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ISBN 978-989-97433-8-0 E-book edition 2017 by SciKa
Book of abstracts of the
CENTERIS 2017 – Conference on Enterprise Information Systems /
ProjMAN 2017 – International Conference on Project MANagement /
HCist 2017 – International Conference on Health and Social Care Information Systems and Technologies
268
Feasibility analysis of a matrix of mental health indicators
for evidence-based management: a research protocol
Inacia Bezerra de Limac, André Luiz Teixeira Vincia, Rui Pedro Charters
Rijob, Domingos Alvesa, Antonia Regina Ferreira Furegatoc
a Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
bSchool of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal
cSchool of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
Abstract
The purpose of the present work is to describe the research protocol used as the basis for a proposal to build an
international consensus matrix of mental health indicators for a mental health care networks. The criteria inclusion
of the indicators is the usage and the result of that usage in selected countries. Proposed steps: review of mental
health care networks management indicators; to analyze the convergence of use and interpretations regarding
mental health indicators in countries with a single health system; establish the use of administrative scales of the
services network, using these indicators; to select suitable indicators for its implementation and availability in the
web information system. The results obtained may serve as a gold standard, which can assist the mental health
manager in the planning and decision-making tasks of the mental health care network.
Keywords: Mental health; Indicators; Public Health System.
1. Introduction
According to the World Health Organization (WHO), a Mental Health Information System (MHIS)4
has the goals of collecting, processing, analyzing, disseminating and using information about a mental
health service and the needs of the population of its scope. In addition, it aims to improve the
effectiveness and efficiency of services and also ensure the fairness of provided care by allowing more
informed decision making, thus increasing the quality of care.
In addition, the WHO itself, through the Mental Health Action Plan for 2013-2020, has as one of its
four priority objectives the strengthening of information systems, evidence and research in the field of
mental health4, 5. Moreover, WHO5 recommends that one of the principles for the creation of MHIS is
ISBN 978-989-97433-8-0 E-book edition 2017 by SciKa
Book of abstracts of the
CENTERIS 2017 – Conference on Enterprise Information Systems /
ProjMAN 2017 – International Conference on Project MANagement /
HCist 2017 – International Conference on Health and Social Care Information Systems and Technologies
269
the use of indicators that can summarize the information relevant to a particular phenomenon, may
represent a situation and therefore can be used to quantify a given change. Specifically, WHO5 states:
“Develop a core set of mental health indicators and provide guidance, training and technical support
on the development of surveillance/information systems to capture information for the core mental
health indicators, facilitate the use of these data to monitor inequities and health outcomes, and augment
the information collected by WHO's Global Mental Health Observatory (as a part of WHO's Global
Health Observatory) by establishing baseline data to monitor the global mental health situation
(including progress on reaching the targets laid out in this action plan).”
No consensus yet exists about which mental health indicators should be used routinely13, 14. Once
these indicators are identified, the information system can be designed by targeting them and based on
their feasibility and available resources.
Therefore the goal of this paper is to describe the research protocol used as the basis for a proposal
of an international consensus matrix of mental health indicators for evidence-based management of a
mental health care network. The results obtained can assist the mental health manager in the planning
and decision-making tasks, especially with regard to management in the mental health care network.
The next section describes key theoretical elements used for the development of the goals of this
work. The third section will introduce the research methods and the steps of carrying out, and finally,
the fourth section, the conclusions of the work and future research steps.
2. Extending the Thornicroft and Tansella framework for mental health services.
To achieve a more complete description of the network operation through health indicators, we
developed an expansion of the mental health matrix model, for use as a conceptual framework to guide
the development of this work8. The matrix presents a model that can be used to increase clinical
effectiveness through evidence-based practice.
This model has two dimensions, a geographical one, which is divided into three levels: national /
regional, local and individual (of the patient), and another that is temporal and is defined by three phases:
input, process(es) and results. At the regional level, we can consider, for example, health policies. At
the local level we identify services that operate in a certain area of coverage. Finally, at the patient level,
we are concerned with the user’s services. In the meantime, in each level we find the three phases: the
resources invested (entry phase), the activities that are used in the care delivery (process phase) and the
expected results of each level with respect to the change in morbidity and mortality at both the individual
and the population levels (outcome phase). The indicators for this latter phase are often confused with
input or process indicators, because they are more difficult to define and collect. This is the case of a
reduction in the length of hospital occupancy, which should be classified as a process indicator, but used
as an outcome indicator at the individual level8. With this new, extended model, in place, it is possible
to systematize the indicators found and decide which levels and phases they belong to.
ISBN 978-989-97433-8-0 E-book edition 2017 by SciKa
Book of abstracts of the
CENTERIS 2017 – Conference on Enterprise Information Systems /
ProjMAN 2017 – International Conference on Project MANagement /
HCist 2017 – International Conference on Health and Social Care Information Systems and Technologies
270
Meanwhile, the Thornicroft and Tansella’s mental health matrix model is the foundation for such
analysis, but needs some adaptation to accommodate the specific reality of the mental health care
network, as the one in Brazil 9.
5. Evidence-based health policies and practice
As mentioned earlier, the mental health matrix presents a model that can be used to increase clinical
effectiveness through evidence-based practice. But, despite the many achievements of public health,
more attention to evidence-based approaches is needed. Several conceptual steps are fundamental for
Evidence-Based Public Health (EBPH) 10. First, it is necessary to provide scientific information on the
programs and policies that are most effective in promoting health care i.e. conducting evaluation surveys
to generate evidence. Secondly is necessary to turn science into practice by mapping information on
evidence-based interventions from peer-reviewed literature to the realities of a specific real
environment. To achieve this we need to define processes that lead to decision-making. A final step
should incorporate the dissemination of proven interventions to decision-making professionals10, 11, 12.
Recently it has been proposed an evaluation model of municipal and regional management of a Mental
Health Care network in Brazil that comprises various attributes of EBPH 9. This evaluation model has
one of it goals to allow a better understanding of how the network is managed through the knowledge
gathered by its managers. In addition, it also can deliver more elucidation on the impact of using a
computerized information system and in how is the interaction between the professional and the system.
The results obtained from the research protocol presented here will serve as the gold standard for this
evaluation model.
4. Research methods
In this section we will describe the steps planned to build the international consensus matrix of mental
health indicators along with the possible methods used in its execution and analysis.
This work is a descriptive-analytical design, based on the analysis existent literature and other
secondary data. The work will include also the application of the indicators in an existent mental health
information system SISAM-139.
In the Fig. 1 we illustrate the steps of the research protocol presented in this article and were written
in order to guide their understanding. The figure also shows the methods used in each step.
The first step will be to research official documents from English, Spanish and Portuguese speaking
countries, with universal health systems that contain proposals and use mental health indicators.
Moreover, we will also include papers published in international journals or conference proceedings
about indicators in the selected countries.
According to the above criteria, it is initially intended to obtain the indicators data from United
Kingdom, Australia, New Zealand and Canada (English speaking countries); Spain (Spanish-speaking
ISBN 978-989-97433-8-0 E-book edition 2017 by SciKa
Book of abstracts of the
CENTERIS 2017 – Conference on Enterprise Information Systems /
ProjMAN 2017 – International Conference on Project MANagement /
HCist 2017 – International Conference on Health and Social Care Information Systems and Technologies
271
country); Portugal and Brazil (Portuguese-speaking countries). The choice for this criteria occurred in
order to define countries that have health systems similar with the Brazilian one and maintain a network
structure for mental health care. In addition, we decided to prioritize the countries with universal public
health systems that propose mental health indicators for management in their official documents, but
also make use of them.
After the analysis of such documents, we will have a set of indicators that will be evaluated in order
to determinate if they can be part of the consensus matrix.
Thus, the set of tasks associated with this part of the work can be specified as follows: 1) identify
how each indicator is calculated in each country; 2) establish the interpretation of use of each indicator
in each country (knowledge extraction); 3) assign the indicators for each geographic dimension of the
Thornicroft and Tansella Matrix; 4) check indicators that have different use or calculation method
between all the countries.
After the analysis of all the identified indicators, we will choose those that will be part of the
international consensus matrix using an evidence-based approach. Particularly, as already mentioned,
this consensus matrix will have the Matrix of Thornicroft and Tansella as its construction reference and
also focusing on its application on RAPS in Brazil. Therefore, the gold standard matrix of indicators
will have for all the levels of the adapted mental health matrix the following information about the
indicators: indicator’s name, method of calculation, average usage time and the knowledge extraction.
All the indicators that we could not get consensus but have proven significance in the mental health
care will be featured in the supplementary list. In this list, the information of each indicator will be
shown exactly like the gold standard matrix.
It is important to highlight that, unlike what has been thought when collecting a set of indicators for
health, the proposal presented here has the main intention to collect evidence of use for each indicator.
That is, for each indicator is intended to extract knowledge about its use in practice. This is important
because when the desired consensus matrix is consulted it will be possible to access the experiences of
using each indicator for mental health management.
ISBN 978-989-97433-8-0 E-book edition 2017 by SciKa
Book of abstracts of the
CENTERIS 2017 – Conference on Enterprise Information Systems /
ProjMAN 2017 – International Conference on Project MANagement /
HCist 2017 – International Conference on Health and Social Care Information Systems and Technologies
272
Fig 1: Activities of the Research Process.
5. Conclusions and future work.
The results of this project, we intend to offer a framework that will assist the mental health manager
in planning and decision-making tasks, especially with regard to management in the mental health care
network. Thus, it is expected to offer a differentiated view of the indicators showing its usefulness in
several activities of the administration in the Psychosocial Care Network in several levels of the Tansella
matrix. It is also hoped that the calculation and analysis of health indicators will become faster and more
accurate, providing a reliable basis for research and study. In addition to the interdisciplinary
attractiveness of the project, its characteristics should lead, to create a real-time observatory of a mental
health care network. In this sense, the project as a whole is pioneering and ambitious in the scope of
Mental Health Networks since the delineation of the indicators from an international reference of its use,
presented in this project, will allow an alignment of the information systems with the strategy of the
network, with the possibility of linking the strategic objectives with the operational day-to-day,
simulation of options for implementing public health policies and monitoring the implementation of
these same policies. Thus, this research protocol is part of a more general project to create a dynamic
content portal to integrate information about the citizens, users, health professionals and health services
that make up the Psychosocial Attention Network, in order to Qualify the processes of individual care,
work of each health professional and organization of each service, as well as organization of the set of
services of each municipality.
ISBN 978-989-97433-8-0 E-book edition 2017 by SciKa
Book of abstracts of the
CENTERIS 2017 – Conference on Enterprise Information Systems /
ProjMAN 2017 – International Conference on Project MANagement /
HCist 2017 – International Conference on Health and Social Care Information Systems and Technologies
273
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