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A Fair Test of the IAPT LTC/MUS Pathfinders

IAPT data GBU analysis?

Professor Simon Jones

Ms Eleni Theodorou


Objectives:

To : • Share our outline analysis plan• What data to we have for the evaluation? • What is Good, Bad, or Ugly?


Subgroups of interest

Long term condition

Medically unexplained symptom

Yes No

Yes

No

Question: How can we identify people in the various groups?•Data sources•Fields and Codes •GBU analysis


Data Analysis for LTC & MUS service usersFor each of the subgroups•Socio-Demographics profile•Common mental health problems and other comorbidities •describe duration and type of intervention •outcomes of intervention •explore and quantify relations between independent/predictor variables •Question: Are there any other analysis which you would find useful?


Outcome scales

• Personal Health Questionnaire (PHQ9) • Generalised Anxiety Disorder (GAD)

score • Work and Social Adjustment Scale

Score (W&SAS) Question: Which outcome is the

most appropriate for MUS/LTC?• GBU analysis


Data Validation Study

Primary care services

• Use of medication • Psychotropic • Non-psychotropic • Referral rate

Acute/Secondary Services

• Outpatient activity• In-patient activity• Accident and

Emergency activity

Validate the self-reported co-morbidities from IAPT dataset a against CHOICE (NIHR Programme Grant) data set based on routinely collected primary and secondary healthcare data sets (i.e. Doncaster and Newham).


Economic analysisTo ascertain the cost-effectiveness of the service in improving the outcomes of the different patient sub-groups•Convert PHQ-9 into QALYs

– See Brazier, Yang , Tsuchiya , Rowen (2010) A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures, Eur J Health Econ.

•To validate the map between PHQ-9 and EQ-5D we will also seek to identify a dataset where both PHQ-9 and EQ-5D are measured and observed and can be regressed along with interaction and polynomial effects to account for non-linearity and other confounding variables.


IAPT Highlight Report


IAPT MDS - Personal and demographic detailsM/R Data Set Data Elements

R NHS NUMBER R NHS NUMBER STATUS INDICATOR CODE M LOCAL PATIENT IDENTIFIER M ORGANISATION CODE (CODE OF PROVIDER) M PERSON BIRTH DATE R PERSON GENDER CODE CURRENT M POSTCODE OF USUAL ADDRESS R GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) R ETHNIC CATEGORY R RELIGIOUS OR OTHER BELIEF SYSTEM AFFILIATION CODE R SEXUAL ORIENTATION (CURRENT) R EX-BRITISH ARMED FORCES INDICATOR

RLONG TERM PHYSICAL HEALTH CONDITION INDICATOR (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)


IAPT MDS - Disability

M/R Data Set Data Elements R NHS NUMBER R LOCAL PATIENT IDENTIFIER R ORGANISATION CODE (CODE OF PROVIDER) R DISABILITY CODE

01 Behaviour and Emotional02 Hearing03 Manual Dexterity04 Memory or ability to concentrate, learn or understand (Learning Disability)05 Mobility and Gross Motor06 Perception of Physical Danger07 Personal, Self Care and Continence 08 Progressive Conditions and Physical Health (such as HIV, cancer, multiple sclerosis, fits etc)09 Sight10 SpeechXX OtherNN No DISABILITYZZ Not Stated (PERSON asked but declined to provide a response)


IAPT MDS - Referral detailsM/R Data Set Data Elements R NHS NUMBER M LOCAL PATIENT IDENTIFIER M ORGANISATION CODE (CODE OF PROVIDER) M SERVICE REQUEST IDENTIFIER R REFERRAL REQUEST RECEIVED DATE R SOURCE OF REFERRAL FOR MENTAL HEALTH R SERVICE REQUEST ACCEPTANCE INDICATOR R ORGANISATION CODE (CODE OF COMMISSIONER) R PROVISIONAL DIAGNOSIS (ICD)

RYEAR AND MONTH OF SYMPTOMS ONSET (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) R PREVIOUS SYMPTOM INDICATOR

RIMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES CARE SPELL END CODE

REND DATE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)


IAPT MDS- Appointment detailsM/R Data Set Data Elements

R NHS NUMBER M LOCAL PATIENT IDENTIFIER

MORGANISATION CODE (CODE OF PROVIDER) M SERVICE REQUEST IDENTIFIER

M APPOINTMENT DATE

RCARE PROFESSIONAL ROLE CODE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) M ATTENDED OR DID NOT ATTEND CODE

RCLINICAL CONTACT DURATION OF APPOINTMENT

RAPPOINTMENT TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES) R CONSULTATION MEDIUM USED

R

THERAPY TYPE (IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES)

(Up to four types may be recorded for each APPOINTMENT)R EMPLOYMENT STATUS

REMPLOYMENT SUPPORT SUITABILITY INDICATOR R EMPLOYMENT SUPPORT REFERRAL DATE

R PSYCHOTROPIC MEDICATION USAGE

R STATUTORY SICK PAY INDICATOR R PHQ-9 TOTAL SCORE

RGENERALISED ANXIETY DISORDER SCORE

RWORK AND SOCIAL ADJUSTMENT SCALE SCORE

RAGORAPHOBIA MOBILITY INVENTORY SCORE (WHEN ACCOMPANIED)

RAGORAPHOBIA MOBILITY INVENTORY SCORE (WHEN ALONE) R AGORAPHOBIA SCORE

RGENERALISED ANXIETY DISORDER PENN STATE WORRY SCORE

RHEALTH ANXIETY INVENTORY SHORT WEEK SCALE SCORE

ROBSESSIVE COMPULSIVE DISORDER INVENTORY SCORE

RPANIC DISORDER SEVERITY SCALE SCORE

RPOST TRAUMATIC STRESS DISORDER IMPACT OF EVENTS SCALE REVISED SCORE

R SOCIAL PHOBIA INVENTORY SCORE R SOCIAL PHOBIA SCORE R SPECIFIC PHOBIA SCORE


Thanks for listening

Simon Jones

[email protected]

Acknowledgements:

XXX

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