Modelling mental healthcare improvement in highly integrated care systems: the case of the Basque Country (Spain)

Currently there is growing interest in providing integrated mental health care between hospital (acute residential care) and community-based services (… and other health systems). Mental health systems are complex due to the high disorder prevalence, socio-economic burden, stigma associated, and high gap of unmet population needs. Mental health can be considered an ecosystem related to, at least, physical health and social services ones. Decision support systems are robust tools for guiding and improving planning and management of health ecosystems by integrating methods like Bayesian networks. These models identify critical variables, domains and constructs and their corresponding causal relationships. The objective of this research is to design an integrated and integral theoretical Bayesian network for guiding mental health planning and management, and in consequence, improving mental health care delivery

Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland)

Background Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. Objective The purpose of this study was to observe the patterns of use and their technical performance (efciency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential rela‑ tionship between technical performance and the corresponding workforce structure. Methods The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. Results The analysis showed a statistically signifcant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efciency on average and a low probability of being efcient. The most efcient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. Conclusions The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efciency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of efective policies and interventions in the southern Finnish MH system

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

Sistema de Salut Mental; Comparació d'atenció a la salut mentalMental Health System; Mental health care comparisonSistema de Salud Mental; Comparación de atención a la salud mentalAims: 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.The REFINEMENT project has received funding from the European Commission under the Seventh Framework Programme (7FP) and lies within the Specific Programme ‘Cooperation’ – Theme ‘Health’: HEALTH.2010.3.2–1: Financing systems’ effect on quality of health care. Duration: 1 January 2011 to 31 December 2013. 7FP. Project number: 261459

Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020

Objetivo: Este artículo revisa y evalúa el uso de los Atlas Integrales de Salud Mental como herramientas de apoyo a la planificación de servicios dentro del modelo de investigación de ecosistemas de atención de salud. Método: Se describen los tipos de atlas y el procedimiento para su elaboración. Se presentan los realizados en España y se evalúa su impacto en la planificación de servicios de salud mental. Los atlas agregan información sobre las características locales del sistema de atención, la disponibilidad geográfica de recursos recogida mediante el instrumento DESDE-LTC, y su uso. Utilizan un sistema de información geográfica y otras herramientas visuales. Siguen una metodología de abajo arriba con colaboración de personas decisoras de agencias de planificación para su elaboración y validación externa. Resultados: Desde 2005 se han realizado Atlas Integrales de Salud Mental en nueve comunidades autónomas que comprenden alrededor del 65% de la población de España. Los atlas han tenido un impacto desigual en la planificación de servicios, con un mayor impacto en Cataluña, Vizcaya y Guipúzcoa, y Andalucía, donde responsables sociales han participado activamente en su codise ˜no y su aplicación a la planificación de servicios sociosanitarios. Conclusiones: Los atlas permiten detectar carencias o duplicidades en la atención, monitorizar cambios a lo largo del tiempo, realizar comparaciones nacionales e internacionales, modelar la eficiencia y hacer análisis benchmark. Este conocimiento puede incorporarse a los sistemas de apoyo a la decisión para una más eficaz planificación de los servicios de salud mental basada en evidencia informada.Objective: This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. Method: This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. Results: Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. Conclusions: Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy

Pattern of healthcare resource utilization and direct costs associated with manic episodes in Spain

<p>Abstract</p> <p>Background</p> <p>Although some studies indicate that bipolar disorder causes high health care resources consumption, no study is available addressing a cost estimation of bipolar disorder in Spain. The aim of this observational study was to evaluate healthcare resource utilization and the associated direct cost in patients with manic episodes in the Spanish setting.</p> <p>Methods</p> <p>Retrospective descriptive study was carried out in a consecutive sample of patients with a DSM-IV diagnosis of bipolar type I disorder with or without psychotic symptoms, aged 18 years or older, and who were having an active manic episode at the time of inclusion. Information regarding the current manic episode was collected retrospectively from the medical record and patient interview.</p> <p>Results</p> <p>Seven hundred and eighty-four evaluable patients, recruited by 182 psychiatrists, were included in the study. The direct cost associated with healthcare resource utilization during the manic episode was high, with a mean cost of nearly €4,500 per patient, of which approximately 55% corresponded to the cost of hospitalization, 30% to the cost of psychopharmacological treatment and 10% to the cost of specialized care.</p> <p>Conclusions</p> <p>Our results show the high cost of management of the patient with a manic episode, which is mainly due to hospitalizations. In this regard, any intervention on the management of the manic patient that could reduce the need for hospitalization would have a significant impact on the costs of the disease.</p

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

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.The REFINEMENT project has received funding from the European Commission under the Seventh Framework Programme (7FP) and lies within the Specific Programme ‘Cooperation’ – Theme ‘Health’: HEALTH.2010.3.2–1: Financing systems’ effect on quality of health care. Duration: 1 January 2011 to 31 December 2013. 7FP. Project number: 261459

Automatic Mapping of Discontinuity Persistence on Rock Masses Using 3D Point Clouds

Finding new ways to quantify discontinuity persistence values in rock masses in an automatic or semi-automatic manner is a considerable challenge, as an alternative to the use of traditional methods based on measuring patches or traces with tapes. Remote sensing techniques potentially provide new ways of analysing visible data from the rock mass. This work presents a methodology for the automatic mapping of discontinuity persistence on rock masses, using 3D point clouds. The method proposed herein starts by clustering points that belong to patches of a given discontinuity. Coplanar clusters are then merged into a single group of points. Persistence is measured in the directions of the dip and strike for each coplanar set of points, resulting in the extraction of the length of the maximum chord and the area of the convex hull. The proposed approach is implemented in a graphic interface with open source software. Three case studies are utilized to illustrate the methodology: (1) small-scale laboratory setup consisting of a regular distribution of cubes with similar dimensions, (2) more complex geometry consisting of a real rock mass surface in an excavated cavern and (3) slope with persistent sub-vertical discontinuities. Results presented good agreement with field measurements, validating the methodology. Complexities and difficulties related to the method (e.g. natural discontinuity waviness) are reported and discussed. An assessment on the applicability of the method to the 3D point cloud is also presented. Utilization of remote sensing data for a more objective characterization of the persistence of planar discontinuities affecting rock masses is highlighted herein

Modelling the balance of care: Impact of an evidence-informed policy on a mental health ecosystem

Major efforts worldwide have been made to provide balanced Mental Health (MH) care. Any integrated MH ecosystem includes hospital and community-based care, highlighting the role of outpatient care in reducing relapses and readmissions. This study aimed (i) to identify potential expert-based causal relationships between inpatient and outpatient care variables, (ii) to assess them by using statistical procedures, and finally (iii) to assess the potential impact of a specific policy enhancing the MH care balance on real ecosystem performance. Causal relationships (Bayesian network) between inpatient and outpatient care variables were defined by expert knowledge and confirmed by using multivariate linear regression (generalized least squares). Based on the Bayesian network and regression results, a decision support system that combines data envelopment analysis, Monte Carlo simulation and fuzzy inference was used to assess the potential impact of the designed policy. As expected, there were strong statistical relationships between outpatient and inpatient care variables, which preliminarily confirmed their potential and a priori causal nature. The global impact of the proposed policy on the ecosystem was positive in terms of efficiency assessment, stability and entropy. To the best of our knowledge, this is the first study that formalized expert-based causal relationships between inpatient and outpatient care variables. These relationships, structured by a Bayesian network, can be used for designing evidenceinformed policies trying to balance MH care provision. By integrating causal models and statistical analysis, decision support systems are useful tools to support evidence-informed planning and decision making, as they allow us to predict the potential impact of specific policies on the ecosystem prior to its real application, reducing the risk and considering the population’s needs and scientific findings

Rockfalls: analysis of the block fragmentation through field experiments

Abstract Fragmentation is a common feature of rockfall that exerts a strong control on the trajectories of the generated blocks, the impact energies, and the runout. In this paper, we present a set of four real-scale rockfall tests aimed at studying the fragmentation of the rocky blocks, from the global design of the field procedure to the data analysis and the main results. A total of 124 limestone, dacite, or granite blocks ranging between 0.2 and 5 m3 were dropped from different heights (8.5 to 23.6 m) onto four slopes with different shapes (single or double bench) and slope angles (42º to 71º). The characteristics of the blocks, in particular the size, surface texture and joint condition, were measured before the drops. The trajectories of the blocks and both the initial and the impact velocities were tracked and recorded by means of three high-speed video cameras. A total of 200 block-to-ground impacts have been studied. On average, 40% of the blocks broke upon impact on the slope or on the ground, making it necessary to measure the fragments. The initial and final sizes of the blocks/fragments were measured by hand with tape, though photogrammetric techniques (UAV and terrestrial) were also used for comparison purposes. The information gathered during the field tests provides a deep insight into the fragmentation processes. On the one hand, the high-resolution slow-motion videos help to describe when and how the block breakage takes place and the spatial distribution of the pieces. On the other hand, it is possible to compute the block trajectories, the velocities, and the energy losses using videogrammetry. The results include, for instance, a block average fragmentation of 54% and 14% for the limestone and granitoids, respectively; the systematic inventory of the size fragments, which may be used for fitting the power law distributions; and after each breakage, the total angle of aperture occupied by the fragments has been measured, with values in the range 25º–145º. To figure out the different behavior of the blocks in terms of breakage/no breakage, each block-to-ground impact has been characterized with a set of parameters describing the energy level, the robustness of the substrate, and the configuration of the block contact at the impact point, among others. All these terms are combined in a function F, which is used to adjust the field data. The adjustment has been carried out, first, for the whole 200 events and later for a subset of them. The procedure and the results are described in the paper. Although the discrimination capability of F is moderately satisfactory, it is very sensitive to the test site and setup. It must be highlighted that these field tests are a unique source of data to adjust the parameters of the numerical simulation models in use for rockfall studies and risk mitigation, especially when fragmentation during the propagation is considered

Application of a Statistical Approach for the Assessment of Design Block in Rockfall: A Case Study in Sesia Valley (Northern Italy)

Rockfall is one of the most dangerous and unpredictable slope instabilities. Modelling this phenomenon is a very complex issue because of the high number of variables influencing the triggering and the propagation phases. In particular, the choice of the design block volume can affect the results of the propagation analysis as well as the reliability of the risk mitigation structures (Hungr et al. 1999). Thus, De Biagi et al. (2017b) proposed a methodology based on a statistical approach for building a fallen blocks volume-frequency law. The approach takes into account both the volumes of fallen blocks measured onto the slope and the historical events, providing a relationship between the volume and the recurrence period. A subsequent note (De Biagi 2017) suggests how to take into account the errors that can be made with this methodology due to the usual limited number of recorded events and surveyed blocks. In this paper, the statistical method is applied to a case of recurrent rockfall events that affect Nosuggio village, located in the Sesia Valley (North Piedmont, Italy). The study shows how it is possible to obtain a reliable volume-frequency law even in the case in which a well-structured survey of the blocks is not easy to perform