Mencía Ruiz Gutiérrez-Colosía

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

BackgroundThe harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS).MethodsThe development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal).ResultsDESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making.ConclusionDESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

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.

The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment

Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed “top-down” and “bottom-up” approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary.

A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study

Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems’ Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.

Emotional abilities and HbA1c levels in patients with type 1 diabetes

In recent years a growing body of research is focused on the relationships between emotions and health. When it comes to diabetes, findings suggest that distress might play a key role in the acquisition and maintenance of health habits associated with diabetic management. This report describes two studies examining the roles of emotional abilities in diabetic management from two different conceptual points of view using two culturally different samples. In study 1, we examined the relationship between emotional intelligence and HbA1c levels in a sample of eighty-five patients with type 1 diabetes mellitus (DM1) in Israel. In study 2, we examined the relationship between specific emotional regulation strategies and HbA1c in sixty-seven adolescents with DM1, while examining the mediating role of distress in this association. The results showed a negative association between emotional intelligence and HbA1c levels, even after controlling for potential intervening factors. We found that the relationship between difficulties in emotion regulation and HbA1c seemed to be mediated by diabetes-related distress. These findings may aid in the design of psychological models for future research as well as interventions aimed at improving emotional abilities in people with DM1.

Assessment of Relative Technical Efficiency of Small Mental Health Areas in Bizkaia (Basque Country, Spain).

Mental disorders cause an enormous burden to society. Considering the current economic context, an efficient use of scarce inputs, with an appropriate outcome production, is crucial. This situation defines a classical Relative Technical Efficiency (RTE) problem. A well-known methodology to assess RTE is the Data Envelopment Analysis, although it presents some limitations. These may be overcome through a hybrid strategy that integrates Monte-Carlo simulation and artificial intelligence. This study aims to (1) design of a Decision Support System for the assessment of RTE of Small Mental Health Areas based on DEA; and (2) analyse 19 mental health areas of the Bizkaian Healthcare System (Spain) to classify them and to identify potential management improvements. The results have showed higher global RTE in the output-oriented orientation than in the input-oriented one. This suggests that a decision strategy based on improving the input management, within the ranges of the expert-driven model of community healthcare, could be appropriate. A future research line will focus our attention on the validation process through the analysis of micromanagement interventions and their potential impacts in the real system.

Decision support systems for assessing integrated mental health care: the refinement toolkit

This symposium aims to present three mental health system evaluation tools which were developed for the Refinement project. The REFINEMENT (REsearch on FINancing systems’ Effect on the quality of MENTal health care) project had the purpose to study the relationship between different European models of health care financing and the extent to which mental health care services meet the goals of high quality, equity, efficiency and better long term health outcomes. This project was financed for 3 years by the European Commission within the 7th Framework Programme from 2011 to 2013. The Refinement project researchers used these tools in order to analyze eight European countries with very different stages in the development of mental health care, considering different balances between community and institutional care: Austria, England, Finland, France, Italy, Norway, Romania and Spain. This symposium will include results of the analysis carried out in these countries. This tool set provides useful and essential knowledge for the evidence–informed mental health planning and policy making in Europe. Describing and mapping the mental health services: THE REFINEMENT MAPPING SERVICES TOOLKIT (REMAST) The REMAST/DESDE-LTC tool aims at analyzing the spatial dimension of mental health care delivered by health and social services by means of Geographical Information System (GIS). The REMAST includes the standardized description of mental health care through the DESDE-LTC; a Service Inventory to collect complementary information; a detailed description about policies, plans and structural organizations of different mental health care services; and the Verona SES Index to describe the areas socio-economically. All data collected is utilized for the creation of specific maps in order to describe the spatial context of all mapped services. The influence of provider payment mechanism on continuity and coordination of mental health care: THE FINANCING & INCENTIVE TOOLKIT (FINCENTO) The FINCENTO tool focuses on the description of financing mechanisms for mental health care, and the identification of financial incentives/disincentives in provider payment mechanisms. The tool is intended to help in examining the impact of financial incentives/disincentives for providers and users/consumers in order to explore their effects on quality of care for people with mental health needs, including the appropriateness of pathways for people with mental health problems through the specialist mental health and general health care systems. Studying the pathways of mental health care: THE REFINEMENT PATHWAYS TOOLKIT (REPATO) REPATO (REfinement PAthways Tool) is an instrument for collecting empirical knowledge on pathways of service utilisation of persons with mental health needs, including the identification and comparison of typical patterns of service use in a wide variety of health and social care systems, identifying factors that possibly influence these patterns of service use, and assessing whether the identified pathways conform to quality of care in terms of continuity of care. REPATO consist of three main parts: (1) service utilisation patterns within primary care, and also between primary care and specialist mental health care, (2) continuity of mental health care and (3) readmission following acute psychiatric hospitalisation. Understanding the pathways of care that individuals follow within a mental health system can support the understanding of impact of different financial incentives and disincentives, as well as of issues around continuity of care.