12 research outputs found
A prototype software framework for transparent, reusable and updatable computational health economic models
Most health economic analyses are undertaken with the aid of computers.
However, the ethical dimensions of implementing health economic models as
software (or computational health economic models (CHEMs)) are poorly
understood. We propose that developers and funders of CHEMs share ethical
responsibilities to (i) establish socially acceptable user requirements and
design specifications; (ii) ensure fitness for purpose; and (iii) support
socially beneficial use. We further propose that a transparent (T), reusable
(R) and updatable (U) CHEM is suggestive of a project team that has largely
fulfilled these responsibilities. We propose six criteria for assessing CHEMs:
(T1) software files are open access; (T2) project team contributions and
judgments are easily identified; (R1) programming practices promote
generalisability and transferability; (R2) licenses restrict only unethical
reuse; (U1) maintenance infrastructure is in place; and (U2) new releases are
systematically retested and appropriately deprecated. To facilitate CHEMs that
meet TRU criteria, we have developed a prototype software framework in the
open-source programming language R. The framework comprises six code libraries
for authoring CHEMs, supplying CHEMs with data and undertaking analyses with
CHEMs. The prototype software framework integrates with services for software
development and research data archiving. We determine that an initial set of
youth mental health CHEMs we developed with the prototype software framework
wholly meet criteria T1-2, R1-2 and U1 and partially meet criterion U2. Our
assessment criteria and prototype software framework can help inform and
improve ethical implementation of CHEMs. Resource barriers to ethical CHEM
practice should be addressed by research funders.Comment: 17 pages, 4 tables, 1 figur
Heterogeneity of quality of life in young people attending primary mental health services
AIMS: The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics. METHODS: Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership. RESULTS: 1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features. CONCLUSIONS: Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened
Who are the ‘Missing Middle’? Obtaining a consensus definition of the ‘Missing Middle’ from experts in youth mental health
Background: As highlighted in Australia’s Royal and Productivity Commissions into mental health, significant subgroups of individuals are failing to have their needs met, or are ‘falling through the cracks’ in the current system - a phenomenon increasingly referred to as the missing middle. A barrier to devising solutions is that the term missing middle is not clearly defined. Using the Delphi method, we aimed to define the term and explore the acceptability of the proposed definition.
Method: Three expert groups were recruited through advertisements and targeted email invitations. Experts included: carers and young people with a lived experience of mental ill-health; researchers and policy makers; clinicians, and service providers. Using a three-stage Delphi process, we elicited definitions, refined, and developed a consensus definition.
Results: Ten subthemes describing the missing middle were identified, with four of these endorsed across all expert groups from the outset: service gap, inflexibility, inadequate service quality and duration, and social disadvantage. Additional subthemes were later endorsed. Feedback was sought on a consensus-driven definition that encompassed the original four endorsed subthemes.
Conclusion: A broad definition of the missing middle was developed, repositioning the term to a systems lens, referring to a missing middle service gap. The newly formulated definition represents the missing middle as a term to describe a gap in care where existing mental health services are not meeting the needs of individuals in a meaningful way. The study also demonstrated the utility of the Delphi approach in capturing and unifying viewpoints from diverse expert groups