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HoNOS and HoNOS65+:Is it a Useful Tool in Predicting Length of Stay?
Peter Thomas, Glen Bowcock
Andrea Taylor & John McMurray
Mental Health Drug and Alcohol Directorate, Northern Sydney Local Health District
June 2013
Introduction
Access and Demand Management is gaining increasing importance as LHDs seek greater control over resource management.
In NSW, all jurisdictions are required to use Estimated Date of Discharge (EDD) & Patient Flow Portal to manage bed resources
EDD has no credibility with MH Clinicians as MH lacks an accurate predictive tool
Variability in MH LOS makes Diagnostic Related Groups a poor predictor of MH LOS
Background
Background
Previous studies have examined the relationship between HoNOS and LOS with varying and inconclusive results
Tom Trauer et al. 2008 : Psychotic symptoms and disability are associated with longer length of stay
Harnett et al. 2005 : No association between HoNOSCA and Length of Stay
Page et al. 2001: HoNOS Scores could predict length of stay
Goldney et al. 1998: No correlation between HoNOS Scores and Length of Stay
Boot et al. 1997: HoNOS Scores moderately predict length of stay
Methodology Source of Data
Local Health District’s (LHD) Health Information Exchange (HIE) Database
NSLHD MH-OAT and Activity Collection Database (FISCH)
Definitions Length of Stay includes only Days in Pysch taken from HIE episode
table
Inclusions
1st Admission during the study period for each consumer HoNOS/HoNOS65+ collection occurred in the period 2003 - 2012 HoNOS/HoNOS65+ Collection occurred on or after the admission date All 12 individual items had a valid rating (0 – 4) MH-OAT Collection linked with Inpatient data using State Unique
Patient Identifier (SUPI)
Methodology Exclusions
Non-Acute units One mixed use Facility (ie. Acute and Non-Acute units) where frequent
transfers between Acute and Non-Acute Units distorted the results All subsequent admissions during the study period for each consumer
Sample Size 22,364 Acute Mental Health Admissions were recorded in NS LHD
during the study period. 11,311 Consumers admitted during the study period 3,231 Admissions met the criteria for inclusion
2,530 consumers had valid HoNOS collections 701 consumers had valid HoNOS65+ collections
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
Results
A moderately high correlation between HoNOS rating on Admission and ALOS has been found in NSLHD MH Acute Units
Removing the Behavioural Sub Scale when reviewing the ratings increases the correlation
Possible implications for developing tools to assist in standardising EDD practices and resource management planning
Generalising these results for potential ABF classification weighting would require care to avoid potential rater bias, as the need to maintain or increase funding may lead to inflated ratings
Summary
Thank You