Vostanis Panos, Martin Peter, Davies Roger, De Francesco Davide, Jones Melanie, Sweeting Ruth, Ritchie Benjamin, Allen Pauline, Wolpert Miranda
Professor of Child Psychiatry, University of Leicester, UK
Lead Statistician, Evidence Based Practice Unit, University College London and the Anna Freud Centre, UK.
J Health Serv Res Policy. 2015 Oct;20(4):202-9. doi: 10.1177/1355819615580868. Epub 2015 Apr 21.
There is a need to develop a payment system for services for children with mental health problems that allows more targeted commissioning based on fairness and need. This is currently constrained by lack of clinical consensus on the best way forward, wide variation in practice, and lack of data about activity and outcomes. In the context of a national initiative in England our aim was to develop a basis for an improved payment system.
Three inter-related studies: a qualitative consultation with child and adolescent mental health services (CAMHS) stakeholders on what the key principles for establishing a payment system should be, via online survey (n = 180) and two participatory workshops (n = 91); review of relevant national clinical guidelines (n = 15); and a quantitative study of the relationship between disorders and resource use (n = 1774 children from 23 teams).
CAMHS stakeholders stressed the need for a broader definition of need than only diagnosis, including the measurement of indirect service activities and appropriate outcome measurement. National clinical guidance suggested key aspects of best practice for care packages but did not include consideration of contextual factors such as complexity. Modelling data on cases found that problem type and degree of impairment independently predicted resource use, alongside evidence for substantial service variation in the allocation of resources for similar problems.
A framework for an episode-based payment system for CAMHS should include consideration of: complexity and indirect service activities; evidence-based care packages; different needs in terms of impairment and symptoms; and outcome measurement as a core component.
有必要为有心理健康问题的儿童开发一种服务支付系统，该系统能基于公平性和需求实现更具针对性的委托。目前，这受到以下因素的制约：在最佳前进方向上缺乏临床共识、实践差异巨大以及缺乏关于活动和结果的数据。在英格兰的一项全国性倡议背景下，我们的目标是为改进支付系统奠定基础。
三项相互关联的研究：通过在线调查（n = 180）和两次参与式研讨会（n = 91），就建立支付系统的关键原则与儿童及青少年心理健康服务（CAMHS）利益相关者进行定性咨询；审查相关国家临床指南（n = 15）；以及对疾病与资源利用之间的关系进行定量研究（来自23个团队的1774名儿童）。
CAMHS利益相关者强调，需求的定义应比仅基于诊断更广泛，包括间接服务活动的衡量和适当的结果衡量。国家临床指南提出了护理套餐最佳实践的关键方面，但未考虑复杂性等背景因素。对病例数据进行建模发现，问题类型和损伤程度独立预测资源利用情况，同时有证据表明在为类似问题分配资源时服务存在很大差异。
CAMHS基于发作的支付系统框架应考虑：复杂性和间接服务活动；循证护理套餐；损伤和症状方面的不同需求；以及将结果衡量作为核心组成部分。
