Process and outcome mental health indicators using administrative databases in Italy

Background In Italy and in other European countries, both at local and national level, the process of de-institutionalisation and implementation of a community-based model in mental health care has been characterized by a lack of evaluation. In particular, no activity is or has been in place to develop or maintain standards of quality of care. The aim of this study is to investigate the feasibility of the calculation of process and outcome indicators using administrative databases. Methods Process and outcome indicators of mental health care for 2 Local Health Authorities of Emilia-Romagna Region (Italy, 1.298.103 adult inhabitants) were obtained through linkage of hospital discharge records, the community mental health service database (year 2009) and the drug prescription database (years 2009 and 2010). The study cohorts include patients with a primary ICD-9-CM diagnosis code 290.xx-319 hospitalized or treated in the community mental health services in the year 2009. The set of indicators explore treated prevalence and incidence rates by disorder and setting, continuity between hospital and community care, retention in treatment, rehospitalizations, antidepressant drug and mood stabilizer prescriptions. Results Hospitalization rates varied by diagnosis (from 19 to 160 per 100.000 inhabitants) and increased with age. Treated prevalence in the two study areas was 2% and incidence was 0.7%. Of the patients treated by community mental health services, about 2% had a non-defined or a non-psychiatric diagnosis. The proportion of patients rehospitalized within 30 days from discharge was 19%. Less than 10% of patients with severe mental illness discontinued treatment with community mental health services. Conclusions Calculation of the selected indicators proved to be feasible, conditional on quality checks for completeness and accuracy of the primary diagnosis. Implementation of these indicators on a larger scale (regional or national) and on a regular basis may provide a unique opportunity to set up a mental health surveillance system and monitor treated prevalence and incidence of mental disorders as well as continuity of care and treatment outcomes at the patient level.