Adult

Data source

PRIMHD

Description

Percentage of overnight discharges from the mental health and addiction service organisation’s inpatient unit(s) where a community service contact was recorded in the seven days immediately following that discharge.

This KPI calculates an overall follow up rate, which is the percentage of all acute inpatient discharges that were followed up, regardless of where that follow up occurred (DHB, NGO or both)

Indictor rationale

A responsive community support system for persons who have experienced an acute psychiatric episode requiring hospitalisation is essential to maintain clinical and functional stability and to minimise the need for hospital readmission.

Service users leaving hospital after a psychiatric admission with a formal discharge plan, involving linkages with community services and supports, are less likely to need early readmission. Research indicates that service users have increased vulnerability immediately following discharge, including higher risk for suicide.

Denominator

Count of acute inpatient discharges

Numerator

Count of acute inpatient discharges where a follow up community contact (for the same person) exists where:

Community follow-up activity start date is between 1 and 7 days after acute inpatient discharge date

• ActivityStartDate >= dateadd(1, day, InpatientDischargeDate)
• ActivityStartDate < dateadd(8, day, InpatientDischargeDate)

Note: as of November 2020 terminology has changed from ReferralClosureDate to InpatientDischargeDate to eliminate confusion.

Technical notes

This denominator is shared with the other members of the acute inpatient KPI suite: 28-day readmission, length of stay, and pre-admission community contact.

General terminology

An acute inpatient discharge is any referral record where:

1. ReferralEndDate is not null — ended referral
2. TeamType is Inpatient — into an inpatient team
3. ReferralEndCode is DR, DW or DT — ended in a way where we expect follow-up
4. ReferralTo is not PI, AE or NP — was not moving on to another hospital setting
5. Exists at least one activity where — there was at least one acute inpatient bednight
   1. ActivityTypeCode is T02 or T03 — acute inpatient bednight codes
   2. ActivityUnitCount > 0 — for more than 0 days

An inpatient discharge date is calculated as the:

1. Maximum ActivityEndDate for a referral record where: — end of last activity
   1. ActivityType is T02, T03, T04 or T37 — inpatient activity only

A community contact is any activity record where:

1. TeamType is not Inpatient — not inpatient follow up
2. ActivityUnitType is contact — not a bednight, seclusion or leave
3. ActivitySetting is not WR, OM or SM — includes service user participation
4. ActivityType is not T08, T35 or T32 — includes service user participation

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Data Source

PRIMHD

Description

Percentage of overnight discharges from the mental health and addiction service organisation’s acute inpatient unit(s) that result in readmission within 28 days of discharge.

This KPI calculates an overall readmission rate, which is the percentage of all acute inpatient discharges that were readmitted, regardless of where that readmission occurred (same DHB or different DHB)

Indictor rationale

Psychiatric inpatient services aim to provide treatment that enables individuals to return to the community as soon as possible. Unplanned admissions 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.

Denominator

Count of acute inpatient discharges

Numerator

Count of acute inpatient discharges where a readmission occurs within 28 days; that is where an activity exists (for the same person), where:

• Referral team type is Inpatient — into an inpatient team
• Activity type is T02 or T03 — acute inpatient bednight codes
• Activity unit count > 0 — for more than 0 days
• Activity start date is between 0 and 28 days after inpatient discharge date
  • ReadmissionActivityStartDate >= dateadd(0, day, InpatientDischargeDate)
  • ReadmissionActivityStartDate < dateadd(29, day, InpatientDischargeDate)

Technical notes

This denominator is shared with the other members of the acute inpatient KPI suite: 7-day follow-up, length of stay, and pre-admission community contact.

General terminology

An acute inpatient discharge is any referral record where:

1. ReferralEndDate is not null — ended referral
2. TeamType is Inpatient — into an inpatient team
3. ReferralEndCode is DR, DW or DT — ended in a way where we expect follow-up
4. ReferralTo is not PI, AE or NP — was not moving on to another hospital setting
5. Exists at least one activity where — there was at least one acute inpatient bednight
   1. ActivityTypeCode is T02 or T03 — acute inpatient bednight codes
   2. ActivityUnitCount > 0 — for more than 0 days

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Data source

PRIMHD

Description

Acute inpatient occupied bednights for in scope discharges closed during the reporting period

Measurement dimensions

• Average
• Median

Technical notes

The average is derived by summing the number of acute inpatient occupied bednights, divided by the number of in scope discharges

The median is the middle value when eligible in scope discharges are ranked in order of length of stay, for example half the discharges are above the median length of stay and half are below.

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Data source

PRIMHD

Description

Percentage of overnight discharges from the mental health and addiction service organisation’s inpatient unit(s) closed in the reporting period for which a community service contact was recorded in the seven days immediately preceding the day of admission

Measurement dimensions

Percentages for

• Same DHB Only: Where face to face community mental health contact was recorded by the same DHB as the admitting DHB in the seven days pre admission. This is the core indicator and represented in the dashboard.
• NGO Only: Where face to face community mental health contact was recorded by only an NGO service in the seven days pre admission.
• DHB and NGO: Where face to face community mental health contact was recorded by the same DHB as the admitting DHB and NGO service in the seven days pre admission.
• Different DHB: Where face to face community mental health contact was recorded by a DHB other than the admitting DHB in the seven days pre-admission.
• Not seen: Where NO face to face community mental health contact was recorded by neither admitting DHB nor an NGO service in the seven days prior to admission.

Numerator

Number of in scope discharges in the denominator for which a face to face community mental health contact was recorded in the seven days immediately preceding the day of admission.

Contact must occur in the seven days prior to admission but not on the day of admission.

Denominator

Total number of in scope acute inpatient discharges closed during the reference period where the referral source is not from psychiatric inpatient

Technical notes

Numerator

Eligible Community Mental Health Contact:

• Activity unit type: contact; and
• Activity type code not:
  • T08 (Care/liaison coordination contacts)
  • T32 (Contact with family/whānau, consumer not present),
  • T35 (Did not attend)
  • T37 (On leave); and
• Activity setting code not:
  • WR (written correspondence)
  • SM (SMS text messaging)
  • OM (other social media or e-therapy).

Eligible team codes in Community Mental Health:

1. Any team where service organisation type is not District Health Board (DHB); or
2. If service organisation type is DHB:
   1. Team target population descriptions:
      1. Adult population
      2. Mixed population
      3. or Older People Population; and
   2. Team setting description is community based or team type description is community team.

Denominator

In addition to the definition of number of in scope discharges, the following exclusion is applied:

1. Referral_From code is PI (psychiatric inpatient)

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Data source

PRIMHD and Stats NZ DHB population projections

Description

Number of distinct service users secluded during a reporting period, irrespective of when the seclusion event started or ended.

Measurement dimensions

• Number of people secluded
• Number of people secluded per 100k Population

Numerator

Total number of distinct people with seclusion events overlapping the reporting period.

Denominator

Per 100K Population: DHBs population projection for the reporting period (/100,000) – aged between 20 and 64.

Some DHBs provide regional residential mental health services. For these DHBs, the effective population they serve is larger than the population (DHB based) used to calculate the per 100,000 population rate used by the seclusion indicator. The impact of this is that the DHBs with regional services could be recording a higher seclusion rate by population than is in fact the case.

Technical notes

Numerator

Eligible activity type: T33 (seclusion)

Process of identifying seclusion episode from PRIMHD:

1. Indexed seclusion activities by referral ID, individual and service organisation in order of activity start time.
2. Roll up continuous or overlapping seclusion activities into one episode.
3. Where there is less than 60 minute break between two seclusion events, it is concatenated into one event, in line with MOH definition.
4. Assign age at episode start.
5. Assign seclusion events to the corresponding reporting period. Where a seclusion event crosses over multiple reporting periods, both the event and individual is counted in multiple times across the reporting periods where it spans while seclusion hours are apportioned across the multiple reporting periods.
6. Filter for adult population and adult service by applying the following criteria:
   1. Team type code not = 05 (forensic team) and
   2. Age at episode start is between 20 and 64.

Denominator

Population:

• Projections produced by Statistics New Zealand according to assumptions specified by the Ministry of Health.
• Filter applied for the relevant financial year and population aged between 20 and 64.

Person secluded:

Count of distinct individuals that had at least one seclusion event during the reporting period

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Data source

PRIMHD

Description

Whānau engagement following first face to face contact is important. Early initial contact should be established regardless of service or team types.

Measurement dimensions

• Number of eligible episodes with whānau engagement.
• Percentage of eligible episodes with whānau engagement.
• Percentage of eligible episodes with whānau engagement where first activity is community non crisis.
• Percentage of eligible episodes with whānau engagement within 2 days for all activity types.
• Percentage of eligible episodes with whānau engagement within 2 days where first activity is community non crisis.

Technical notes

1. Reporting entity: DHB of service.
2. Reporting period: Quarterly based on the first eligible activity start date.
3. Age bands: 18-19, 20-29, 30-39, 40-49, 50-59, 60+ with age determined as at the referral start date
4. Ethnicity: Māori, Pacific, European, Other
5. First eligible face to face activity type: Inpatient, Community Crisis and Community non crisis
6. Eligible face to face activity types:
   1. Any activity types except the following:
      1. T08 Care/liaison coordination contacts
      2. Out of scope activity settings:
      3. WR (written correspondence)
      4. SM (SMS text messaging)
      5. PH (telephone)
      6. OM (other social media or e-therapy).
   2. Eligible whānau contact:
7. In scope activity types:
   1. T32 Contact with family/whānau, consumer not present
   2. T36 Contact with family/whānau, consumer present
   3. T47 Support for family/whānau.
8. Out of scope activity settings:
   1. WR (written correspondence)
   2. SM (SMS text messaging)
   3. OM (other social media or e-therapy).
9. Inclusion of open referrals, for example where referral end date = NULL.
10. Exclusion of Alcohol & Drug Teams and Forensic Services.
11. Exclusion of NGOs.
12. Results reported for the most recent one to two quarters are highly likely to be preliminary when first eligible face to face activity or first whānau contact are retrospectively submitted to PRIMHD.

Process of identifying and collapsing overlapping eligible episode from PRIMHD:

1. Filter for referrals with eligible face to face activities.
2. Index referrals by referral ID, individual client and service organisation in order of referral start date time.
3. Determine whether each referral overlaps the one before and/or the one after.
4. Where the start date is within 28 days of the end date of another collapsed referral, this is considered as one continuous episode.
5. Roll up continuous or overlapping referrals with the same service organisation into one collapsed referral (episode).
6. Order eligible activities within the collapsed and filtered referrals.
7. Determine the first face to face contact and the first whānau contact (if exists).
8. Assign age at referral start and filter for clients where age at referral start is 18 and above.
9. Determine the time from first face to face contact to the first whānau contact.
10.  Assign flags where the first face to face contact is inpatient, community crisis or community non-crisis.
    1. Inpatient
       1. T02 Mental health intensive care inpatient or equivalent occupied bed nights
       2. T03 Mental health acute inpatient or equivalent occupied bed nights
       3. T04 Mental health sub-acute inpatient or equivalent occupied bed nights.
    2. Community crisis: T01 Mental health crisis attendances.
    3. Community non crisis: All other face to face activity types.
11. Assign episode to the corresponding reporting period based on the first eligible face to face activity date.
12. Aggregate and calculate:
    1. Number of episodes (A)
    2. Number of episodes with whānau engagement (B)
    3. Number of episodes with whānau engagement that are within 2 days (C)
    4. Percentage of eligible episodes with whānau engagement – (B) divided by (A)
    5. Percentage of eligible episodes with whānau engagement that are within 2 days – (C) divided by (B).

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