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      Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study

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          Abstract

          Background

          As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems.

          Objective

          The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs.

          Methods

          A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices.

          Results

          The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units.

          Conclusions

          This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries.

          International Registered Report Identifier (IRRID)

          RR1-10.2196/26214

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          Most cited references26

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          Practice guideline for the treatment of patients with schizophrenia, second edition.

          Nicholas Lehman, Linda Lieberman, T H McGlashan … (2004)
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            Selecting indicators for the quality of diabetes care at the health systems level in OECD countries.

            Antonio Nicolucci, Sheldon Greenfield, Soeren Mattke (2006)
            In the context of the Organization for Economic Cooperation and Development (OECD) Quality Indicators Project, a set of quality indicators for diabetes care was developed, to be used for benchmarking the performance of health care systems. Diabetes complications markedly reduce quality and length of life and are also responsible for enormous health care costs. A large body of evidence has shown that several effective treatments and practices may substantially reduce this burden. However, a marked variability has been documented in preventive and therapeutic approaches, thus suggesting that the level of diabetes care currently delivered may not produce the possible health-related gains. Existing quality indicators have been reviewed, with particular attention to the work done by the National Diabetes Quality Improvement Alliance (NDQIA) in the US. All the measures identified were evaluated for their importance, scientific soundness, and feasibility. In addition, the panel members selected new distal outcome measures. These measures are currently not used in provider comparisons, but they could reveal valuable insight into the differential performance of health systems. /b>. Four process and two proximal outcome measures were selected among those endorsed by the NDQIA. In addition, three new long-term outcome measures have been proposed to gain insight into whether and to what degree differences in the processes and intermediate outcomes that are captured by the established measures translate into better outcomes for patients. The measures selected can contribute to policymakers' and researchers' understanding of differences in the quality of diabetes care between health systems. Further work is required to assess the availability of reliable and comparable data across OECD countries.
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              Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment

              Christopher M Perlman, John P Hirdes, Howard Barbaree … (2013)
              Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs) using the Resident Assessment Instrument - Mental Health (RAI-MH), a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI) and Cognitive Performance Scale (CPS), were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance and restraints but had a relatively small impact on adjusted rates/prevalence. Conclusions The RAI-MH is a feasible assessment system for deriving MHQIs. Given the breadth of clinical content on the RAI-MH there is an opportunity to expand the number of MHQIs beyond indicators of depression, cognitive performance, and restraints. Further research is needed to improve risk adjustment of the MHQIs for their use in mental health services report card and benchmarking activities.
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                Author and article information

                Contributors
                Roberto Rodriguez-Jimenez:
                ORCID: https://orcid.org/0000-0003-2251-7249
                Department of PsychiatryInstituto de Investigación Sanitaria Hospital 12 de Octubre (imas12)Av de Córdoba km 5,400Madrid, 28041Spain34 91 390 85 36roberto.rodriguez.jimenez@gmail.com
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: April 2021
                Publication date (Electronic): 7 April 2021
                Volume: 10
                Issue: 4
                Electronic Location Identifier: e26214
                Affiliations
                [1 ] Department of Psychiatry Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) Madrid Spain
                [2 ] Biomedical Research Networking Centre in Mental Health (CIBERSAM) Madrid Spain
                [3 ] Faculty of Medicine Universidad Complutense de Madrid Madrid Spain
                [4 ] Department of Psychiatry Hospital de la Santa Creu i Sant Pau Barcelona Spain
                [5 ] Department of Psychiatry Hospital Clínico Universitario Lozano Blesa Zaragoza Spain
                [6 ] Department of Psychiatry Hospital de Conxo Universidad de Santiago Santiago de Compostela Spain
                [7 ] Department of Psychiatry Jefe del servicio de psiquiatría del Hospital Universitario Rio Hortega de Valladolid Valladolid Spain
                [8 ] Department of Psychiatry Complejo Asistencial de Zamora Zamora Spain
                [9 ] Department of Psychiatry Hospital General Universitario de Ciudad Real Ciudad Real Spain
                [10 ] Department of Psychiatry Hospital Universitario Virgen Macarena Sevilla Spain
                [11 ] Department of Psychiatry Faculty of Medicine University of Seville Sevilla Spain
                [12 ] Department of Psychiatry Hospital Universitario Doctor Peset Valencia Spain
                Author notes
                Corresponding Author: Roberto Rodriguez-Jimenez roberto.rodriguez.jimenez@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-2251-7249
                https://orcid.org/0000-0003-2562-711X
                https://orcid.org/0000-0001-9531-8641
                https://orcid.org/0000-0001-5165-9612
                https://orcid.org/0000-0002-3639-2523
                https://orcid.org/0000-0003-3913-3399
                https://orcid.org/0000-0001-5301-1211
                https://orcid.org/0000-0002-2856-6562
                Article
                Publisher ID: v10i4e26214
                DOI: 10.2196/26214
                PMC ID: 8060864
                PubMed ID: 33729167
                SO-VID: 50886db8-4ee9-4cb6-886c-90a08607af59
                Copyright © ©Roberto Rodriguez-Jimenez, Iluminada Corripio, Ricardo Campos, Mario Páramo, Manuel Franco-Martin, Estefanía Segura, Sergio González, José Martínez-Raga. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 07.04.2021.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                Date received : 3 December 2020
                Date revision requested : 28 January 2021
                Date revision received : 11 March 2021
                Date accepted : 17 March 2021
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: acute inpatient psychiatric units,organization,resources,scorecard,spain
                Data availability:
                Keywords: acute inpatient psychiatric units, organization, resources, scorecard, spain

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