Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN)

Abstract

BackgroundAustralia’s National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN) has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN’s activities and achievements, with a view to providing lessons for others embarking on similar exercises.MethodWe conducted a desktop review of relevant documents to summarise the history of AMHOCN.ResultsAMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of ‘trial and error’. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering ‘information literacy’; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences.ConclusionAMHOCN’s efforts have contributed to routine outcome measurement gaining a firm foothold in Australia’s public sector mental health services.

Routine outcome measurement in Australia

“…AMHOCN has ensured that the outcome data collected are useful at a clinical level. It has done this by encouraging clinicians to use outcome measurement as a means of facilitating dialogue with consumers and as a means of guiding clinical decisions and creating resources such as the web-based decision support tool (described above) to assist with this (Burgess et al, 2012). It has also promoted the clinical utility of outcome measurement by developing the information literacy of the workforce, and assisting clinicians to think about meaningful questions that can be answered by the outcome data that are collected.…”

“…Through AMHOCN we have been responsible for the training and service development necessary to get routine outcome measurement off the ground and to see it embedded in serviced delivery, for managing the high volumes of outcome data generated, and for analysing and reporting on these data in a meaningful manner. More detail about AMHOCN and about its role in these activities is provided throughout the course of this paper, and additional information is available in other publications (Burgess et al, 2012) and on our website (http://amhocn.org/).…”

“…AMHOCN has supported the training of the nation ' s mental health workforce through face-toface sessions and web-based training (Burgess et al, 2012). The approach to training has varied across states and territories, with some adopting a train-thetrainer approach whereby trainers are trained and then supported in delivering training themselves by a standard set of training materials, and others employing a small group of staff to train their workforce.…”

“…creating an ' episodizer ' algorithm to identify legitimate combinations of collection occasions, creating a ' validator ' to allow states and territories to pre-validate the information they submit), and maintaining a ' gold standard ' data warehouse that only contains data that comply with the business rules of the NOCC protocol (Burgess et al, 2012). AMHOCN has ensured that the outcome data collected are useful at a clinical level.…”

Measuring and improving the quality of mental health care: a global perspective

“…The principal outcome measures are the Health of the Nation Outcome Scales (HoNOS) and a quality of life instrument. To be able to implement this initiative on such a large scale required considerable investment in mental health providers, ongoing training and a broad program of engagement 79 .…”