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APHA Scientific Session and Event Listing

Susan Lister, MPH and Grant Sara, MD. InforMH, Macquarie Hospital, PO Box 169, North Ryde, New South Wales, 1670, Australia, +612 8877 5110, slister@nsccahs.health.nsw.gov.au

Background: Demand for mental health care is increasing in NSW and hospital emergency departments (EDs) are becoming a major setting for assessment and treatment. In NSW, ED diagnosis is used to identify clients with mental illness and measure the performance of these services but the effectiveness of this approach has not been assessed.

Objectives: This study examines the effectiveness of ED diagnosis in predicting service pathways of patients with a mental illness.

Methods: A linked data set from routinely collected ED and inpatient data in NSW for the year 2004-5 was created. For patients with a mental health (MH) ED diagnosis, comparisons were made between admissions to a MH unit and those to other wards. Predictive value of ED diagnosis was calculated and other ED performance measures were investigated including Access block. A comparative analysis was undertaken to identify the most effective predictors of service need.

Results and conclusions: Of all presentations to EDs, 3% (42,372) had a MH ED diagnosis of whom 6,141 were admitted to a MH unit and 11,201 were admitted elsewhere. Positive predictive value (PV+) was 35% and PV- was 99%. Sensitivity of ED diagnosis was 84% and specificity 97%. Access block in NSW was over 30% with wide variation between hospitals. Results of these and other performance measures will be presented. Refinement of the measures by facility type and diagnostic code is possible but diagnosis as allocated in ED remains a poor predictor of service pathway. Alternatives are identified and discussed.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe two or more current measures used to determine service pathways for patients presenting to Emergency Departments (EDs) with a mental illness 2.Outline the methodology used in the study for comparing performance between EDs
• Identify at least one effective predictor of service need for patients with a mental illness

Keywords: Mental Health Services, Performance Measures

Presenting author's disclosure statement:

Not Answered

Handout (.ppt format, 254.0 kb)