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Rating brief ambulatory episodes [message #161]

Mon, 09 August 2004 00:26

Dean Lewin
Messages: 18
Registered: April 2003

Junior Member

Hi,

The usual rating period for the HoNOS is the previous 2 weeks (except for discharge from inpatient episodes, where it is the previous 3 days). This is applicable for most ambulatory episodes, however there are circumstances where the episode is less than 2 weeks and the there is the potential for overlap with the admission rating.

We believe that this overlap may impact on the clinical utility of the measures as staff become less confident that ratings made for brief ambulatory episodes will reflect the persons assessment.

In practice, we believe that most clinicians will only rate on the length of the episode if it less than two weeks but we are considering formalising this by making an addition to the exceptions in our collection protocol to state that the HoNOS rating period for "...ambulatory episodes of less than 2 weeks, the rating period will be for the whole of the episode"

Are there any comments or issues that might arise with this?

thanking you

Dean Lewin
Principal Project Officer
Systems and Outcomes Team
Mental Health Unit
Queensland Health
07 32341458

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Re: Rating brief ambulatory episodes [message #170]

Thu, 02 September 2004 02:32

Tim Coombs
Messages: 104
Registered: December 2002

Senior Member

Hi Dean,

Changing the rating period to the preceding episode has a couple of implications for me. First, is the point I made in regards to changes to rating periods when we may not even have the established guidelines operating and the implications for training staff in the new guidelines. The second point is that once you start playing with the HoNOS rating period in ambulatory settings, what do you do about the LSP? Average over 3 months or preceding period? Some ambulatory episodes last less than 3 months, so you begin to have additional rules for the other measures (We haven't even mentioned the HoNOSCA or the HoNOS65+). I think we have enough training and embedding to do with the current "simple" set of rules across all states and territories before we make changes. The other side of the coin is that changes at this point may just send the signal that enables some to say, "see it really isn't that good a system, why bother anyway"? It is true that sometimes there will not be an exact match between the real world, the data collection protocol and the rating rules. The aim as I understand is to get to 80% completion as per the data collection protocol. If you think that the occasions that you outline are 20% of all collection occasions then it may be a problem, otherwise in training I appeal to the need to get the majority of the collection right, the majority of the time. Once that is done when can work at smoothing out the bugs.

Regards

Tim

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Re: Rating brief ambulatory episodes [message #197]

Sun, 17 October 2004 22:00

Dean Lewin
Messages: 18
Registered: April 2003

Junior Member

Thanks for that Tim,

I think you have mentioned some good points.

I have raised this issue on behalf of the whole Queensland outcomes team as we would like to see further exploration and discussion on this forum and by the expert reference groups.

It is our experience that as services become more mature with using outcomes data to inform clinical practice, issues such as HoNOS (and HONOSCA and HoNOS65) rating periods for brief ambulatory episodes have become increasingly relevant.

Do any other forum members have any comments?

cheers

Dean Lewin
on behalf of the
"Beyond Outcomes" Team
Queensland Health

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