Difference between revisions of "Measuring quality in behavioral health care"

Revision as of 22:10, 16 November 2011

The Institute of Medicine (2001) defines quality as, “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Unfortunately, there is substantial variation in the experience of recommended care. On average 55% of the people receive recommended care, but only 11% of people with alcohol dependence receive recommended care (McGlynn, 2003). This variability holds for preventive, acute, and chronic conditions. Hence, there is a need to measure outcomes continuously to gauge the performance of our health care delivery system. Center for Medicaid and Medicare services has announced incentives for providers and organizations demonstrating “meaningful use” of Electronic Health Records and those that report on selected core measures. These selected measures can be organized using the IOM framework (2001), under the domains of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity so that the connections between measuring selected outcomes and quality of care can be established. An example of how the IOM model can be used to measure outcomes at the client and system level in a behavioral health delivery system follows.

IOM Domains

I. Effectiveness – providing services based on scientific knowledge

a. Client Outcomes

i. Did clients receive care based on Evidence-based programs

ii. Maintain medication list

iii. Measure client progress over time using standardized tools with respect to: Education, work situation, well-being, criminal justice involvement, Functioning

b. System Outcome

i. Percent of clients that received care based on Evidence-based programs

ii. Percent of clients that show improvement on standard assessments over time

iii. Percent of clients with complete histories so that the most appropriate levels of service can be delivered

iv. Percent of clients for whom medication lists are completed

II. Efficiency – avoid waste

a. Client Outcomes

i. Did client complete treatment regimen

ii. Time from request to face-to face appointment

iii. Appropriate and accurate level of care placements of patients

b. System Outcomes

i. Achievement of contract capacity

ii. Time from request to face-to face appointment on average

III. Safety – avoid injury and harm to people

a. Client Outcomes

i. Reduced hospitalizations

ii. Reduced emergency department contact

iii. Reduced reports of critical incidents

b. System Outcome

i. Processes and protocols implemented to improve safety and avoid errors in identification and medication

ii. Automated systems that identify errors before they happen

IV. Person-Centeredness - provide care that is respectful of & responsive to individual preferences

a. Client Outcome

i. Consumer satisfaction with services

b. System Outcome

i. Number of person centered plans

ii. Creating a culture that fosters coordinating care across patient conditions, services, and settings over time

V. Timeliness – reduce wait time

a. Client Outcomes

i. Time from referral to placement

ii. Timely and accurate data collection

b. System Outcome

i. Timely communication and exchange of results across practitioners

VI. Equity – provide care that does not vary in quality because of personal characteristics

a. Client Outcomes

i. Compare the demographics of consumers from each city/town receiving services with the overall population demographics of the city/town in order to flag over- or under-representation.

b. System Outcome

i. Ensuring quality and access to services across patient populations and geographic locations

ii. Compare outcomes by various demographic subgroups, such as gender, race, ethnicity, geographic location, etc.

References

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks, J, DeCristofaro A, and Kerr EA, “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635–2645.

Submitted by Minakshi Tikoo