Utility of the Health of the Nation Outcome Scales (HoNOS) in Predicting Mental Health Service Costs for Patients with Common Mental Health Problems: Historical Cohort Study
Abstract:BackgroundFew countries have made much progress in implementing transparent and efficient systems for the allocation of mental health care resources. In England there are ongoing efforts by the National Health Service (NHS) to develop mental health ‘payment by results’ (PbR). The system depends on the ability of patient ‘clusters’ derived from the Health of the Nation Outcome Scales (HoNOS) to predict costs. We therefore investigated the associations of individual HoNOS items and the Total HoNOS score at basel… Show more
“…Large datasets have thus become available to evaluate the psychometric quality of the instrument, and some negative findings have emerged. For instance, the HoNOS appears not to be associated with need-for-care as operationalized by costs of treatment in a large British cohort of 1343 patients with common mental health problems [ 35 ]. For this patient group, the sensitivity to change in severity of psychopathology of the HoNOS appears to be limited as only three items (7, 8, and 9) seem relevant and appropriate [ 21 ].…”
BackgroundThe present study investigates the suitability of various treatment outcome indicators to evaluate performance of mental health institutions that provide care to patients with severe mental illness. Several categorical approaches are compared to a reference indicator (continuous outcome) using pretest-posttest data of the Health of Nation Outcome Scales (HoNOS).MethodsData from 10 institutions and 3189 patients were used, comprising outcomes of the first year of treatment by teams providing long-term care.ResultsFindings revealed differences between continuous indicators (standardized pre-post difference score ES and ΔT) and categorical indicators (SEM, JTRCI, JTCS, JTRCI&CS, JTrevised) on their ranking of institutions, as well as substantial differences among categorical indicators; the outcome according to the traditional JT approach was most concordant with the continuous outcome indicators.ConclusionsFor research comparing group averages, a continuous outcome indicator such as ES or ΔT is preferred, as this best preserves information from the original variable. Categorical outcomes can be used to illustrate what is accomplished in clinical terms. For categorical outcome, the classical Jacobson-Truax approach is preferred over the more complex method of Parabiaghi et al. with eight outcome categories. The latter may be valuable in clinical practice as it allows for a more detailed characterization of individual patients.
“…Large datasets have thus become available to evaluate the psychometric quality of the instrument, and some negative findings have emerged. For instance, the HoNOS appears not to be associated with need-for-care as operationalized by costs of treatment in a large British cohort of 1343 patients with common mental health problems [ 35 ]. For this patient group, the sensitivity to change in severity of psychopathology of the HoNOS appears to be limited as only three items (7, 8, and 9) seem relevant and appropriate [ 21 ].…”
BackgroundThe present study investigates the suitability of various treatment outcome indicators to evaluate performance of mental health institutions that provide care to patients with severe mental illness. Several categorical approaches are compared to a reference indicator (continuous outcome) using pretest-posttest data of the Health of Nation Outcome Scales (HoNOS).MethodsData from 10 institutions and 3189 patients were used, comprising outcomes of the first year of treatment by teams providing long-term care.ResultsFindings revealed differences between continuous indicators (standardized pre-post difference score ES and ΔT) and categorical indicators (SEM, JTRCI, JTCS, JTRCI&CS, JTrevised) on their ranking of institutions, as well as substantial differences among categorical indicators; the outcome according to the traditional JT approach was most concordant with the continuous outcome indicators.ConclusionsFor research comparing group averages, a continuous outcome indicator such as ES or ΔT is preferred, as this best preserves information from the original variable. Categorical outcomes can be used to illustrate what is accomplished in clinical terms. For categorical outcome, the classical Jacobson-Truax approach is preferred over the more complex method of Parabiaghi et al. with eight outcome categories. The latter may be valuable in clinical practice as it allows for a more detailed characterization of individual patients.
“…O grupo constrói, por meio de suas falas (linguagem), explicações inconscientes que justificam alguns obstáculos relacionados ao cuidado do idoso com transtorno mental (11) . intersetorial (20)(21) . Sendo assim, mais uma estratégia seria a partir das representações da equipe sobre a ausência de rede e protocolos, a construção de indicadores para avaliação dessas representações (1,10,20) .…”
Section: La Percepción De Los Profesionales De La Salud Sobre El Cuidunclassified
“…intersetorial (20)(21) . Sendo assim, mais uma estratégia seria a partir das representações da equipe sobre a ausência de rede e protocolos, a construção de indicadores para avaliação dessas representações (1,10,20) .…”
Section: La Percepción De Los Profesionales De La Salud Sobre El Cuidunclassified
“…Com os resultados poderiam conceber estratégias mais acuradas em pontos específicos da rede para aumentar a eficiência e um exemplo seriam a estratégia de referência, capacitação para aplicação de escalas e construção de protocolos de acolhimento e atendimento (20)(21) . Profissionais qualificados em gestão e suporte se saúde são vitais para supervisionar a implementação de estratégias para alcançar melhores níveis de atenção em saúde mental (6,10) .…”
Section: La Percepción De Los Profesionales De La Salud Sobre El Cuidunclassified
Objetivo: compreender as percepções da equipe de um Centro de Atenção Psicossocial sobre o cuidado ao idoso com transtorno mental. Método: estudo qualitativo com referencial teóricometodológico: Teoria das Representações Sociais. O campo de estudo foi um Centro de Atenção Psicossocial no interior do estado de São Paulo. Amostra composta por conveniência,fechada por exaustão, constituída por 12 profissionais. A coleta de dados foi realizada por meio da entrevista semiestruturada e estes foram analisados pela análise temática de conteúdo.Resultados: emergiram três categorias que evidenciam contradições sobre a percepção dos profissionais acerca do papel do CAPS. Essas contradições podem estar ancoradas nas representações sobre as dificuldades relatadas na assistência ao idoso, que se sobrepõem às dificuldades no cuidado ao indivíduo com transtorno mental. A ausência de estratégias para o atendimento cotidiano é abordada e a educação profissional é apontada como importante, porém ausente. O desgaste do profissional em saúde mental emerge e a percepção sobre a falta de recursos humanos é revelada nos discursos. Essas problemáticas trazem uma representação de práticas insuficientes que refletirão no cuidado ao idoso com transtorno mental. Conclusão: o estudo contribui com esclarecimentos a serem abordados em estudos de intervenção para potencializar a transformação do cuidado.
“…More recently, however, HoNOS total score was found not to be a useful predictor of mental health service costs in a sample of patients with common mental health problems, and indeed only the 'self injury' item showed any relationship [18]. Golay and colleagues [19] also found that overall the HoNOS items had weak predictive validity for duration of stay in hospital, re-hospitalization and also time before re-hospitalization.…”
The Health of the nation outcome scales (HoNOS) [1] were designed to measure the health and social functioning of adults with severe mental health problems. They form part of the English mental health minimum data set and are recommended by the department of health and are part of the attempt to develop “payment by results” (PbR) for mental health [2]. They are also widely used in Australia, New Zealand and Canada [3, 4], and have also been used in Europe [5]. Although they are widely used there are still questions about their psychometric validity and their ability to predict anything useful.
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