title: Factors explaining priority setting at community mental health centres: a quantitative analysis of referral assessments.
abstract: BACKGROUND
  Clinicians at Norwegian community mental health centres assess referrals from general practitioners and classify them into three priority groups (high priority, low priority, and refusal) according to need where need is defined by three prioritization criteria (severity, effect, and cost-effectiveness). In this study, we seek to operationalize the three criteria and analyze to what extent they have an effect on clinical-level priority setting after controlling for clinician characteristics and organisational factors.
  
  
  METHODS
  Twenty anonymous referrals were rated by 42 admission team members employed at 14 community mental health centres in the South-East Health Region of Norway. Intra-class correlation coefficients were calculated and logistic regressions were performed.
  
  
  RESULTS
  Variation in clinicians' assessments of the three criteria was highest for effect and cost-effectiveness. An ordered logistic regression model showed that all three criteria for prioritization, three clinician characteristics (education, being a manager or not, and "guideline awareness"), and the centres themselves (fixed effects), explained priority decisions. The relative importance of the explanatory factors, however, depended on the priority decision studied. For the classification of all admitted patients into high- and low-priority groups, all clinician characteristics became insignificant. For the classification of patients, into those admitted and non-admitted, one criterion (effect) and "being a manager or not" became insignificant, while profession ("being a psychiatrist") became significant.
  
  
  CONCLUSIONS
  Our findings suggest that variation in priority decisions can be reduced by: (i) reducing the disagreement in clinicians' assessments of cost-effectiveness and effect, and (ii) restricting priority decisions to clinicians with a similar background (education, being a manager or not, and "guideline awareness").
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, PO 1089, N-0317, Oslo, Norway. sverre.grepperud@medisin.uio.no.
authors.forename: Sverre
authors.initials: S
authors.lastname: Grepperud
authors.affiliation: Lovisenberg Diakonale Hospital, N-0440, Oslo, Norway. paho@lds.no.
authors.forename: Per Arne
authors.initials: PA
authors.lastname: Holman
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, PO 1089, N-0317, Oslo, Norway. k.r.wangen@medisin.uio.no.
authors.forename: Knut Reidar
authors.initials: KR
authors.lastname: Wangen
mesh_terms: D000328:Adult; D001364:Awareness; D003155:Community Mental Health Centers; D003362:Cost-Benefit Analysis; D005260:Female; D058006:General Practice; D006292:Health Priorities; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway; D012017:Referral and Consultation