Key performance indicators for mental health and substance use disorders: a literature review and discussion paper

With an increasing recognition of the importance of mental and substance use disorders (MESUDS) for population health and health systems and the potential value of systems-based performance indicators in addressing this issue, we aimed to describe the development and content of key performance indicators (KPIs) for MESUDS. Publications were identified through official websites, Google searches and PubMed. Following 'PRISMA' guidelines, 25 studies were kept for qualitative synthesis and six for quantitative analysis. We describe their use in practice by comparing their application across a range of public and mixed healthcare systems. Currently, the KPI development for MESUDS adopts several methodologies, including expert opinion, literature review, stakeholder consultation, and the structured consensus method. The rationales provided for selection of particular KPIs vary greatly between systems. Systems exhibit different levels of KPI adaptability, which is reflective of dynamic changes in evidence-based practices. We noted bias in the level of KPI assessment toward system/health plan evaluation followed by program/service evaluation. Similarly, there is a large skew toward KPIs that reflect evaluation of processes. Collection of data in all systems is nearly exclusively reliant on electronic administrative/medical data. Experiences from these systems are synthesized into methodological recommendations and considerations for further research and clinical practice are provided.