Ahmed, Anam

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Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTEvaluating Existing Efforts to Implement QualityIndicators in Behavioral Health SettingsAnam AhmedUSF MCOM- LVHN CampusFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtAhmed, A. Norris, E. (2018, March). Evaluating Existing Efforts to Implement Quality Indicators in Behavioral Health Settings. PosterPresented at: 2018 SELECT Capstone Posters and Presentations Day. Kasych Family Pavilon, Lehigh Valley Health Network,Allentown, PA.  BackgroundIncreased focus on quality improvement in today’s healthcare climate. In psychiatry quality can be hard to assess and evidence based guidelines are not always implemented. Efforts to measure quality are limited but there have been initiatives to develop formal indicator schemes. Evaluating these initiatives could lead to better understanding of the quality of evidence and gaps in the literature.© 2018 Lehigh Valley Health NetworkMethods •  Indicators from 11 programs in 4 countries compiled →179 total measures•  Framed into 7 domains with 29 subdomains•  Figure 1 shows the PRISMA flow diagram for the initial selection of papers. •  Cochrane GRADE process systemized quality analysis of each paper, a simplified version of the results of this can be seen in Table 1•  While there was variation of quality among the literature, most of the studies were of moderate to high quality and were either systematic reviews or retrospective analyses•  After sorting each study, 7 were found in over 70% of the papers and the most common subdomains can be seen in Table 2 •  No one study included every domain and domains included did not follow any patternResults Meaningful efforts to standardize mental health care quality measurement exist however it has been challenging to create indicators that are standardized, evidence-based, and inclusive of the scope of practice. Schemes encompass structure, process, and outcomes measures however outcomes are the least tested variable. The quality of is also of moderate to high quality. Ideally, schemes could fill gap in quality of psychiatric services but have to be easily measurable, evidence driven, and not limited to focused areas of psychiatry.  There are significant gaps in the current literature for psychiatric quality assessment. While existing indicator schemes are a start in the creation of a formal framework to provide higher quality care, many of the indicators are not evidence based, are not fully inclusive of the various aspects of behavioral health treatment, and are lacking in outcome assessment. Addressing these concerns could help guide patient treatment, improve patient functioning and satisfaction, and lower costs.ConclusionDiscussion Problem StatementWhat is current state of published quality assessment for psychiatric care and what commonalities exist with indicators and outcomes?Table 1. Timing of Various Health System Steps   IIML VA Mental HealthUniversity of Tubingen NICE RAI-MH OCED SAMHSA AMBHA NCQA NQF AHRQ  Disease Symptoms Depression/Bipolar X X X X X X X X X X X Anxiety X X X X X X X X XPsychosis X X X X X X X X XPharmacology Med rec X X XSelection of meds X X X X X X X X X X XDosing X  X  X  XSide effects X X X X X X X XMonitoring X X X X X X XSubstance Screening X X X XPsychosomatic tx X X X X XPharmacological tx X X X X XDual diagnosis tx X X X X XAccess/wait times for treatment X X X XPatient safety Suicide  X X X X X XRestraints X X X XMed errors or adverse events X X X X XElopement XEvidence Based Practice Family Involvement X X X XPsychotherapy X X X X X X X X X XCase management X X X X X XEmployment/housing support X XACT teams X XContinuity and coordination Discharge planning X X X X X XOutpatient follow-up X X X X X X X X X X XCoord with primary care X X X XPatient functioning X X X X X X X X X XChange in symptoms X X X X XReadmission rates X X X X X X Relapse X X   XTable 2. Grading Evidence Study Description of Study Specify Study Question ReproducibleAssess Risk of BiasSummary of FindingsValidity AssessmentStrength of Evidence IIMHL Created list of indicators through compilation of existing measurement programs across various countries Yes Yes Yes Yes Yes High VA Mental Health Set of 52 quality indicators to assess veterans diagnosed with at least 1 psychiatric diagnosis Yes No No Yes No HighUniversity of Tubingen Developed questionnaire with 46 items for inpatient psychiatric patients in Germany Yes Yes No Yes No LowNICE Used 60 indicators to create treatment guidelines for all scopes of mental illness in the UK Yes Yes Yes Yes Yes ModerateRAI-MH Assessment system for deriving MHQIs in Canada Yes Yes Yes Yes No HighOCED Used structured review process, to select set of 12 indicators to evaluate patient treatment and outcomes. Yes No No No No ModerateSAMHSA Guided identification of 24 indicators to monitor behavioral health in the US Yes Yes No Yes No ModerateAMBHA National committee which created 51 performance measures for behavioral health programs  Yes Yes No No No ModerateNCQA Government level agency who created  20 indicators for performance improvement tool Yes Yes No Yes No ModerateNQF Evaluated set of 56 behavioral health measures across the country Yes Yes No Yes No HighAHRQ Database of 78 indicators that was used by multiple studies No Yes No Yes No N/ARecords identified  through searching PubMed and Cochrane N=252Eg. Mental illness AND quality indicatorRecords screened to exclude those not about mental illness or quality indicatorsFull text articles assessed according to PRISMA checklist N=42Studies included in qualitative analysisN=11Studies not done in the US or Europe or from before 1998 screenedRecords excludedN=210Figure 1. Prisma FlowsheetPRISMA flow diagram for selection of literature for review of quality indicators in psychiatric settings •  Retrospective analysis of efforts to implement indicators for quality measures•  Studies from the US and Europe from the past 20 years were chosen based on the PRISMA checklist graded on quality using the Cochrane GRADE guidelines as high, moderate, or low, or very low quality. Indicators reviewed to see what was found in the greatest percentage of the literature•  A subset of most common subdomains was determined by the researcher and compared across the studies.  Lehigh Valley Health Network, Allentown, PAEvaluating Existing Efforts to Implement Quality Indicators in Behavioral Health SettingsAnam Ahmed, Mentor - Dr. Edward NorrisQuality of evidence categorized as: 1. High — Cochrane or systematic review, randomized control trial. 2. Moderate — non-randomized control study or unsystematic review. 3. Low — expert opinion, uncontrolled studies.  4. Not applicable — measure was extracted from grey literature (eg government organizations or databases).AHRQ – Agency for Healthcare ResearchNQF – National Quality ForumNCQA – National Committee for Quality AssuranceAMBHA – American Managed Behavioral Healthcare AssociationSAMHSA – Substance Abuse and Mental Health Services AdministrationOCED – Organization for Economic Co-operative and Development NICE – National Institute for Clinical Excellence (UK)RAI-MH – Resident Assessment Instrument for Mental Health (Canada)IIMCH – International Knowledge Exchange Network for Mental Health

Evaluating Existing Efforts to Implement Quality Indicators in Behavioral Health Settings

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Evaluating Existing Efforts to Implement Quality Indicators in Behavioral Health Settings

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