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Work packages

Work Package 1: Management

Lead partner: University of Verona (Italy)

Tasks

  • 1. To link together the project components
  • 2. To maintain communication with the European Commision
  • 3. To establish and adopt common operational procedures
  • 4. To ensure consistent technical reporting to the European Commision
  • 5. To ensure compliance of all beneficiaries with the obligations derived by the grant agreement
  • 6. To ensure a correct and timely financial management and reporting
  • 7. To administer the European Commision contribution
  • 8. To ensure respect of ethical issues and attention paid to gender issues

Description of the work

University of Verona administers the Community contribution regarding its allocation between partners and activities, in accordance with the grant agreement and the decision taken by the Consortium. University of Verona ensures that all the appropriate payments are made to the other beneficiaries without unjustified delay. It keeps records and financial accounts making it possible to determine at any time what portion of the Community financial contribution has been paid to each beneficiary for the purpose of the project and informs the European Commision of its distribution. In order to strictly monitor the status of the project accounts, each six months a financial report is issued by each partner, containing cost statements and cost justifications. University of Verona verifies the consistency of the project costs with the tasks performed by each partner.

Based on the bi-annual task reports requested to each partner, an internal activity report is prepared by University of Verona and Terveyden ja hyvinvoinnin laitos, which contains an overview, including a summary of the progress of the work towards the objectives, including a list of the deliverables and milestones achieved during the period, a description of the monitoring actions (measurement/evaluation/corrective actions) undertaken to ensure adherence to the project workplan, a summary of the risk analysis performed. The above documents represent the basis for verifying the compliance of the beneficiaries with their obligations under the grant agreement and for preparing the periodic report to be provided to the European Commission.

University of Verona, supported by Ludwig Boltzmann Institut für Sozialpsychiatrie, is in charge of the maintenance of the Consortium Agreement. Steering Committee will ensure compliance of the partners with the rules established in the grant agreement and in the Consortium Agreement for what concerns:

  • Internal organization of the consortium including decision making procedures;
  • Rules on dissemination and use, and access rights;
  • Distribution of the Community financial contribution;
  • Settlement of internal disputes, including cases of abuse of power;
  • Liability, indemnification and confidentiality arrangements between the beneficiaries.

University of Verona informs in a timely manner the other partners and the European Commision of any change incurred in the consortium as far as legal and administrative status of any partners is concerned and about any circumstances affecting the participation of any partner and the implementation of the project.

University of Verona, supported by PSICOST, supervises the organization of the project meetings, ensuring that all partners take part in meetings concerning the supervision, monitoring and evaluation of the project and that such meetings are open to the participation of the European Commission.

In order to establish common operational procedures the Steering Committee, with the collaboration of Terveyden ja hyvinvoinnin laitos, prepares written guidelines, operational instructions and common templates (e.g. common format for all project deliverables, interim cost statements forms, risk analysis templates, task activity evaluation forms, etc.) to be followed by the partners for carrying out their activities.


Other work packages for University of Verona (Italy)

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Work Package 2: Evaluation

Lead partner: Terveyden ja hyvinvoinnin laitos (Finland)

Tasks

  • 1. To organize ongoing external evaluation of the project by an advisory board (AB)
  • 2. To secure the correct and smooth flow of the project activities
  • 3. To implement quality assurance at all stages of the project

Description of work

Terveyden ja hyvinvoinnin laitos will coordinate the work of an external project Advisory Board (AB). Terveyden ja hyvinvoinnin laitos will be responsible for: producing AB reports. The AB contributes to discussion on project results and to dissemination of project results in each AB member’s network.

Terveyden ja hyvinvoinnin laitos will evaluate project task progress and deliverables on an ongoing basis and support the Steering Committee in the monitoring of the research activities, by setting up a web-based system for project monitoring to check progression of the project activities, ensuring adherence to project timetable. Project monitoring will be based checklists prepared by each work package leader.

Terveyden ja hyvinvoinnin laitos will evaluate all project deliverables to ensure high quality of the scientific and technical results and appropriateness of results for the flow of the project.

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Work Package 3: Dissemination

Lead partner: PSICOST (Spain)

Tasks

  • 1. To raise awareness and interest in different stakeholders
  • 2. To build links with stakeholders, other projects/activities
  • 3. To provide opportunities for stakeholders to communicate with the e-DESDE team
  • 4. To communicate results in accessible way
  • 5. To increase likelihood of long term sustainability of ideas in project
  • 6. To impact assessment of the results of the project in health policy and academia

Description of work

We have identified a range of communication channels to disseminate materials related to the REFINEMENT project. We intend to reach the many different stakeholders for whom the project should have relevant messages, including academics, policy makers, services users and the general public. It involves a combination of tasks carried out at a central level, together with activities carried out at individual country level, some structured and some on an ad-hoc basis. Dissemination actions will help generate and sustain awareness of REFINEMENT and its work programme, before moving on to communicate the results of the project to interested groups when appropriate. They will be critical to enhancing the prospects of the sustainability of outputs beyond the end of this European Commision project.

Stakeholder group categories and selected examples of stakeholders to be targeted: A) International, National and Local Policy Makers: European Commission, DG Health and Consumers; European Commission, DG Employment and Social Affairs; European Parliament Ministries of Health and Social Welfare in member States; Municipal and Local Authorities Statutory Disability Rights Organizations. B) International agencies and organizations World Health Organization (WHO), Organization for Economic Co-operation and Development (OECD); European Centre for Disease Control - Knowledge and Information service; Eurostat; European Foundation for the Improvement of Living and Working Conditions. C) Mental health organizations Inclusion Europe; Mental Health Europe (MHE) ; European Association of Families of People with Mental Illness (EUFAMI); European Coalition for Community Living (ECCL) D) Service providers Association of Service Providers for People with Disabilities (EASPD); European Platform for Rehabilitation (EPR). E) Academics & Research Organizations and Networks Mental Health Economics European Network (MHEEN), Deinstitutionalisation and Community Living, Outcomes and Costs (DECLOC).

Dissemination channels. A) Publications: newsletters, policy briefs, journal articles, lay summaries of work for service users and providers, project summaries in national languages and a minimum of two press releases. B) Presentations at conferences, virtual presentations and policy workshops and seminars as well as user organization events.

Development of aids to communication: Project website, brochures and leaflets, press kit, presentation kit, other electronic medium (SINTEF eROOM System).

Dissemination activities will be conducted both at a central level under the auspices of PSICOST, as well as activities undertaken directly by project partners. Regular liaison will take place between PSICOST dissemination coordinators and project partners to look at work undertaken to date, and to whom that work has been targeted, as well as to provide advice and other support as appropriate to partners. In undertaking local dissemination activities, country partners will be encouraged to draw upon existing resources, relationships and networks. Dissemination at Country level (by web pages, translation of leaflets, lay summaries and policy sheets, etc.) will be also conducted.

Impact analysis will follow the recommendations of the European Union High level group on Health Services and Medical Care- Report(Brussels, 2004): a) Screening: Review of relevant documents on the topic with a focus on European Union; b) Scoping: Identification of scope at European, National, Regional and Local level at every participating country: A listing of key stakeholders in every country will be performed; and c) Appraisal of the impact of the project results at Healthcare policy (awareness, practice, services and governance) at three levels (Europe, National, and Regional) and in Academia (there are two further levels that should be assessed at least two years after the completion of the project and that have not been included here).

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Work Package 4: Analysis of the Financing of Health and Social Care Systems

Lead partner: LSE (UK)

Tasks

  • 1. To build on, update and augment existing knowledge from literature that identify and describe health care financing models in general and for mental health in particular, including the use of specific tools to influence the mix and utilisation of services so as to promote better outcomes for health care service users, while being mindful of equity and efficiency concerns: including reimbursement mechanisms, different contractual arrangements, resource allocation mechanisms and consumer-directed payments
  • 2. To create a bespoke tool to map models of financing and funding both for general health services across nine countries, and then for health care financing models for services for people with different mental health problems and selected comparator physical health problems. This will include analysis of social and long term care systems where they are responsible for delivering health care services
  • 3. To also map the extent to which funds are used by public, voluntary or private sector service providers for general health system, mental health and selected physical health problems
  • 4. To map the use of specific instruments, e.g. use of different contractual arrangements, targeted performance related payments etc., to influence mix and quality of services in general and mental health specific sectors
  • 5. To determine from our literature review and mapping exercise the extent to which mental health services use the same model of health care financing as for physical health

Description of work

A systematic review protocol will be developed consisted with standard review protocol guidance to help identify research on health care financing models and tools used to influence the mix and utilisation of services so as to promote better quality and outcomes for health care service users in general and mental health services in particular. The protocol with cover a range of bibliographic databases; key web based resources will be included in the search along with a hand search of key journals. Pilot searches in different databases will be run to help refine search.

The literature search strategy will be run in different electronic databases. Results will be stored in Endnote reference database. References will be screened on basis of titles and abstracts; those that appear to meet our inclusion criteria will be retrieved and read in full. Papers that meet our inclusion criteria will be coded e.g. in terms of country setting, type of innovation, sectors where applied etc. A review paper summarising the findings of the review will be prepared.

We will prepare a structured tool and protocol to collect data on general health care and mental health specific financing models and use of innovative financing mechanisms for each of our nine countries. The tool will consist of three parts: the first includes a template to report on financing models in operation in each of the nine countries. It also sets out to collect data on how additional data in respect of specific instruments and system characteristics may influence the flow of funds and service mix, e.g. to consider whether approaches to resources are allocated on the basis of need; whether there are financial barriers to service access, as well as to look at financing and funding at the interface between the health, long term care and social care systems. The tool will also include steps and guidance on the collection of experience in the use innovative financing tools previously identified within our literature review. This will include information on the use of tools for mental health services and selected physical health comparators specific sectors where mechanisms are used. Secondly a protocol for the collection of qualitative data through semistructured interviews with stakeholders (including health administrators, purchasers, providers and representatives of patient and carer organizations) will be developed. This will be accompanied by a manual and glossary intended to help facilitate future use of the tool.

Using our bespoke data collection tool we will map in detail financing models and the use of innovative financing tools in all nine countries. To date little work has been done to systematically model these interfaces. In doing this we shall be mindful to build on previous work to augment existing information. We will, for instance, make use of detailed Health System Reviews published by the European Observatory on Health Systems and Policies as well as country reports prepared by the OECD and the Mental Health Economics European Network. We will extract key data from these sources on approaches to financing and funding and then verify that this data is accurate to aid in identifying areas where to target detailed data collection. Timelines will be drawn indicating when different health care financing mechanisms were introduced so that we may be able in work packages 6 and 7 to associate changes in financing mechanisms with changes in quality and outcomes.

Based on data collected above we will analyze the extent to which financing mechanisms used for mental health services have differed over time from other chronic diseases in order to feed into our discussions linking quality and financing in Work Package 7.

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Work Package 5: Functional and Dysfunctional Financial Incentives

Lead partner: Ludwig Boltzmann Institut für Sozialpsychiatrie (Austria)

Tasks

  • 1. To carry out a literature survey on financial incentives/disincentives for mental health care service utilisation, with an explicit focus on the positive and negative consequences of such incentives for quality of care, including continuity of care
  • 2. To develop a structured tool for describing the known contractual financial incentives for providing and using mental health services, as well as for identifying less well known informal incentives and disincentives, and investigating the positive and negative consequences of such incentives for quality of care including the appropriateness of pathways through the services, especially in terms of continuity of care
  • 3. By employing the tool developed in objective point 2: to identify the incentives/disincentives which are de facto operating in the care for persons with mental disorders in the partner countries, and elicit their positive and negative consequences for quality of care including the appropriateness of pathways through the services, especially in terms of continuity of care
  • 4. To analyze the findings on incentives and produce a comparative report on pathways and prepare input for WP 9

Description of the work

A systematic review protocol will be developed in cooperation with WP 4 (LSE) consistent with standard review protocol guidance to help identify research on financial incentives/disincentives (on the purchaser/provider-user level) for mental health care service utilisation, especially on patient transfer between services, and on the positive and negative consequences of such incentives for quality of care, including pathways of persons with mental disorders through health and social care services, putting special emphasis on admission and discharge processes, and – in case of transfer between services - the interface between services. Continuity of care is also a relevant issue which will be investigated. This literature review will build on the initial findings of WP 4 literature review on financing systems and follow-up references found there on incentives. Aspect of power relationships between the three actors purchaser-provider-patient will be especially paid attention to. The protocol will cover a range of bibliographic databases; key web based resources will be included in the search along with a hand search of key journals. Pilot searches in different databases will be run to help refine the search. The literature search strategy will be run in different electronic databases. Results will be stored in Endnote reference database. References will be screened on basis of titles and abstracts; those that appear to meet our inclusion criteria will be retrieved and read in full. Papers that meet our inclusion criteria will be coded. A review paper summarising the findings of the review will be prepared.

A structured tool will be developed for collecting information on the known contractual financial incentives for providing and using mental health services, as well as for identifying less well known informal incentives and disincentives, and investigating the positive and negative consequences of such incentives for quality of care including the appropriateness of pathways through the services, especially in terms of continuity of care. The tool will consist of three parts: Each tool will contain (a) a section on collecting and analyzing data and information already available (but in widespread different sources, which means that “detective work” has to be done), (b) a section with semi-structured interviews with stakeholders (including health administrators, purchasers, providers, representative of user and carer organizations) and c) a manual and glossary intended to facilitate the use of the tool. A pilot study will be conducted and training for researchers from the 9 partner countries will be organized.

By employing the tool developed in task 5.2, incentives/disincentives which are effective in the care for persons with mental disorders in the partner countries, and their positive and negative consequences for quality of care including the appropriateness of pathways through the services, especially in terms of continuity of care, will be elicited.

The country information obtained from tasks 5.3 will be used to compare the situation in different countries and relate the finding to the variance in the characteristics of the financing and incentive systems, identified by WPs 4 and 5. A comparison with the results of WP 8 (quality of care and met/unmet needs) will be carried out. Input will be provided for WP 7 (pathways) and WP 8 (quality of care) to analyze whether and to what extent, differences in incentives explained differences in pathways and quality of care. Also input for WP 9 (models) will be prepared.


Other work package for Ludwig Boltzmann Institut für Sozialpsychiatrie (Austria)

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Work Package 6: Mapping Services for Mental Health Care

Lead partner: University of Verona (Italy)

Tasks

  • 1. To describe all services (general health, mental health and social services) available for people with mental illness
  • 2. To explain the complexity of the models adopted in each country to deal with mental disorders
  • 3. To compare the models used in each country
  • 4. To develop an Atlas of Mental Health Care that will give decision-makers within countries – who seek to learn from successful health systems elsewhere –more detailed accounts of services

Description of the work

In each of the nine countries catchment areas, through interviews to stakeholders, administrators of Health Information Systems, regional and local health institution databases, will be identified at which level it will be possible to collect data (national, regional or services level). An structured methodology will be used to obtain these general information.

Starting from information obtained in Task 6.1, a bespoke instrument (REMAST) based on previous developed international instruments (ESMS, DESDE and WHO-AIMS) will be developed to cover all the type of services that provide care for, or are used by, persons with mental disorders (D 6.1). The instrument will be piloted in two different settings and refined according the results of piloting. A one-day training course will be organized for the investigators at month 4.

In each country, the instrument for mapping services (developed in Task 6.2) will be administered to obtain a list of general health, mental health and social services available and to classify them in categories according to the instrument classification.

Each service will then be georeferenced using GIS software package (ArcGis) by University of Verona and maps of these areas will be published on the Project website (protected by userid and passwords) (D6.2). The spatial distribution analyses will allow to build an indicator of quality of allocation of services.


Other work packages for University of Verona (Italy)

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Work Package 7: Identifying and Interpreting Pathways of Care

Lead partner: Ludwig Boltzmann Institut für Sozialpsychiatrie (Austria)

Tasks

  • 1. To carry out a literature review on pathways of persons with mental disorders through the general health, specialized mental health and social care services
  • 2. To develop a structured tool for describing the typical and most common pathways of persons suffering from mental disorders through the general health, specialized mental health and social services in each partner country
  • 3. In employing the tool developed in objective point 2: To identify the typical and most common pathways of persons suffering from mental disorders through the relevant services in each partner country
  • 4. To carry out record linkage studies in all nine partner countries in order to identify existing pathways of individual patients with empirical methods
  • 5. To analyze the findings on pathways and produce a comparative report on pathways and prepare input for WP 9

Description of the work

A systematic review protocol will be developed consistent with standard review protocol guidance to help identify research on pathways of persons with mental disorders through health and social care services, putting special emphasis on admission and discharge processes, and – in case of transfer between services - the interface between services. Continuity of care is also a relevant issue which will be investigated. The protocol will cover a range of bibliographic databases; key web based resources will be included in the search along with a hand search of key journals. Pilot searches in different databases will be run to help refine search. The literature search strategy will be run in different electronic databases. Results will be stored in Endnote reference database. References will be screened on basis of titles and abstracts; those that appear to meet our inclusion criteria will be retrieved and read in full. Papers that meet our inclusion criteria will be coded. A review paper summarising the findings of the review will be prepared.

A structured tool for describing the typical and most common pathways of persons suffering from mental disorders through the relevant services in each partner country will be developed. Aspects of admission and discharge patterns as well as transfer between services and continuity of care will be emphasized. The tool will consist of three parts: Each tool will contain (a) a section on collecting and analyzing data and information already available (but in widespread different sources, which means that “detective work” has to be done), (b) a section with semi-structured interviews with stakeholders (including health administrators, purchasers, providers, representative of user and carer organizations) and c) a manual and glossary. Analogue tools will be developed for WP 4, 5 and 8. A pilot study will be carried and a training for researchers from the 9 partner countries will be organized.

With the help of the instrument developed in task 7.2 and based on the WP 5 service mapping of health and social care facilities for each partner country, the typical and most common pathways of persons suffering from mental disorders, through the relevant services in each partner country, will be identified, emphasizing aspects of admission and discharge decisions, as well as transfer between services, and the main criteria for decisions at those interfaces between services.

A research protocol for record linkage studies in all partner countries will be worked out, in order to empirically identify patterns of pathway through different services. All partner countries have data bases available where contacts of individual patients can be traced across institutions, ranging from hospital only data in some countries (where readmissions can be linked) to a wide range of institutions including social and general health care (e.g GP) services. Through “pseudonymisation” such record linkage has become possible. Except for the UK (where a subcontract is necessary to cooperate with the owners of the relevant database) these record linkage studies will be carried out by the staff of the partner institutions.

The country information obtained from tasks 7.3 and 7.4. will be used to compare the situation in different countries and relate the findings to the variance in the characteristics of the financing and incentive systems, identified by WPs 4 and 5. A comparison with the results of WP 8 (quality of care and met/unmet needs) will be carried out. Input for work package 9 is prepared.


Other work package for Ludwig Boltzmann Institut für Sozialpsychiatrie (Austria)

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Work Package 8: Quality of Mental Health Care and Met-Unmet Needs

Lead partner: University of Verona (Italy)

Tasks

  • 1. To identify indicators of performances and outcomes of mental health care
  • 2. To identify at which levels (national/regional, local or individual) data are available in the nine European countries
  • 3. To develop a strategy for the collection of information about performance and outcome indicators of quality of mental health care
  • 4. To train the investigators in the data collection tasks
  • 5. To perform the statistical analyses of the data collected
  • 6. To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the mental health care

Description of the work

A systematic review protocol will be developed consisted with standard review protocol guidance to help identify research on indicators of quality/performances of mental health care. The protocol will cover a range of bibliographic databases; key web based resources will be included in the search along with a hand search of key journals. Pilot searches in different databases will be run to help refine search. The literature search strategy will be run in different electronic databases. Results will be stored in Endnote reference database. References will be screened on basis of titles and abstracts; those that appear to meet our inclusion criteria will be retrieved and read in full. Papers that meet our inclusion criteria will be coded e.g. in terms of country setting and type of indicators. A review paper summarising the findings of the review will be prepared (D 8.1).

A Technical Committee (TC), composed by all principal investigator will prepare an instrument to assess the availability of data on performance and outcome indicators of quality of mental health care in the nine countries. A scheme will be prepared for collecting relevant information from each partner country. Where possible data on accessibility, policy for equity, assessment of needs, mortality, QoL and satisfaction will be collected and analyzed on a national, regional/local or individual level (where Mental Health Information Systems are available).

Data on accessibility, policy for equity, assessment of needs, mortality, QoL and satisfaction will be collected and analyzed on a national and regional/local level. The instrument will be used to collect data from

  • - national and international literature;
  • - interviews of stakeholders;
  • - national or regional databases' reports.
  • For those countries who will have access to individual data through pseudonomysed record linkage, data at individual level will be collected by each partner and then sent to WP Leader.

    Results of this work package will be integrated in a descriptive way with results from WP 4, 5, 6, 7 and finally prepared for input into the modelling WP 9.


    Other work packages for University of Verona (Italy)

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    Work Package 9: Building Best Practice Models of Mental Health Care Financing

    Lead partner: SINTEF (Norway)

    Tasks

    • 1. To assess the extent to which theory meets practice in the operation of mental health care financing models drawing on theoretical frameworks and both quantitative and qualitative information emerging from WP 4 – 8. This will include analysis of the interfaces between health, social and long term care systems where they are responsible for delivering mental health services
    • 2. Drawing on data from WP 4 -8 to identify strengths and weakness and how best to use different incentives and tools to influence the operation of different mental health care financing systems, being mindful of equity, efficiency and quality concerns
    • 3. To provide exemplars of how different health care financing tools and instruments work or do not work drawing on case vignettes from across our nine countries. This will include comparison with the use of tools for other selected areas of the health care system. If data permit, to conduct multi-level analysis to identify how changes in aspects of health care system financing have influenced different dimensions of performance assessment
    • 4. To build a series of mental health care financing models drawing on both theoretical and practical experience, taking into account different health care system structures and contexts across Europe

    Description of the work

    Drawing on our review of the literature on health care financing and mental health care financing specifically, conceptual models and empirical findings from the literature, will together with description of the participating countries health and financing systems from work package 4-6 and findings from assessment of pathways and quality of care in work package 7-8, form the basis for the development of a decision support tool. A manual on this use of this tool will also be developed.

    Prepare data from service mapping (WP 6), pathways of care (WP 7) and quality indicators and need for care (WP 8) to be used for analysis purposes within the framework analytical tool. Use data from work packages 4-8 on the national level and below the national level to examine associations between financing system characteristic and financing mechanisms on one side and different aspects of quality on the other side. We will perform analysis within a multi level statistical approach to the extent that data permit.

    Use findings from task 9.2 to identify exemplars of effective and ineffective use of financing tools. Assess further the characteristics of these exemplars by performing both quantitative and qualitative analysis in terms of e.g. structured interviews. The analyses will specifically take equity, efficiency and quality concerns into account. Exemplars for instance might include joint budgeting arrangements between health and social care services.

    Drawing on data identified in tasks 9.2 and 9.3 we will build best practice models for mental health care financing, taking account of different interfaces and links with long term care and social care services that are found in different countries. Flow of funds diagrams will be constructed to illustrate this visually.

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