The introduction of outcomes and casemix concepts within routine data collections requires a set of nationally agreed rules that guide clinicians as to what is expected of them in the collection and reporting of data. The protocol used for outcomes data is, in many ways, the most critical aspect of the process. Andrews et al (1994) summed this up simply by stating that 'a measure is not a method'.15
Consumer outcomes presume a change over time in the person's health status and functioning. Gathering information about consumer outcomes therefore requires the measures to be used at regular intervals in the cycle of care. It is important that the information is collected at times that make sense to both the clinician and the consumer, for example: at entry or re-entry to the service; at case review; and at discharge or case closure. In conjunction with this requirement, there is a need to have some standard to help understand the outcome data and enable reasonable comparisons to be made between, for example, different agencies or different groups of consumers.
This is a difficult issue in the mental health field because there is no 'standard' care cycle. Some people require only a brief period of treatment, while others are under the ongoing care of the mental health services for many years. For this latter group, we need to distinguish between short and long term outcomes – that is, to use the measures to review progress at defined intervals, as well as to assess the overall change between the beginning and end of treatment.
Because many of the concepts and definitions used in Australia's standard health collections are centred on hospital care only, the development of a comprehensive reporting protocol for mental health services was unable to draw on established precedents. To resolve these issues, all States and Territories collaborated in the development of a data collection protocol for what has become known as the 'National Outcomes and Casemix Collection' or 'NOCC'. Released in August 2002, the protocol defines the counting rules to be used and establishes the basis for the new outcomes and casemix data to be reported in consistent ways.16
15 Andrews et al (1994)
16 Department of Health and Ageing (2002). National Outcomes and Casemix Collection: Technical Specification of State and Territory Reporting Requirements for the Outcomes and Casemix Components of 'Agreed Data' under National Mental Health Information Development Funding Agreements. Department of Health and Ageing, Canberra.