Rasch analysis of a patient-reported outcome measure for self-perceived health among psychiatric patients in Denmark.

BACKGROUND: Patient-reported outcome measures (PROMs) are valuable and necessary tools for establishing and maintaining patient-centred healthcare. The PRO-Psychiatry initiative was primarily initiated to support the patient's voice in treatment decision-making and secondarily to monitor patient-perceived quality of care. The result of the initiative is a patient-reported instrument developed in collaboration between patients and clinicians. We aimed to validate the PROM developed for measuring self-perceived health among psychiatric patients in North Denmark Region, in terms of internal consistency, criterion validity and responsiveness. METHOD: Patients in contact with a psychiatric hospital in the North Denmark Region from September 2018 to March 2021 were included in the study. The PROM constitutes a scale of 17 items covering various aspects of self-perceived health including well-being (7 items), lack of well-being (5 items) and social functioning (5 items), where the former domain entails the WHO-5 Well-Being Index. The potential range of the total scale score is 0-85. We applied McDonald's omega, average inter-item correlation (AIIC) and differential item functioning (DIF). In addition, we used mixed effects analyses to estimate temporal correlations. The instrument was compared with self-rated overall mental and psychiatric health. RESULTS: The patient population consisted of 1132 unique patients and a total of 2476 responses corresponding to one response per patient pathway. McDonald's omega was found to be 0.92 (95% CI 0.92 to 0.93), while the AIIC was found to be 0.42 (95% CI 0.39 to 0.44). For DIF, the largest systematic variation resulted in a maximum difference of 2.3 points on the total score when adjusting for the latent trait and was found when comparing initial measurements with follow-up measurements. The correlation between the total score and the outcomes regarding overall physical and mental health was 0.52 (95% CI 0.48 to 0.56) and 0.74 (95% CI 0.72 to 0.76). Similar correlations were found for the corresponding changes over time. CONCLUSION: The scale showed high consistency and little systematic variation between the comparison groups. The concurrent correlations and analyses of responsiveness coincided with the prespecified hypotheses. Overall, we deem the Danish PRO-Psychiatry instrument to possess suitable psychometric properties for measuring self-perceived health among a psychiatric population.

Disparities in prehospital and emergency surgical care among patients with perforated ulcers and a history of mental illness: a nationwide cohort study.

PURPOSE: To compare patients with and without a history of mental illness on process and outcome measures in relation to prehospital and emergency surgical care for patients with perforated ulcer. METHODS: A nationwide registry-based cohort study of patients undergoing emergency surgery for perforated ulcer. We used data from the Danish Prehospital Database 2016-2017 and the Danish Emergency Surgery Registry 2004-2018 combined with data from other Danish databases. Patients were categorized according to severity of mental health history. RESULTS: We identified 4.767 patients undergoing emergency surgery for perforated ulcer. Among patients calling the EMS with no history of mental illness, 51% were identified with abdominal pain when calling the EMS compared to 31% and 25% among patients with a history of moderate and major mental illness, respectively. Median time from hospital arrival to surgery was 6.0 h (IQR: 3.6;10.7). Adjusting for age, sex and comorbidity, patients with a history of major mental illness underwent surgery 46 min (95% CI: 4;88) later compared to patients with no history of mental illness. Median number of days-alive-and-out-of-hospital at 90-day follow-up was 67 days (IQR: 0;83). Adjusting for age, sex and comorbidity, patients with a history of major mental illness had 9 days (95% CI: 4;14) less alive and out-of-hospital at 90-day follow-up. CONCLUSION: One-third of the population had a history of mental illness or vulnerability. Patients with a history of major mental illness were less likely to be identified with abdominal pain if calling the EMS prior to arrival. They had longer delays from hospital arrival to surgery and higher mortality.

Multi-morbid patients with co-existing mental and physical illness.

This review investigates the mortality gap that exists between people with or people without mental illness. Poor physical health is the leading cause of excess mortality among people with mental illness. Mental disorders increase the risk of developing a broad range of physical diseases and the risk of death caused by somatic diseases is increased. Also, mental disorder is associated with less optimal treatment in the somatic healthcare system, which is also evident within a broad spectrum of somatic diseases. The role of structural factors such as the design of the healthcare system and stigma are developing.

Music to improve sleep quality in adults with depression-related insomnia (MUSTAFI): randomized controlled trial.

BACKGROUND: Insomnia in depression is common and difficult to resolve. Unresolved depression-related sleep disturbances increase risk of relapse at high costs for individuals and society. Trials have suggested music for insomnia in various populations, but there is little research on the effectiveness of music for depression-related insomnia. METHODS: We examined the efficacy of a music intervention on insomnia, depression symptoms and quality of life in adults with depression-related insomnia. A two-armed randomized controlled trial was conducted, including depression outpatients with insomnia (n = 112) in a 1:1 ratio to music intervention and waitlist control group. The intervention group listened to music at bedtime for 4 weeks. Participants received treatment as usual during 8 weeks with assessments at baseline, at 4 and 8 weeks. The primary outcome measure was Pittsburgh Sleep Quality Index (PSQI), secondary outcomes comprised Actigraphy, the Hamilton Depression Rating Scale (HAMD-17) and World Health Organisation well-being questionnaires (WHO-5, WHOQOL-BREF). RESULTS: The music intervention group experienced significant improvements in sleep quality and well-being at 4 weeks according to global PSQI scores (effect size = -2.1, 95%CI -3.3; -0.9) and WHO-5 scores (effect size 8.4, 95%CI 2.7;14.0). At 8 weeks, i.e. 4 weeks after termination of the music intervention, the improvement in global PSQI scores had decreased (effect size = -0.1, 95%CI -1.3; 1.1). Actigraphy sleep assessments showed no changes and there was no detection of change in depression symptoms. CONCLUSIONS: Music intervention is suggested as a safe and moderately effective sleep aid in depression-related insomnia. Trial registration: Clinicaltrials.gov. ID NCT03676491.

Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions.

OBJECTIVE: Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. METHODS: For coercive episodes reported to the national administrative register for the period 2011-16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex. RESULTS: Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint. CONCLUSION: The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.

Differences in quality of care, mortality, suicidal behavior, and readmissions among migrants and Danish-born inpatients with major depressive disorder.

BACKGROUND: The increasing global migration has made migrants' health a pertinent topic. This article aimed to examine whether migrants were less likely than Danish-born residents to receive guideline recommended care when hospitalized for major depressive disorder (MDD) and potential differences in clinical outcomes, including all-cause mortality, suicidal behavior, and readmissions during 1-year follow-up after first-time admission. METHODS: A national cohort study was performed, including all adult MDD inpatients at mental care units in the period 2011-2017. Migrants and two migrant subgroups (non-Western and Western) were compared with Danish-born patients. Quality of care was examined using multivariable Poisson and linear regression models. Clinical outcomes were examined using Cox proportional hazards regression analysis. RESULTS: Migrant-status was associated with a non-significantly lower chance of receiving high-quality care (relative risk [RR] = 0.93, confidence interval [CI] 0.86:1.01) and lower readmission rates for depression (hazard rate ratio [HR] = 0.93, CI 0.86:1.01), and significantly higher all-cause mortality (HR = 1.55, CI 1.19:2.01) and lower all-cause readmission rate (HR = 0.88, CI 0.83:0.94). No clear association was found regarding suicidal behavior. While associations were comparable for migrant subgroups regarding readmission, the associations with low quality of care and of all-cause mortality appeared strongest among Western migrants. CONCLUSIONS: Among inpatients with MDD in a universal tax-financed healthcare system, being a migrant was associated with a potential lower quality of in-hospital care and worse clinical outcomes. These results warrant further investigation to clarify the underlying explanation for these inequalities and to develop and test interventions to ensure better quality of care and clinical outcomes for migrant patients.

Disparities in Reperfusion Therapy and Time Delays Among Patients With Ischemic Stroke and a History of Mental Illness.

BACKGROUND: Comorbid mental illness may delay recognition of stroke symptoms and reduce the chance of reperfusion therapy. The aim of this study was to compare the use of reperfusion therapy and treatment delays in patients with or without a history of mental illness. METHODS: A nationwide registry-based cohort study of patients with ischemic stroke. We combined data from the Danish Stroke Registry and the Danish Quality Database for Prehospital Emergency Medical Services from 2016 to 2017 containing information on reperfusion therapy (thrombolysis or thrombectomy) and relevant time stamps. Patients were categorized according to the severity of their mental health history (how recent and severity, for example, hospital- versus primary-based care). RESULTS: A total of 19 592 admissions were included (18% had a minor, 3% had a moderate, and 3% had a history of major mental illness). Significant differences were found regarding age, comorbidity, and socioeconomic factors. Reperfusion therapy was used in 17% of patients. Patients with a history of mental illness were less likely to receive reperfusion therapy: risk ratios with 95% CI were 0.79 (0.72-0.86) for minor, 0.85 (0.72-0.99) for moderate, and 0.63 (0.51-0.77) for patients with a history major mental illness, respectively. Total prehospital delay was longer for patients with a history of major mental illness compared to patients with no history of mental illness, especially when no call had been made to the emergency medical service. The median times from symptom onset to hospital arrival was 811 minutes (197-2845) and 115 minutes (41-188), respectively. We found no differences regarding door-to-needle time, response time, on-scene time, transport time, nor in time-to-imaging among patients arriving within 4 hours from symptoms onset between patients with and without a history of mental illness. CONCLUSIONS: Almost one-quarter of patients with ischemic stroke had a history of mental illness. Regardless of severity of mental illness, these patients were less likely to receive reperfusion therapy. Longer delays from symptom onset to hospital arrival contributed to the patients' risk of not being eligible for reperfusion therapy.

Inequities in Mental Health Care Quality and Clinical Outcomes Among Inpatients with Depression Within a Tax-Financed Universal Health Care System.

Purpose: The objective was to examine potential socioeconomic inequities in guideline recommended quality of care as well as several clinical outcomes among first-time inpatients with major depressive disorder (MDD) in a tax-financed universal health care system. Patients and Methods: A nationwide cohort study was performed based on individual-level record linkage of public registers in Denmark. The study included all adult incident inpatients with MDD at Danish psychiatric hospitals in the period 2011-2017 (n=10,949). Socioeconomic position was assessed according to the level of education and income. Outcomes included quality of depression care for inpatients as reflected by the fulfillment of guideline recommended quality of care measures as well as clinical outcomes in terms of all-cause mortality, suicidal behavior, readmission for depression and all-cause readmission. Results: Patients with low-level education or low-level income were statistically significantly less likely to receive high quality of in-hospital care, defined as fulfillment of at least 70% of relevant performance measures (adjusted relative risk (RR) 0.92 and 0.87, respectively). In addition, the same patients had a higher all-cause mortality (adjusted RR 1.22 and 1.41, respectively). Patients with low education or middle income were associated with a higher risk of suicidal behavior (adjusted RR 1.28 and 1.19, respectively). While no differences were found in the risk of all-cause readmission, low-level education and income was associated with a lower risk of readmission due to MDD (adjusted RR 0.91 and 0.87, respectively). Conclusion: Inequities in quality of care and clinical outcomes were observed among MDD inpatients in a tax-financed universal health care system, indicating that lack of access to care and insurance is not the only explanation for inequity in health.

Composite measures of quality of health care: Evidence mapping of methodology and reporting.

BACKGROUND: Quality indicators are used to quantify the quality of care. A large number of quality indicators makes assessment of overall quality difficult, time consuming and impractical. There is consequently an increasing interest for composite measures based on a combination of multiple indicators. OBJECTIVE: To examine the use of different approaches to construct composite measures of quality of care and to assess the use of methodological considerations and justifications. METHODS: We conducted a literature search on PubMed and EMBASE databases (latest update 1 December 2020). For each publication, we extracted information on the weighting and aggregation methodology that had been used to construct composite indicator(s). RESULTS: A total of 2711 publications were identified of which 145 were included after a screening process. Opportunity scoring with equal weights was the most used approach (86/145, 59%) followed by all-or-none scoring (48/145, 33%). Other approaches regarding aggregation or weighting of individual indicators were used in 32 publications (22%). The rationale for selecting a specific type of composite measure was reported in 36 publications (25%), whereas 22 papers (15%) addressed limitations regarding the composite measure. CONCLUSION: Opportunity scoring and all-or-none scoring are the most frequently used approaches when constructing composite measures of quality of care. The attention towards the rationale and limitations of the composite measures appears low. DISCUSSION: Considering the widespread use and the potential implications for decision-making of composite measures, a high level of transparency regarding the construction process of the composite and the functionality of the measures is crucial.

Exploring the relation between clinician ratings and patient-reported experience and outcomes.

BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important ways for patients to be more actively involved in their treatment and enhance shared decision-making. OBJECTIVE: The current study investigated the associations between PROMs, PREMs and various symptoms measures reported by clinicians and psychiatric patients. METHOD: One hundred and twenty people admitted to a psychiatric hospital completed two PREMs, one PROM (the shortened version of the Manchester Short Assessment of Quality of Life scale) and Effects of Symptoms on Daily Functioning (the Sheehan Disability Scale), the Patient Clinical Global Impression and the Modified Colorado Symptom Index. Their psychiatrists rated them using the Global Assessment of Functioning scale, the Health of the Nation Outcome Scales and the Therapist Clinical Global Impression. RESULTS: There was a strong correlation between patient's evaluation of their quality of life (PROM), experience of their care (PREM) and the overall severity of their condition and their progress. The pattern of correlation between patients' and clinicians' measures revealed a three-layer structure representing a continuum from inner experience to external presentation of experiences. CONCLUSION: Together these findings help identify and emphasize various domains of subjective experiences and their relation to external ratings.

Evaluating the implementation and use of patient-reported outcome measures in a mental health hospital in Denmark: a qualitative study.

BACKGROUND: Reporting of barriers and successes associated with the implementation and use of patient-reported outcomes (PROs) is limited as a means to ensure enhanced patient involvement, shared decision-making and improved treatment and care. We set out to evaluate the implementation and use of the PRO-Psychiatry initiative on patient-reported outcome measures in Danish mental health care. We aimed to described four specific areas: the quality of the clinical consultations before and after the implementation of PRO-Psychiatry as perceived by the patients (objective A), the motivation for participating in PRO-Psychiatry as perceived by patients and clinicians (objective B), the implementation process as perceived by patients, clinicians and managers (objective C) and suggestions for improvement (objective D). METHODS: The PRO-Psychiatry initiative was evaluated through a participatory approach, including patients, clinicians and managers. A repeated cross-sectional interview-based survey explored the quality of the clinical consultation before and after the implementation of PRO-Psychiatry. A three-step semi-structured group interview, inspired by the modified mini-Delphi method, was used to establish consensus on the evaluation of the implementation and use of the initiative. RESULTS: The evaluation pointed at PRO-Psychiatry as a meaningful initiative, which motivated patients and supported clinicians. The patients emphasised the importance of PROs, but they also found that PROs were not used enough. Clinically relevant improvements were detected after the implementation of the initiative; more patients felt heard and experienced that clinicians took a greater interest in their problems. The clinicians valued the easily accessible real-time graphical display of the PRO responses in the electronic health record (EHR). Clinicians and managers agreed that clinical PRO practices, patient compliance and use of PROs in treatment and care should be supported during implementation. CONCLUSION: The evaluation was overall positive. Patients and clinicians were willing to participate, found the online reporting easy and valued the direct access to PRO responses in the EHR. An essential feature was the integration of well-defined and functional PRO practices into the existing clinical workflow. Using PROs in the clinical sessions in a way that was palpable to the patient was found to be a significant improvement need. At the individual level, PRO-Psychiatry can use patient outcome information to support dialogue, encourage shared decision-making and promote self-management during recovery. At the aggregated patient level, the PROs can be used for monitoring the patient-perceived quality of care and for research.

Using patient-reported outcome measures in psychiatric hospital care: an observational study describing an iterative implementation process in Denmark.

BACKGROUND: Patient-reported outcomes (PROs) are increasingly recognized as valuable sources of information to enhance our understanding of the quality of healthcare from the patient's perspective. OBJECTIVE: This study aimed to describe the implementation process of the Danish nationwide PRO-Psychiatry project, including iterative tests of previously developed PRO measurement concept and an online data collection tool. Additional aims were to identify the 'best practice' for the routine use of PROs in hospital-based psychiatry and design information material about the project. METHODS: We conducted an action-oriented observational study to explore the pilot implementation of the PRO-Psychiatry project, which was initiated in February 2018. The study was based on an iterative plan-do-learn approach. An inpatient unit and an outpatient unit from the same psychiatric department in the North Denmark Region were selected for the pilot implementation. The implementation was anchored in multidisciplinary implementation teams at unit level. These teams managed the implementation process according to four tasks defined by the department management. RESULTS: The teams designed, tested, evaluated and adjusted the localized work practices relating to the use of PRO-Psychiatry. The comprehensibility of the predesigned PROs, the usability of the Information Technology(IT) system and the routine use of PROs during clinical consultations were repeatedly tested and adjusted until the functionality was satisfactory. Furthermore, the teams designed information material for patients (emails, posters, handouts and webpages) and clinicians (online clinical guidelines). The team members informed their colleagues about the progress of PRO-Psychiatry at staff meetings and rolled out the initiative through one-to-one teaching. CONCLUSIONS: The pilot implementation was deemed successful. PRO-Psychiatry was rolled out to other units in the region, and a national decision was made to pilot implement the initiative in the other four Danish regions.

Patient-reported outcome measures in mental health clinical research: a descriptive review in comparison with clinician-rated outcome measures.

PURPOSE: To review how patient-reported outcome (PRO) measures in mental health clinical research complement traditional clinician-rated outcome (CRO) measures. DATA SOURCES: Medline, Embase, PsycInfo and Scopus. STUDY SELECTION: Latest update of the literature search was conducted in August 2019, using a specified set of search terms to identify controlled and uncontrolled studies (published since 1996) of pharmacological or non-pharmacological interventions in adults (≥18 years) in hospital-based mental health care. DATA EXTRACTION: Two authors extracted data independently using a pre-designed extraction form. RESULTS OF DATA SYNTHESIS: Among the 2962 publications identified, 257 were assessed by full text reading. A total of 24 studies reported in 26 publications were included in this descriptive review. We identified subjective and objective outcome measures, classified these according to the pharmacopsychometric triangle and compared them qualitatively in terms of incremental information added to the clinical study question. The data reviewed here from primarily depression and schizophrenia intervention studies show that results from PRO measures and CRO measures generally point in the same direction. There was a relative lack of PRO measures on functioning and medication side effects compared with PRO measures on symptom burden and health-related quality of life. CONCLUSION: PROs and CROs supplement each other and at most times support identical study conclusions. Future studies would benefit from a more systematic approach toward use of PROs and a clearer rationale of how to weigh and report the results in comparison with CROs.

Analysis of Suicides Reported as Adverse Events in Psychiatry Resulted in Nine Quality Improvement Initiatives.

Background: The majority of persons who die by suicide have a mental disorder. Preventive strategies should include addressing social and psychological factors and the treatment of the mental disorder. Aim: We aimed to identify breaches in clinical care and identify areas for quality improvement initiatives. Method: An aggregate analysis of suicides reported as adverse events during 2012-2016 to Psychiatry, North Denmark Region was carried out. We developed an audit chart and identified items through (a) medical chart review and (b) consensus meetings in an expert panel. Results: A total of 35 cases were analyzed. Suicide risk assessments were adequately documented in the medial chart in six of 35 cases. Risk assessments emphasized suicidal ideation rather than well-known risk factors such as previous suicide attempts, substance abuse, physical illness, or job loss. Relatives were involved in four of 35 of the risk assessments. The panel suggested nine areas for quality improvement. Limitations: Most people who die by suicide are not seen in mental health facilities prior to suicide, and hence conclusions can only be generalized to these patients. Information on the gap between "Work-as-Done" and "Work-As-Imagined" was not recognized. Conclusion: Most of the risk assessments among suicides reported as adverse events to our mental health facilities were insufficient. Quality improvement initiatives focusing on training, documentation, involving relatives, communication, and data sharing must be planned to improve clinical care.

From accreditation to quality improvement-The Danish National Quality Programme.

The Danish government launched a new National Quality Programme (NQP) in healthcare in 2015. It has changed the focus from old public management in terms of accreditation, regulation, rules and standards to new public governance focusing on delivering high quality healthcare and outcomes of value for the patients, health professionals and the Danish healthcare system. The NQP aims to strengthen the focus on continuous quality improvement and the launch of the programme was accompanied by a decision to phase out accreditation of public hospitals. The NQP includes 1) eight specific national quality goals, 2) a national educational programme for quality management, and 3) establishment of quality improvement collaboratives. Since the establishment of the NQP the indicator results have improved in several important clinical areas. However, causal conclusions related to the effect of the NQP cannot yet be made. This perspective on quality paper aims to give a short introduction to the NQP and documented outcomes.

Emergency Medical Services response levels and subsequent emergency contacts among patients with a history of mental illness in Denmark: a nationwide study.

BACKGROUND AND IMPORTANCE: People with mental illness have higher use of emergency services than the general population and may experience problems with navigating in complex healthcare systems. Poor physical health contributes to the excess mortality among the mentally ill. OBJECTIVE: To compare the level of Emergency Medical Services (EMS) response and subsequent contacts emergency between patients with and without a history of mental illness. DESIGN, SETTING, AND PARTICIPANTS: A nationwide cohort study was conducted in Denmark including medical 1-1-2 calls 2016 2017. The healthcare system is financed through taxation allowing free access to healthcare services including ambulance services. EXPOSURE: Exposed groups had a history of major, moderate, or minor mental illness. OUTCOME MEASURES AND ANALYSIS: We studied seven national prehospital care Performance Indicators (PI 1-7). The selected PI concerned EMS response levels and subsequent contacts to prehospital and in-hospital services. Exposed groups were compared to nonexposed groups using regression analyses. RESULTS: We included 492 388 medical 1-1-2 calls: 8, 10, and 18% of calls concerned patients with a history of major, moderate, or minor mental illness, respectively.There were no clinically relevant differences regarding response times (PI 1-2) or registration of symptoms (PI 3) between groups.If only telephone advice was offered, patients with a history of major, moderate or minor mental illness were more likely to recall within 24 h (PI 4): adjusted risk ratio (RR) 2.11 (1.88-2.40), 1.96 (1.20-2.21), and 1.38 (1.20-1.60), but less or equally likely to have an unplanned hospital contact within 7 days (PI 6): adjusted RRs 1.05 (0.99-1.12), 1.04 (0.99-1.10), and 0.90 (0.85-0.94), respectively.If released at the scene, the risk of recalling (PI 5) or having an unplanned hospital contact (PI 7) was higher among patients with a history of mental illness: adjusted RRs 2.86 (2.44-3.36), 2.41 (2.05-2.83), and 1.57 (1.35-1.84), and adjusted RRs 2.10 (1.94-2.28), 1.68 (1.55-1.81), and 1.25 (1.17-1.33), respectively.Patients with a history of mental illness were more likely to receive telephone advice only adjusted RRs 1.61 (1.53-1.70), 1.30 (1.24-1.37), and 1.08 (1.04-1.13), and being released at scene adjusted RRs 1.11 (1.08-1.13), 1.03 (1.01-1.04), and 1.05 (1.03-1.07). CONCLUSION: More than one-third of the study population had a history of mental illness. These patients received a significantly lighter EMS response than patients with no history of mental illness. They were significantly more likely to use the emergency care system again if released at scene. This risk increased with the increasing severity of the mental illness.

Patient-reported indicators in mental health care: towards international standards among members of the OECD.

BACKGROUND: Achieving people-centred health care systems requires new and innovative strategies to capture information about whether, and to what degree, health care is successful in improving health from the perspective of the patient. Patient-reported outcome measures (PROMs) and Patient-reported experience measures (PREMs) can bring some of these new insights, and are increasingly used in research, clinical care, and policymaking. METHODS: This paper reflects the ongoing discussions and findings of the OECD PaRIS Working Group on Patient-reported Indicators for Mental Health Care. RESULTS: The OECD has been measuring quality of care for mental health conditions over the last 14 years through the Health Care Quality and Outcomes (HCQO) program; nonetheless, information on how persons with mental health problems value the services they receive, and impact of the services, remains limited. As of 2018, a survey from the OECD showed that only five of the twelve countries surveyed (Australia, Israel, Netherlands, Sweden, United Kingdom) reported PROMs and PREMs collection on a regular basis in mental health settings. The paper details some of the challenges specific to the collection and use of PROMs and PREMs in mental health care, and examples from countries which have implemented comprehensive programmes to gather information about PROMs and PREMs for individuals receiving mental health services. CONCLUSIONS: Given the health and economic impact of mental ill-health across all OECD countries, there is significant value to being able to assess the quality and outcomes of care in this area using internationally-comparable measures. Continued international harmonisation of PROMs and PREMs for mental health through international coordination is a key way to facilitate the sharing of national experiences, promote the use of PROMs and PREMs, and create meaningful indicators for national and international benchmarking.

Measuring patient voice matters: setting the scene for patient-reported indicators.

BACKGROUND: Achieving people-centred health care systems requires new and innovative strategies to capture information about whether, and to what degree, health care is successful in improving health from the perspective of the patient. Patient-reported outcome measures (PROMs) and Patient-reported experience measures (PREMs) can bring some of these new insights, and are increasingly used in research, clinical care, and policymaking. METHODS: This paper reflects the ongoing discussions and findings of the OECD PaRIS Working Group on Patient-reported Indicators for Mental Health Care. RESULTS: The OECD has been measuring quality of care for mental health conditions over the last 14 years through the Health Care Quality and Outcomes (HCQO) program; nonetheless, information on how persons with mental health problems value the services they receive, and impact of the services, remains limited. As of 2018, a survey from the OECD showed that only five of the twelve countries surveyed (Australia, Israel, Netherlands, Sweden, United Kingdom) reported PROMs and PREMs collection on a regular basis in mental health settings. The paper details some of the challenges specific to the collection and use of PROMs and PREMs in mental health care, and examples from countries which have implemented comprehensive programmes to gather information about PROMs and PREMs for individuals receiving mental health services. CONCLUSIONS: Given the health and economic impact of mental ill-health across all OECD countries, there is significant value to being able to assess the quality and outcomes of care in this area using internationally-comparable measures. Continued international harmonisation of PROMs and PREMs for mental health through international coordination is a key way to facilitate the sharing of national experiences, promote the use of PROMs and PREMs, and create meaningful indicators for national and international benchmarking.

Quality in practice: applying the patient inventory method at a Danish psychiatric hospital.

QUALITY PROBLEM: Patient care pathways should be organized according to the needs of the patients. This requires methods to assess whether the specific pathways ensure the right care for the right person at the right time and in the right setting. INITIAL ASSESSMENT: Previous investigations indicate that ~25% of the patients in Danish hospitals experience inappropriate elements in their care pathways. CHOICE OF SOLUTION: This study applied the Patient Inventory method to identify inappropriate elements in care pathways in 15 psychiatric in-patient wards in Denmark. IMPLEMENTATION: The pathway for 201 patients was systematically evaluated by the clinical staff to identify whether the admission of the patient was avoidable, the hospitalization was unnecessarily prolonged or if the patient could receive more relevant treatment elsewhere. A subsequent meeting between the clinical staff and management qualified the assessment and identified possible solutions to problems. EVALUATION: A total of 54 (26.9%) of the included patients were assessed to have inappropriate elements in their care pathways, some with more than one type, resulting in a total of 65 episodes.Eight of these episodes (13.1%) were admissions considered to be avoidable, 26 (42.2%) were unnecessary prolongation of admissions, and 31 (58.1%) were patients assessed to be able to receive more relevant care elsewhere. LESSONS LEARNED: One out of four assessed patients admitted to a psychiatric ward was exposed to an inappropriate element in their care pathway. The Patient Inventory tool can assist in a structured dialogue between clinical staff and management to identify focus areas for improvement efforts.