title: Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment.
abstract: 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.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo N2L 3G1, Canada. chris.perlman@uwaterloo.ca
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Perlman
authors.forename: John P
authors.initials: JP
authors.lastname: Hirdes
authors.forename: Howard
authors.initials: H
authors.lastname: Barbaree
authors.forename: Brant E
authors.initials: BE
authors.lastname: Fries
authors.forename: Ian
authors.initials: I
authors.lastname: McKillop
authors.forename: John N
authors.initials: JN
authors.lastname: Morris
authors.forename: Terry
authors.initials: T
authors.lastname: Rabinowitz
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D016208:Databases, Factual; D003863:Depression; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D009864:Ontario; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult