Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health.

AIMS: Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. METHODS: This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. RESULTS: The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. CONCLUSIONS: Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.

Standard comparison of local mental health care systems in eight European countries.

AIMS: There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. METHODS: A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. RESULTS: The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. CONCLUSIONS: There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.

Use of an integrated Atlas of Mental Health Care for evidence informed policy in Catalonia (Spain).

BACKGROUND: This paper aims to present the Integrated Atlas of Mental Health of Catalonia (2010) focusing on: (a) the importance of using a taxonomy-based coding and standard system of data collection when assessing health services; and (b) its relevance as a tool for evidence-informed policy. METHOD: This study maps all the care-related services for people with mental disorders available in Catalonia in 2010, using the 'Description and Evaluation of Services and Directories in Europe for long-term care' (DESDE-LTC). The unit of analysis is the Basic Stable Input of Care (BSIC), which is the minimal organisation unit composed by a set of inputs with temporal stability. We presented data on: (a) availability of BSICs and their capacity; (b) the adequacy of the provision of care, taking into account availability and accessibility; (c) the evolution of BSCIs from 2002 to 2010; and (d) the perceived relevance of Atlas of Mental Health as a tool for evidence-informed policy. RESULTS: We identified a total of 639 BSICs. A lack of Health services was detected in highly rural areas, although there was moderate availability of Social Services. Overall, more than 80% of the small mental health areas in Catalonia had an adequate core mental health service. Since 2002 the availability of mental health services has increased. Decision makers found the Atlas a useful and relevant tool for evidence informed policy. CONCLUSIONS: Policy makers can use Atlases to detect gaps and inequities in the provision of care for people with mental health needs.

Epidemiología de gestión de la morbilidad psiquiátrica atendida en los hospitales españoles / No disponible

Introducción: Para una correcta planificación enSalud Mental es fundamental conocer la carga asistencialhospitalaria derivada de los ingresos psicopatológicos,por ello abordamos el estudio de la realidad psiquiátricahospitalaria española.Objetivo: Analizar los episodios hospitalarios psiquiátricosen España y las variables sociodemográficasy clínicas asociadas a estos.Material y métodos: Estudio epidemiológico descriptivode la morbilidad en psicopatología hospitalaria,bajo un diseño ecológico. Se analizan todos los ingresospsiquiátricos de los hospitales del Sistema Nacional deSalud (SNS) del año 2002 (69.413 altas), utilizandocomo fuentes de información el Conjunto Mínimo deDatos al Alta Hospitalaria (CMBDAH) y los GruposRelacionados por el Diagnóstico (GRD).Resultados y discusión: Se evidencian diferencias enfunción del sexo (principalmente psicopatológicas y deestancia hospitalaria) y se constata, mediante indicadoresmultivariantes, la diversidad en cuanto a carga asistencialy a la gestión que de los episodios de hospitalizaciónrealizan las diferentes comunidades(AU)

Introduction: According to a correct Mental Healthplanning, to know the hospital assistance load derivedfrom the psychiatric admissions is required. Thus, westudied the psychiatric hospitalization reality in Spain.Objective: To analyse the psychiatric hospitalizationepisodes in Spain, and its clinical and social-demographicvariables associated.Material and methods: Epidemiologic descriptivestudy of the morbidity in psychopathology hospitalization,within an ecological design. The analysis of all thepsychiatric admissions in the National Health SystemHospitals (SNS) for the year 2002 was effected (69,413admissions), using the Minimum Basic Data Set at HospitalDischarge (CMBDAH) and Diagnosis RelatedGroups (DRG’s), as sources of information.Results and discussion: Differences in terms of sexare showed (mainly, psycho-pathologic and hospitalstay), and the diversity as for assistance load and for themanagement of the hospitalization episodes conductedby the different autonomous regions is noted, by meansof multivariate indicators(AU)