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

Previous studies have examined the relationship between HoNOS and LOS with varying and inconclusive results  Tom Trauer et al : Psychotic symptoms and disability are associated with longer length of stay  Harnett et al : 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  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

 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

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