Scream

This artwork shows the moments where I had felt lost, missing, unworthy, powerless, hopeless, and ultimately alone

Costs and Performance of English Mental Health Providers

Background: Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. Aims of the Study: The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. Methods: The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multilevel log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. Results: There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. Discussion and Limitations: The results suggest that some providers may have to increase efficiency in order to remain financially viable if providers are paid national fixed prices (tariffs) under the new payment system. Although the classification system for payment is not based on diagnosis, a limitation of the study is the inability to explore the effect of diagnosis due to poor coding in the MHMDS. Implications for Health Care Provision and Use: We find that some mental health care providers in England are associated with higher costs of provision after controlling for characteristics of service users and providers. These higher costs may be associated with higher quality care or with inefficient provision of care. Implications for Health Policies: The introduction of a national tariff is likely to provide a strong incentive to reduce costs. Policies may need to consider safe-guarding local health economies if some providers make substantial losses under the new payment regime. Implications for Further Research: Future research should consider the relationship between costs and quality to ascertain whether reducing costs may potentially negatively impact patient outcomes

Building an Aotearoa New Zealand-wide Digital Curation Community of Practice

How do you build awareness and capability for digital curation knowledge and experience across a country? The National Library of New Zealand has a statutory role in supporting and advancing the work of Aotearoa New Zealand libraries to ensure documentary heritage and taonga is collected and preserved across the country’s memory system. This role includes supporting the collecting and curation of born-digital content. Aotearoa New Zealand’s Gallery Library Archive Museum (GLAM) sector is small but varied and diverse, so requires a flexible and adaptive plan to grow experience and capability in this area. This paper will describe the background research undertaken to gain a better understanding of the current environment, describe the development and delivery of pilot training in managing born-digital archival content, and outline our next steps. Driving this effort has been two foundational principles: 1) theory and practice are always in conversation with each other and practical hands-on experience is as important as theoretical knowledge and understanding; and 2) the work of growing capability should be done in a spirt of collaboration and partnership, meeting each other as equals and learning from each other

The performance of mental healthcare providers in England

This thesis investigates the performance of mental health providers in England on resource use (length of inpatient stay and costs) and quality (readmission rates and patient outcomes). Under a new payment system, it is intended that a national tariff (price) based on national average costs will be introduced and a part of future payments will be contingent on outcomes. Therefore, providers will have incentives to control costs and improve patient outcomes. We investigate the potential to achieve these aims using two nationally representative patient-level data sets: Hospital Episode Statistics (HES) and the Mental Health Minimum Data Set (MHMDS). We utilise multilevel models, which allows us to isolate the residual variation in our response variable attributable to providers. Residual variation is quantified using Empirical Bayes (EB) methods and comparative standard errors are used to rank providers to make inferences about performance. We model length of stay (LOS) using a Poisson model; costs using a log-linear model and a generalized linear model (GLM) with a gamma distribution and log link; outcomes using ordered probit and linear models; and costs and outcomes simultaneously using a bivariate model. We employ a comprehensive range of patient and provider covariates. Demographic, diagnostic, severity and treatment variables are key drivers of LOS and costs. Worse outcomes are associated with severity and better outcomes with older age and social support. Provider-level emergency readmission rates are associated with lower LOS and formal admissions with higher LOS. Provider-level variables have negligible effects on outcomes but a notable effect on costs. Ranking providers by residual variation suggests some providers can improve performance. Providers performing below average face financial instability under a national tariff and when a part of payment is linked to outcomes. The correlation in provider-level residual costs and outcomes is miniscule suggesting that cost-containment and outcome improving efforts by providers should not conflict

Utilizing Performance Management to Harness the Power of Quality Improvement in Public Health

Widespread adoption of quality improvement activities in public health trails other U.S. sectors. Launching the national public health accreditation program of the Public Health Accreditation Board (PHAB) has propelled health department momentum around quality improvement uptake. Domain 9 of the PHAB standards focuses on evaluation and improvement of performance, and is acting as a strong driver for quality improvement and performance management implementation within health departments. Several performance management models have received broad acceptance, including among government and nonprofits, and have direct public health application. Turning Point is a model designed specifically for public health users. All models in current use reinforce customer centricity; streamlined, value added processes; and strategic alignment. Importantly, all are structured to steer quality improvement efforts toward organizational priorities, ensuring that quality improvement complements performance management

Costs and Performance of English Mental Health Providers.

BACKGROUND: Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. AIMS OF THE STUDY: The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. METHODS: The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. RESULTS: There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. DISCUSSION AND LIMITATIONS: The results suggest that some providers may have to increase efficiency in order to remain financially viable if providers are paid national fixed prices (tariffs) under the new payment system. Although the classification system for payment is not based on diagnosis, a limitation of the study is the inability to explore the effect of diagnosis due to poor coding in the MHMDS. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: We find that some mental health care providers in England are associated with higher costs of provision after controlling for characteristics of service users and providers. These higher costs may be associated with higher quality care or with inefficient provision of care. IMPLICATIONS FOR HEALTH POLICIES: The introduction of a national tariff is likely to provide a strong incentive to reduce costs. Policies may need to consider safe-guarding local health economies if some providers make substantial losses under the new payment regime. IMPLICATIONS FOR FURTHER RESEARCH: Future research should consider the relationship between costs and quality to ascertain whether reducing costs may potentially negatively impact patient outcomes

Using a “Train the Trainer” Model and Active Learning to Reach Biology Freshmen

In Spring 2013, we collaborated with the UK Biology Department to create, teach, and assess course-integrated information literacy sessions for 17 BIO 155 sections, reaching 462 students once a week for two weeks (thus 34 sessions reaching 934 attendees). We experimented with a “train-the-trainer” model, providing an introductory session to TAs, then alternating librarian-led sections and TA-led sections. We taught in a Macbook lab, using mini presentations mixed with active instruction and tools such as PollEverywhere and Course Guides. We assessed the information literacy concepts learned using a Google Docs survey. We will share our challenges and successes initiating this program

General practitioners' views of clinically led commissioning: cross-sectional survey in England.

OBJECTIVES: Involving general practitioners (GPs) in the commissioning/purchasing of services has been an important element in English health policy for many years. The Health and Social Care Act 2012 handed responsibility for commissioning of the majority of care for local populations to GP-led Clinical Commissioning Groups (CCGs). In this paper, we explore GP attitudes to involvement in commissioning and future intentions for engagement. DESIGN AND SETTING: Survey of a random sample of GPs across England in 2015. METHOD: The Eighth National GP Worklife Survey was distributed to GPs in spring 2015. Responses were received from 2611 respondents (response rate = 46%). We compared responses across different GP characteristics and conducted two sample tests of proportions to identify statistically significant differences in responses across groups. We also used multivariate logistic regression to identify the characteristics associated with wanting a formal CCG role in the future. RESULTS: While GPs generally agree that they can add value to aspects of commissioning, only a minority feel that this is an important part of their role. Many current leaders intend to quit in the next 5 years, and there is limited appetite among those not currently in a formal role to take up such a role in the future. CCGs were set up as 'membership organisations' but only a minority of respondents reported feeling that they had 'ownership' of their local CCG and these were often GPs with formal CCG roles. However, respondents generally agree that the CCG has a legitimate role in influencing the work that they do. CONCLUSION: CCGs need to engage in active succession planning to find the next generation of GP leaders. GPs believe that CCGs have a legitimate role in influencing their work, suggesting that there may be scope for CCGs to involve GPs more fully in roles short of formal leadership

Examining the Use of Economic Evaluations in Health‐related Humanitarian Programs in Low- and Middle-Income Countries : A Systematic Review

The costly nature of health sector responses to humanitarian crises and resource constraints means that there is a need to identify methods for priority setting and long-term planning. One method is economic evaluation. The aim of this systematic review is to examine the use of economic evaluations in health-related humanitarian programmes in low- and middle-income countries. This review used peer-reviewed literature published between January 1980 and June 2018 extracted from four main electronic bibliographic databases. The eligibility criteria were full economic evaluations (which compare the costs and outcomes of at least two interventions and provide information on efficiency) of health-related services in humanitarian crises in low- and middle-countries. The quality of eligible studies is appraised using the modified 36-question Drummond checklist. From a total of 8127 total studies, 11 full economic evaluations were identified. All economic evaluations were cost-effectiveness analyses. Three of the 11 studies used a provider perspective, 2 studies used a healthcare system perspective, 3 studies used a societal perspective and 3 studies did not specify the perspective used. The lower quality studies failed to provide 7information on the unit of costs and did not justify the time horizon of costs and discount rates, or conduct a sensitivity analysis. There was limited geographic range of the studies, with 9 of the 11 studies conducted in Africa. Recommendations include greater use of economic evaluation methods and data to enhance the microeconomic understanding of health interventions in humanitarian settings to support greater efficiency and transparency and to strengthen capacity by recruiting economists and providing training in economic methods to humanitarian agencies

Teaching Information Literacy Using a Train-the-Trainer Model with Biology Lab Instructors

In Spring 2013, we collaborated with the Biology Department course coordinator at University of Kentucky to create, teach, and assess course-integrated information literacy sessions for 17 Biology Lab sections, reaching 462 students once a week for two weeks (thus 34 sessions reaching 934 attendees). We also experimented with the “train-the-trainer” model by providing an introductory session to TAs, then alternating one librarian-led section with one TA-led section. We taught in a Macbook lab, using Powerpoint presentations mixed with active instruction and tools such as PollEverywhere and Course Guides. We assessed the information literacy concepts learned using a simple Google Docs survey