7-day-follow-up-after-hospitalization-for-a-MHA

INDICATOR NAME

Name

Follow-up after hospitalization for a mental health or addiction condition

Alternate Name

Percentage of patients aged 16 and older who were seen by a general practitioner/family physician or psychiatrist within seven days of discharge after being hospitalized for a mental illness or addiction

INDICATOR DESCRIPTION

Description

This indicator measures the percentage of psychiatric discharges that had a follow-up visit to either a primary care physician or psychiatrist, within 7 days of discharge. A higher rate is better.

Indicator Status

Active

HQO Reporting tool/product

Public reporting

Dimension

Effective

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

This indicator is calculated as: the numerator divided by the denominator, multiplied by 100

Numerator including inclusion/exclusion

The number of patients who within 7 days of discharge following index hospitalization had at least one psychiatrist or primary care physician visit.

All-cause follow-up: Any visit to a primary care provider (IPDB mainspecialty = ‘GP/FP’ or ‘F.P./Emergency medicine’) or a psychiatrist (IPDB mainspecialty =’psychiatry’) taking place in office, home, or long-term care (OHIP - location = ‘O’ or ‘H’ or ‘L’)

Denominator including inclusion/exclusion

Number of acute care discharges from episode of care in which a Mental Health and Addiction condition is diagnosed and is coded as most responsible diagnosis (CIHI - ICD-10 with dxtype = M, OMHRS - DSM-IV in Q2A/Q2D or provisional dx Q1D/Q1E/Q1F/Q1G/Q1O/Q1P = 1 ) in the first hospitalization of the episode within each fiscal year (minus last 7 days for follow up

Substance-related disorders-ICD-10-CA: F55, F10 to F19; DSM-IV: 291.x (0, 1, 2, 3, 5, 81, 89, 9), 292.0, 292.11, 292.12, 292.81, 292.82, 292.83, 292.84, 292.89, 292.9, 303.xx (00, 90), 304.xx (00, 10, 20, 30, 40, 50, 60, 80, 90), 305.xx (00, 10 to 90 excluding 80); Provisional diagnosis**: (d) substance-related disorder; or
Schizophrenia, delusional and non-organic psychotic disorders-ICD-10-CA: F20 (excluding F20.4), F22, F23, F24, F25, F28, F29, F53.1; DSM-IV: 295.xx (10, 20, 30, 40, 60, 70, , 90), 297.1, 297.3, 298.8, 298.9; Provisional diagnosis**: (e) schizophrenia disorder; or
Mood/affective disorders-Mood/affective disorders-ICD-10-CA: F30, F31, F32, F33, F34, F38, F39, F53.0; DSM-IV: 296 .0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90, 300.4, 301.13; Provisional diagnosis**: (f) mood disorders; or
Anxiety disorders-ICD-10-CA: F40, F41, F42, F43, F48.8, F48.9,; DSM-IV: 300.xx (00, 01, 02, 21, 22, 23, 29), 300.3, 308.3, 309.x (0, 3, 4, 9), 309.24, 309.28, 309.81; Provisional diagnosis**: (g) anxiety disorders or (o) adjustment disorders or
Selected disorders of adult personality and behaviour-Selected disorders of adult personality and behaviour-ICD-10-CA: F60, F61, F62, F69, F21; DSM-IV: 301.0, 301.20, 301.22, 301.4, 301.50, 301.6, 301.7, 301.81, 301.82, 301.83, 301.9 Provisional diagnosis**: (p) personality disorders.
Age range to include: 16-105 years

Exclude:

Patients without a valid health insurance number
Patients without an Ontario residence
Gender not recorded as male or female
Invalid date of birth, admission date/time, discharge date/time
Discharge where the patient signed him/herself out or the patient died
Patients who die or had Hospitalizations with a subsequent readmission (any cause) to acute care (CIHI or OMHRS) within 7 days of index hospitalization discharge date

Note: if OMHRS records occurs within 24 hours of discharge/admission from institution then this should be considered as part of the same episode of care. **For provisional diagnoses: only for data extracted from the Ontario Mental Health Reporting System (OMHRS) with no DSM-IV code recorded.

Adjustment (risk, age/sex standardization)- detailed

Age- and sex-standardized to the 2006 Ontario census population

Age (16-24, 25-44, 45-64, 65-84, 85-105)
Sex (Male and Female)

Data Source

Discharge Abstract Database (DAD), Ontario Health Insurance Plan (OHIP) Claims History Database, Ontario Mental Health Reporting System (OMHRS), Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

Reported Levels of comparability /stratifications (defined)

Age, Income, Region, Rurality, Sex, Time

OTHER RELEVANT INFORMATION

Caveats and Limitations

The rate does not capture medical services delivered in other forms of post-discharge care and by non-physician providers. (e.g., salaried physicians, community mental health programs, client based initiatives). Limitations also include potential coding errors and a lack of clinical detail.

Footnotes

1 Greg McCutcheon. Presentation “F2FFollow-up within 7 days of an Mental health Inpatient Discharge" http://www.slideshare.net/gregmccutcheon1?utm_campaign=profiletracking&utm_medium=sssite&utm_source=ssslideview 2 Fortney J, Sullivan G, Williams K, Jackson C, Morton SC, Koegel P. Measuring Continuity of Care for Clients of Public Mental Health Systems. Health Services Research. 2003; 38: 1157-1175. 3 Cougnard A, Parrot M, Grolleau S, Kalmi E, Desage A, Misdrahi D, Brun-Rousseau H, Verdoux H. (2006) Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study. Acta Psychiatr Scand 113:340-9 4 Crowford M. Suiside following discharge from in-patient psychiatric care. 5 Medicare Payment Advisory Commission. 2007. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission, p. 107 6 Substance Abuse and Mental Health Services Administration. (2009) Results from the 2008 national survey 155 on drug use and health: national finding (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville (MD): Substance Abuse and Mental Health Services Administration; 304 p. 7 Hospital Report 2007. Mental Health