Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of appointments*

Martin, Peter; Davies, R. G.; MacDougall, Amy; Ritchie, Benjamin; Vostanis, Panos; Whale, Andy; Wolpert, Miranda

doi:10.1080/09638237.2017.1370631

Cited by 11 publications

(20 citation statements)

References 20 publications

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“…Problem severity was identified using an algorithm 32,33 based on 30 items of the clinician-rated Current View questionnaire. 31 The algorithm categorises young people into 18 mutually exclusive needs-based groups, but as there were no young people in the ‘suggestive of borderline personality’ group, 17 subgroups were initially used.…”

Section: Methodsmentioning

confidence: 99%

Problem severity and waiting times for young people accessing mental health services

Edbrooke‐Childs

Deighton

2020

BJPsych open

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Background Access to timely care is a quality standard underpinning many international healthcare models, and long waiting times for child and adolescent mental health services are often reported as a barrier to help-seeking. Aims The aim of this study was to examine whether young people with more severe problems have shorter waiting times for mental health services. Method Multilevel multinomial regression analysis controlling for service-area deprivation, age, gender, ethnicity, referral source and contextual factors was conducted on N = 21 419 episodes of care (mean age 12.37 years (s.d. = 3.71), 11 712 (55%) female) using data from child and adolescent mental health services. Results There was high variation in waiting times, which ranged from 0 days to 1629 days (mean 50.65 days (s.d. = 78.03), median 32 days). Compared with young people with less severe problems young people with severe problems, self-harm, psychosis or eating disorders were less likely to experience longer waiting times. Moreover, referrals from sources other than primary care were generally less likely to have longer waiting times than referrals from primary care sources, especially referral from accident and emergency services. Conclusions The findings suggest that young people with more severe problems had shorter waiting times. Intermediary information and resources for support before access to services is needed to prevent escalation of problems and to support individuals and families while waiting for care. Interventions to reduce waiting times should be considered without compromising on the quality and experience of care that young people and families deserve when seeking help.

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Section: Methodsmentioning

confidence: 99%

Problem severity and waiting times for young people accessing mental health services

Edbrooke‐Childs

Deighton

2020

BJPsych open

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“…It is also important to remember that the field of case-mix classification systems, particularly for children and youth with mental health challenges, is in its infancy. To aid in future research and development within this specific field, Martin et al 24 Notably, the interRAI suite of assessment tools address many of these areas deemed important to consider when developing future case-mix classification systems. For example, the inter-RAI ChYMH-DD is a comprehensive, standardized assessment instrument that collects health information across a number of major life domains (eg, education and employment, cognitive and behavioral functioning, natural supports, and physical and mental health).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case-Mix System for Children and Youth With Developmental Disabilities

Stewart

Celebre

Head³

et al. 2020

Health�Serv�Insights

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Limited funding across health and social service programs presents a challenge regarding how to best match resources to the needs of the population. There is increasing consensus that differences in individual characteristics and care needs should be reflected in variations in service costs, which has led to the development of case-mix systems. The present study sought to develop a new approach to allocate resources among children and youth with intellectual and developmental disabilities (IDD) as part of a system-wide Medicaid payment reform initiative in Arkansas. To develop the system, assessment data collected using the interRAI Child and Youth Mental Health-Developmental Disability instrument was matched to paid service claims. The sample consisted of 346 children and youth with developmental disabilities in the home setting. Using automatic interactions detection, individuals were sorted into unique, clinically relevant groups (ie, based on similar resource use) and a standardized relative measure of the cost of services provided to each group was calculated. The resulting case-mix system has 8 distinct, final groups and explains 30% of the variance in per diem costs. Our analyses indicate that this case-mix classification system could provide the foundation for a future prospective payment system that is centered around stability and equitability in the allocation of limited resources within this vulnerable population.

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“…Process variables are those that describe treatments or services given to a person. 14,46,50,51 When using treatments or services as case-mix variables, they may encourage providers to do more of them for financial gain if they are under the control of the providers. Similar to provider variables, consideration should be given to whether variables that describe the needs of the individuals should be used as much as possible, or if there is a valid rationale for reinforcing differences in such variables (eg, to incentivize certain practices).…”

Section: Discussionmentioning

confidence: 99%

“…Only three of the studies cross-validated the predictive performance of their systems on a different data set than the one used for model derivation. 45,48,51 Cross-validation can serve two purposes: to evaluate the generalizability of the model on unseen observations or future users of the health care system, and to compare competing models. 58 Future research should consider using cross-validation when evaluating the predictive performance because the uncross-validated performance metric may give an overestimation.…”

Section: Discussionmentioning

confidence: 99%

Case-Mix Classification for Mental Health Care in Community Settings: A Scoping Review

Tran

Poss

Perlman

et al. 2019

Health�Serv�Insights

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As mental health care transitions from facility-based care to community-based services, methods to classify patients in terms of their expected health care resource use are an essential tool to balance the health care needs and equitable allocation of health care resources. This study performed a scoping review to summarize the nature, extent, and range of research on case-mix classifications used to predict mental health care resource use in community settings. This study identified 17 eligible studies with 32 case-mix classification systems published since the 1980s. Most of these studies came from the USA Veterans Affairs and Medicare systems, and the most recent studies came from Australia. There were a wide variety of choices of input variables and measures of resource use. However, much of the variance in observed resource use was not accounted for by these case-mix systems. The research activity specific to case-mix classification for community mental health care was modest. More consideration should be given to the appropriateness of the input variables, resource use measure, and evaluation of predictive performance. Future research should take advantage of testing case-mix systems developed in other settings for community mental health care settings, if possible.

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Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of appointments*

Abstract: The conceptually-derived classification merits further testing and development in the context of collaborative decision making.

Cited by 11 publications

References 20 publications

Problem severity and waiting times for young people accessing mental health services

Problem severity and waiting times for young people accessing mental health services

A Case-Mix System for Children and Youth With Developmental Disabilities

Case-Mix Classification for Mental Health Care in Community Settings: A Scoping Review

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