The Atlas of Mental Health Care project: International development and applicability for DSS Prof Luis Salvador-Carulla [email protected] Prof Carlos Garcia-Alonso [email protected] NEW LINKS BETWEEN ORGANISATIONAL/BUSINESS RESEARCH AND HEALTH CARE RESEARCH (IHI) Four Questions of leadership, quality and efficiency Do you know how good you are? Do you know where you stand relative to the best? Do you know where the variation exists? Do you know the rate of improvement over time? HEALTH ECOSYSTEMS (Nimo et al, Cascadia, 2016) Complex health systems: TOOLS & ANALYTICAL TECH. Health ecosystems Agents Systems, subsystems, LOCAL ATLAS OF CARE Consumers nested systems Pofessionals, Boundaries and Teams, Availability Population determinants Jurisdictions Organisations Context analysis Capacity GIS Use DSS Logic models Interventions Conceptual maps Packages Financial Flows Social Networks Frameworks Connections & Drivers CONCEPTUAL MAPS Networks interactions Values, goals, SOCIAL NETWORK ANALYSIS targets Complex health systems: DECISION SUPPORT SYSTEMS Context Analysis New Procedures LOCAL ATLAS OF CARE MACRO Knowledge Discovery from Data MESO (KDD) MICRO Availability Expert-based Collaborative Jurisdictions Analysis (EbCA) Context analysis Capacity GIS Use DSS Interventions Framing Logic models New Tools Conceptual maps Packages Scientific Visualisation Financial Flows Social Networks Knowledge Simulation Modelling Data mining (experts) CONCEPTUAL MAPS Health ontology Social Network Analysis Research Synthesis SOCIAL NETWORK ANALYSIS Neuronal Network Analysis Conceptual analysis Cluster based on Rules Monte Carlo DEA Context analysis & Systems thinking Evidence Context Implementation From EBM to System thinking : The Greek Temple Salvador-Carulla et al, Epid Psych Sciences, 2016 Scientific Knowledge Evidence- data Mixed Qualitative info . tacit Carers Cohort , , - Knowl RCTs Context demographics Experiential Experimental Observational Formal and Formal Expert Ecological Consumers GIS, DISCOVERY -- CORROBORATION -- IMPLEMENTATION Decision support system Methodologies: operational, statistical and artificial intelligence Spatial analysis (statistics) Geographical information systems (statistics) Relative technical efficiency assessment (operations) Simulation engines (statistics) Variable values interpretation (Artificial Intelligence) Main Type of Care: Main branches LONG TERM CARE ACESSIBILITY: access to care INFORMATION FOR CARE ACCESIBILITY TO CARE SELF-HELP AND VOLUNTARY OUTPATIENT CARE DAY CARE RESIDENTIAL CARE CARE WITHOUT direct provision of care related to needs (e.g. access to GUIDANCE AND ASSESSMENT COMMUNICATION NON-PROFESSIONAL STAFF ACUTE ACUTE ACUTE employment) PROFESSIONAL STAFF INFORMATION PERSONAL ACCOMPANIMENT HOME & MOBILE EPISODIC 24 HOURS PHYSICIAN COVER OUTPATIENT: contact with the CASE COORDINATION NON MOBILE CONTINUOS NON 24H PHYSICIAN COVER person in a limited period of time NON ACUTE NON ACUTE NON ACUTE PHYSICAL MOBILITY (Continuing care) (Programmed Availability) (eg. visit with the GP). OTHER ACCESSIBILITY CARE HOME & MOBILE WORK 24H PHYSICIAN COVER NON MOBILE WORK RELATED ACTIVITIES NON 24H PHYSICIAN COVER DAY CARE: the person spends NON-WORK STRUCTURED CARE OTHER RESIDENTIAL the day at the facility (e.g. day NON STRUCTURED CARE hospital or social club) 91 different codes- taxonomy tree RESIDENTIAL: the person sleeps at the facility (eg. acute unit -hostel) INFORMATION: guidance/ assessment/ SELF CARE/VOLUNTARY: non-paid information WITHOUT follow up (e.g. information about availability of services) staff (e.g. Alcoholic anonymous) LONG TERM CARE INFORMATION FOR CARE ACCESIBILITY TO CARE SELF-HELP AND VOLUNTARY OUTPATIENT CARE DAY CARE RESIDENTIAL CARE CARE GUIDANCE AND ASSESSMENT COMMUNICATION NON-PROFESSIONAL STAFF ACUTE ACUTE ACUTE STEP 2 PROFESSIONAL STAFF INFORMATION PERSONAL ACCOMPANIMENT HOME & MOBILE EPISODIC 24 HOURS PHYSICIAN COVER CASE COORDINATION NON MOBILE CONTINUOS NON 24H PHYSICIAN COVER NON ACUTE NON ACUTE NON ACUTE PHYSICAL MOBILITY (Continuing care) (Programmed Availability) OTHER ACCESSIBILITY CARE HOME & MOBILE WORK 24H PHYSICIAN COVER NON MOBILE WORK RELATED ACTIVITIES NON 24H PHYSICIAN COVER NON-WORK STRUCTURED CARE OTHER RESIDENTIAL NON STRUCTURED CARE STEP 3 STEP 4 INTEGRATED ATLASES OF MENTAL HEALTH CARE: SPAIN 13 Full Survey Mixed Automated http://cmhr.anu.edu.au/research/projects/atlas-mental-health-care 15 Add slide of history 16 17 18 Mapping of MH Care in Montreal (Lessage et al 2002) http://cmhr.anu.edu.au/research/projects/atlas-mental-health-care RURAL URBAN Pattern of availability of MTCs for adults> 17 years with lived experience of mental illness. Comparison between CHN and Helsinkin and Uusimaa. Needs profile of WSPIR participants at entry Daytime activities Psychological distress Company Physical health Accomodation Employment & volunteering Psychotic symptoms Looking after the home Information on condition & treatment Money Food Intimate relationships Safety to self Other services Self-Care Benefits Basic education Childcare Transport Sexual expression Drugs Alcohol Telephone Safety to others Cultural & spiritual 0% 10% 20% 30% 40% 50% 60% 70% Consumer rated unmet need (n=487) SF rated unmet need (n=559) REsearch on the FINancial Systems’ Effect on the Quality of MENTal Health Care REMAST: Local Atlases (mapping) FINCENTO: Financing REQUALIT: Quality of care REPATO: Pathways of care Glossary of Terms Ruiz et al, Epid & Psych Sciences 2017 Refiniment: Quality indicators in 7 local areas of EU Countries 33 REFINEMENT: POLICY AND PLANNING IMPACT OF THE STUDY Girona • key to reactivate the funding for mental health care • Strengthen mental health management • Development of an integrated, community-oriented MHS SPAIN • Info from Remast + Requalit benchmark area in Spain • Two psychiatric hospitals redesigned to provide specialized care with psychiatrists on-site 24 hours • Acute residential care for mental disorders provided in FINLAND small acute units located at general hospitals, supported by community care teams • Three psychiatric hospitals were closed Helsinki 34 HEALTH ECOSYSTEMS: Atlas of MH for DSS: Barcelona (Catalonia, Basque Country) • 1.- Atlas of Mental Health (context, service availability, capacity, diversity) - Salvador-Carulla et al, 2002, 2006, 2010; Fernandez et al 2015) • 2.- Service utilisation - Ferrer M, et al, 2015 • 3.- Cost of Illness - Salvador-Carulla et al, 2011 • 4. Financing (Financing of Illness) - Salvador -Carulla et al, 2010 • 5.- Spatial analysis (hot and cold-spots) - Rodero-Cosano ML et al, 2016 • 6- Smart and relational indicators - Salvador-Carulla L, Salinas-Pérez JA, et al, 2010 • 7.- Technical efficiency analysis - Torres-Jimenez et al, 2016 • 8.- Analysis of management interventions (micro meso y macro management) - Garcia-Alonso et al, submitted • LOCAL ATLASES OF MH CARE: http://cmhr.anu.edu.au/research/projects/atlas-mental-health-care • MAPPING OF SERVICES IN EUROPE: http://www.refinementproject.eu/ • DESDE-LTC (Tool for Coding and Mapping): http://www.edesdeproject.eu/ EVOLUTION OF MH CARE DELIVERY IN CATALONIA (2002 – 2006 - 2010) Patterns of workforce capacity 39 MENTAL HEALTH CARE IN THE BASQUE COUNTRY Data Area Name Data Area Name B1 Ajuriaguerra G20 Alto Deba-Arrasate B2 Barakaldo G21 Amara B3 Basauri G22 Andoain B4 Bermeo G23 Azpeitia Gipuzkoa B5 Derio G24 Beasain Bizkaia B6 Durango G25 Eguia system system B7 Erandio G26 Eibar B8 Ercilla G27 Irun B9 Etxaniz G28 Ondarreta B10 Galdakao G29 Renteria B11 Gernika G30 Tolosa B12 Ortuella G31 Zarautz B13 Otxarkoaga G32 Zumarraga B14 Portugalete B15 Santurtzi B16 Sestao B17 Uribe B18 Zalla B19 Rekalde MENTAL HEALTH ATLAS 2004 GUIPUZKOA (ESMS) 2013 GUIPUZKOA & BIZKAIA 2017 GUIPUZKOA, BIZKAIA, ARABA 2013 MH NETWORK (OSAKIDETZA) INFORMED THE HEALTH PLANNING AGENCY OF GAPS and PROVISION DRIVEN NEEDS : Placement capacity: - Increase of places in day care, community residential care, employment for SMI - Decrease of long-stay beds RELATIVE TECHNICAL EFFICIENCY (Input-oriented) BIZKAIA GIPUZKOA Eficiencia técnica relativa nivel 1 1 Eficiencia técnica relativa nivel 1 1 0,9 0,9 0,8 0,8 0,7 0,7 0,6 0,6 0,5 0,5 0,4 0,4 0,3 0,3 0,2 0,2 0,1 0,1 0 0 Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Eficiencia técnica relativa nivel 2 Eficiencia técnica relativa nivel 2 1 1 0,9 0,9 0,8 0,8 0,7 0,7 0,6 0,6 0,5 0,5 0,4 0,4 0,3 0,3 0,2 0,2 0,1 0,1 0 0 Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 The aim 4 What is the aim of the project? We want to design and develop a Decision Support System (DSS) for helping decision makers (in Mental Health Care) to understand the system where they operate The management of information under uncertainty is based on probability and possibility theories (Klir 2006) A priori uncertainty Intervention A posteriori uncertainty The only way to U1 U2 reduce UNCERTAINTY is to increase Information: U2-U1 KNOWLEDGE The Generalized Information Theory is based on the concept of uncertainty and INFORMATION. Information is defined in terms of uncertainty decrease. MODELLING MICRO-MANAGEMENT INTERVENTIONS IN BIZKAIA What could happen if we move a psychologist from an acute service in a MHC to another acute service in other MHC? … with a small increase of beds in acute services in other MHC. MHC 8 MHC 6 MHC 3 The DSS shows us that the psychologist MHC 4 MHC rate should be reduced in MHC 6 and 19 we need an additional bed in MHC 4 We have changed