10, A14.
Priebe, S, Badesconyi, A, Fioritti, A, Hansson, L, Kilian, R, Torres-Gonzales, F, Turner, T, Wiersma, D (2005). Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. British Medical Journal 330, 123126.
Quantin, C, Fassa, M, Coatrieux, G, Trouessin, G, Allaert, FA (2008). Combining hashing and enciphering algorithms for epidemiological analysis of gathered data. Methods of Information in Medicine 47, 454458.
Riedel-Heller, SG, Matschinger, H, Angermeyer, MC (2005). Mental disorders – who and what might help? Help-seeking and treatment preferences of the lay public. Social Psychiatry and Psychiatric Epidemiology 40, 167174.
Rossi, A, Morgan, V, Amaddeo, F, Sandri, M, Tansella, M, Jablensky, A (2005). Psychiatric out-patients seen once only in South Verona and Western Australia: a comparative case-register study. Australian and New Zealand Journal of Psychiatry 39, 414422.
Tansella, M, Amaddeo, F, Burti, L, Lasalvia, A, Ruggeri, M (2006). Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatrica Scandinavica 113(Suppl. 429), 9094.
Thornicroft, G, Tansella, M (2002). Balancing community-based and hospital-based mental health care. World Psychiatry 1, 8490.
Weerasinghe, D, Rajarajan, M, Elmufti, K, Rakocevic, V (2008). Patient privacy protection using anonymous access control techniques. Methods of Information in Medicine 47, 235240.
Wendt, C, Frisina, L, Rothgang, H (2009). Healthcare system types: a conceptual framework for comparison. Social Policy and Administration 43, 7090.
Weyns, L, De Paepe, L, Moons, P (2006). Kwaliteit van ontslagmanagement bij psychiatrische patienten: een literatuurstudie naar performantiemaatstaven. Acta Hospitalia 46, 33.
WHO (2005). Mental health: facing the challenges, building solutions. Report from the WHO European Ministerial Conference 2005. World Health Organization Regional Office for Europe: Copenhagen.
WHO-HFA (World Health Organization – Health For All) (2010). (http://www.euro.who.int/en/what-we-do/data-and-evidence/databases/european-health-for-all-database-hfa-db2). Accessed November 2010.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed