1. Reporting Outcomes with MHCT
A Categorical Change ‘Dashboard’

2. Outcomes Analyses We want to:
Embed the routine measurement, analysis and feeding back of clinical outcomes to frontline teams
Improve clinical effectiveness through reflective practice, shared learning, identifying gaps in service, training needs etc.
Support re-organisation and changing priorities

3. Is there any evidence we make a difference?
For several years we have been recording HoNOS (MHCT) scores at key times during patients’ pathway through our services:
At first assessment
When there is a significant change in need e.g. admission
At CPA
At discharge
Comparing a patient’s scores gives us a measure of our effectiveness

4. 3 ways of showing change in HoNOS
Mean total score
But conflates scales getting worse and getting better
HoNOS Four Factor
But conflates change within each scale getting worse and getting better
Changes from score of 4 to 3 equated with, and neutralised by, changes from 0 to 1
Categorical change method
But arbitrary cut-off point

5. Categorical approach to showing change in each HoNOS scale score
Start of episode
End of episode
Low Severity
MHCT scores and classification
0: No problem
1: Subclinical problems
2: Mild problems
Low Severity
Outcome: Remained stable
High Severity
Outcome: Reliable deterioration
High Severity
MHCT scores and classification
3: Moderate problem
4: Severe to very severe problems
Low Severity
Outcome: Reliable improvement
High Severity
Outcome: Remained highly unwell
Predicated upon Reliable gulf between scores
of 2 and below, and 3 and above

6. Reassessing the cut-off
Does basing ‘change’ on a scoring threshold of 2 or below to 3 or above impact on reported outcomes?
Is an improvement in MHCT score from 2 to 0, or deterioration from 0 to 2 significant?
If clinicians tend to ‘under-score’ then this change would be missed
Would ‘change’ based on 2 MHCT points be more appropriate and reliable (a change from 3 to 2 may not be ‘significant’ but the result of poor inter-rater reliability

7. Calculating change based on a vlookup
MHCT Score
Categorical Change
0-0
Remains Stable
0-1
0-2
Reliable Deterioration
0-3
0-4
1-0
1-1
1-2
1-3
1-4
2-0
Reliable Improvement
2-1
2-2
2-3
2-4
3-0
3-1
3-2
3-3
Remains Highly Unwell
3-4
4-0
4-1
4-2
4-3
4-4

8. The resulting Excel table

9. The finished Dashboard

10. What are the issues
Have not completed a comparison between approaches to determine impact of changing the ‘cut-off’
This data extract was based on SU’s discharged between 1/4/15 and 30/9/15, however:
Of 5577 service users discharged, only 2803 (50%) had 2 MHCTs completed
Of those only 527 had a discharge MHCT completed within 30 days of the recorded discharge date

11. Concluding Thoughts
Does changing to a 2 point difference in MHCT points a more accurate reflection of change?
Do we have the right data extract?
How often do we run the report?
How do we close the loop? Is this dashboard accessible to clinicians?
What level do you drill down into it?
How do we deal with the data issues?