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Changes in mental health system performance: the case of Gipuzkoa (Basque Country, Spain)

机译:心理健康系统绩效的变化:Gipuzkoa(巴斯克乡,西班牙)的案例

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摘要

Use of decision support systems may improve policy-making for management of mental health services and systems. System performance can be analyzed by using Relative Technical Efficiency (RTE), stability and entropy indicators. These indicators summarize resource availability, utilization and results as a balance between inputs (resources) and outputs (outcomes). Nevertheless, performance and stability assessment of mental health systems is complex because of difficulty related to data collection, results interpretation and translation of information into practice. The present mental health context requires better ways of planning for allocating resources and improving outcomes. The objective of this study is to assess the RTE, stability and entropy 2012-2015 variations as a consequence of a policy developed by the Mental Health Network of Gipuzkoa (Basque Country, Spain). The Mental Health Network of Gipuzkoa is structured by thirteen small health areas. In these catchment areas, mental health services were standardized by using the DESDE-LTC codification tool. Mental health services were classified according to the main type of care provided (outpatient, day and residential). In the analysis, 57 variables were included, which were classified in resources –inputs- (availability, placement and workforce capacity) and results –outputs- (service utilization, readmissions, discharges and length of stay). A hybrid decision support system, that integrates statistical, operational and artificial intelligence techniques, has been used to analyze the indicators. The main statistical procedure was a Monte-Carlo simulation engine to include the uncertainty of real contexts. The data envelopment analysis, an operational technique, was utilized to assess the RTE. In addition, a prototype of fuzzy inference engine was included for interpreting expert knowledge according to the basic community mental health care model. The stability was calculated by analyzing the frequency distributions of the RTE and, finally, the Shannon’s entropy to estimate system disorder. The main structure of the real policy was identified by developing structured interviews to senior managers and planners of Mental Health System of Gipuzkoa. Results provided information about the changes of the selected indicators throughout three years (2012-2015). The impact of the policy developed can be considered positive but the stability remains poor as new real interventions have to take into account that small changes in data values can result in a change, positive or negative, in the indicators´ value. The methodology presented can be considered appropriate for analyzing mental health services and systems performance. Variations in the indicator values can also be considered as a consequence of the policy impact and, because of that, the decision support system could analyze the evolution of the system. As future research, it is suggested to assess indicator variations throughout the time span and assess the impact of new organizational interventions and policies.
机译:使用决策支持系统可能会改善精神卫生服务和系统管理的政策。通过使用相对技术效率(RTE),稳定性和熵指示器,可以分析系统性能。这些指标总结了资源可用性,利用率和结果作为输入(资源)和输出之间的平衡(结果)。然而,由于与数据收集,结果解释和信息翻译成实践,因此精神卫生系统的性能和稳定性评估很复杂。目前的心理健康背景需要更好的规划方式来分配资源和改进结果。本研究的目的是评估RTE,稳定性和熵2012-2015变化,作为由Gipuzkoa(巴斯克州,西班牙)的心理健康网络开发的政策的结果。 Gipuzkoa的心理健康网络由十三个小卫生地区构成。在这些集水区,通过使用DESDE-LTC编纂工具标准化心理健康服务。根据提供的主要护理(门诊,日和住宅)分类心理健康服务。在分析中,包括57个变量,该变量被分类为 - (可用性,放置和劳动力容量)和结果 - outputs-(服务利用率,自述,放电和逗留时间)。混合决策支持系统,集成统计,操作和人工智能技术,用于分析指标。主要统计程序是一个Monte-Carlo模拟发动机,包括实际情况的不确定性。利用数据包络分析,一种操作技术来评估RTE。此外,包括根据基本社区精神保健模型来解释专家知识的模糊推理引擎的原型。通过分析RTE的频率分布来计算稳定性,最后是Shannon的熵来估计系统障碍。通过向Gipuzkoa的心理健康系统的高级管理人员和策划者制定结构化访谈来确定实际政策的主要结构。结果提供了有关在三年内所选指标更改的信息(2012-2015)。策略的影响可以被认为是积极的,但随着新的真实干预措施必须考虑到数据值的小变化可能导致指标的重大变化,积极或负面的稳定性差。提供的方法可以被认为适合分析心理健康服务和系统性能。由于策略影响,也可以考虑指标值的变化,因为这是,决策支持系统可以分析系统的演变。作为未来的研究,建议在整个时间跨度评估指标变化,并评估新的组织干预措施和政策的影响。

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