Guidance for PHN and provider organisations analysing PMHC MDS data extracts

Introduction

The Department of Health, Disability and Ageing (DoHDA) commissioned the implementation of the Primary Mental Health Care Minimum Dataset (PMHC MDS) in 2016 to support Primary Health Networks (PHNs) in collecting data related to the range of mental health services that are funded by DoHDA and commissioned by the PHNs.

Data specifications, including data model diagrams are available at https://docs.pmhc-mds.com/data-specifications.html.

This document provides guidance for data analysts at PHNs or their provider organisations using data that they have extracted from the PMHC MDS using the PMHC MDS’s Data Extract functionality as documented at https://docs.pmhc-mds.com/projects/user-documentation/en/latest/data-extract.html.

It is intended that data analysts will acquaint themselves with the data specifications before reading this guidance.

Provider Organisations

Central to the PMHC MDS is the concept of a Provider Organisation (PO). As defined in the Key Concepts section of the data specification at https://docs.pmhc-mds.com/projects/data-specification/en/latest/data-model-and-specifications.html#provider-organisation, the PO is the business entity the PHN has commissioned to provide the service. The rules for POs in the PMHC MDS include some atypical data design features that are not evident from the data model diagram but are important for producing accurate results.

The importance of Organisation Path

Each PHN in the PMHC MDS has a registered key. This is set by DoHDA. Each PO in the PMHC MDS also has a key, which is set by the PHN. In addition, each PO has an Organisation Path. This is a composite key made up of the PHN key and the key for the specific PO. The PO Organisation Path is used as a foreign key for all tables linked to the Provider Organisation table.

Keys across PHNs are unique at the PO level. To ensure that spurious joins are not made, the primary key for tables that join directly, or indirectly to a PO, is a composite key comprising Organisation Path and entity (Client, Episode etc) Key, not the entity key alone.

Organisation Path and Client Keys

As described above, client identifiers are unique to POs. In effect this means that a single human being interacting with two POs will have two identifiers, one for each PO. This is because client identifiers are defined either by the POs or in some cases their commissioning PHN.

An important corollary is that it is possible for the same client identifier to refer to different human beings at different POs.

Organisation Path and Episodes

The second notable PO related feature is that the PMHC MDS requires all services delivered in a single Episode to be delivered by the same PO. As for client identifiers, episode identifiers are generated by POs (or potentially PHNs). Also, as for client identifiers, there is a possibility that different POs will apply the same value for unrelated episode keys, thus the composite key for the Episode table is Organisation Path and Episode Key.

Organisation Path and other records

As above, throughout the model, Organisation Path is part of the composite key on all tables subordinate to the Provider Organisation table. Therefore any data analysis on exported tables needs to utilise the composite key.

The relationship between Intakes and Episodes

The PMHC MDS model has a unique process for representing patient interactions with assessment (Intake) and treatment (Episode) organisations.

A typical intake process involves the client contacting a PHN Intake team (e.g. a phone service) that undertakes triage, including an IAR-DST. The Intake team will recommend a subsequent course of action - almost always a referral to a different organisation or organisations for further assistance or treatment, but it is possible to make no referral.

To minimise confusion of the term “referral”, the PMHC MDS endeavours to use the term dispatch to mean the passing of a client to another organisation. Note that it is possible to simultaneously dispatch to more than one organisation. It is also possible that the dispatch “fails” in the sense that for whatever reason the referred-to organisation does not accept the client; in this situation the failed dispatch is not necessarily deleted, but a replacement dispatch can be initiated as well.

The intake record for referrals to an MDS reporting entity are supposed to nclude the organisation path of these entities). When an intake team dispatches a client to an MDS-reporting entity it must pass its own organisation path and the key assigned for the intake to the referred-to (treatment) organisation in addition to any clinical details. At the point where the treatment organisation “accepts” the dispatch it should open its own case, which in turn should ultimately be recorded in a PMHC MDS Episode record. The treatment organisation should also record an Intake Episode record, the entire purpose of which is to link the treatment organisation’s Episode record with the intake team’s Intake record. This link is necessary because different organisations are responsible for the intake and the treatment, and therefore, the Intake and Episode records will often be submitted by different agents. Furthermore, they may be submitted at different times and not in the sequence the events occurred (i.e. the treatment organisation can submit Episode records before the intake team submits the corresponding Intake record).