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Social Work

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Social Work s Role in Behavioral Health Quality Improvement Scott E. Provost, M.M., M.S.W. Associate Director for Research Center for Quality Assessment ... – PowerPoint PPT presentation

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Title: Social Work


1
Social Works Role in Behavioral Health Quality
Improvement
  • Scott E. Provost, M.M., M.S.W.
  • Associate Director for Research
  • Center for Quality Assessment Improvement in
    Mental Health
  • www.cqaimh.org
  • May 10, 2002

2
Objectives
  • Learn about the status of quality assessment and
    improvement in behavioral health
  • Review social works role in shaping quality
    assessment and improvement in behavioral health
  • Identify new areas for social work education,
    practice, and research that can influence the
    quality of behavioral health care services

3
Objective 1
  • Learn about the status of quality assessment and
    improvement in behavioral health

4
Why Measure Quality?
  • To facilitate oversight of health plans,
    hospitals delivery systems, and clinicians
  • To encourage healthcare purchasing based on
    quality, not just cost
  • To increase market share, growth, and revenues
  • To meet standards set by professional societies

5
How is Quality Defined?
  • Quality can be defined as
  • Conformance to Specifications
  • Value
  • Dependability
  • Responsiveness/timeliness
  • Authority/Consumer Empowerment
  • Empathy
  • Support/Follow-up Service
  • Psychological Impressions

6
Quality and Evidence-Based Practice
  • The conscientious, explicit and judicious use of
    current best evidence in making decisions about
    the care of individual patients. (Sackett, et
    al., 1996)

7
Evidenced-Based Interventions
  • Adults
  • Psychopharmacological Interventions
  • Assertive Community Treatment
  • Illness Self-Management
  • Supported Employment
  • Family Support Services
  • Integrated Dual Diagnosis Treatment

8
Evidence-Based Interventions
  • Children
  • Multi-systemic therapy
  • Therapeutic foster care
  • Family Involvement

9
How is Quality Defined?
  • Quality represents the kind of care that
    maximizes benefits and minimizes risks
    (Donabedian, 1980)

10
Status of Quality Assessment and Improvement in
Behavioral Health
  • National Reports on Health Care Quality
  • Quality First Better Health Care for All
    Americans, (Presidents Advisory Commission 1998)
  • To Err is Human (IOM, 2000)
  • Crossing the Quality Chasm (IOM, 2001)
  • Envisioning the National Health Care Quality
    Report (IOM, 2001)

11
Status of Quality Assessment and Improvement in
Behavioral Health
  • Reports on Behavioral Health Care Quality
  • Managing Managed Care Quality Improvement in
    Behavioral Health (IOM, 2001)
  • U.S. Surgeon Generals Report on Mental Health
    (DHHS, 1999)
  • Report of the Surgeon Generals Conference on
    Childrens Mental Health A National Action
    Agenda (DHHS, 2000)
  • Mental Health New Understanding, New Hope (WHO,
    2001)

12
Status of Quality Assessment and Improvement in
Behavioral Health
  • Quality of Care for Depression
  • Detection
  • One-third to one-half of patients with major
    depressive disorder are properly recognized by
    primary care and other practitioners (AHCPR
    Depression in Primary Care Volume 1. Detection
    Diagnosis, 1993)
  • Medication Treatment
  • 55.6-62.6 of individuals enrolled in
    participating health plans who initiate treatment
    for major depression discontinue medication prior
    to 12 weeks (NCQA Quality Compass, 2000)

13
Status of Quality Assessment and Improvement in
Behavioral Health
  • Quality of Care for Schizophrenia
  • Medication Treatment
  • 22.5 were given a dosage above 1,000 CPZ
    equivalents
  • 15 were prescribed a dosage less than 300 CPZ
    equivalents
  • Lehman AF, et al., 1998 (N 719 Individuals with
    Schizophrenia)
  • 13.0 Dosed above PORT guidelines
  • 23.3 Dosed below PORT guidelines
  • Leslie DL, Rosenheck RA, 2001 (N34,925 VA
    Patients)
  • Family Services
  • 40.8 of inpatients were offered or received a
    family service
  • Lehman AF, et al., 1998 (N 719 Individuals with
    Schizophrenia)

14
Status of Quality Assessment and Improvement in
Behavioral Health
  • Quality of Care for ADHD
  • About 50 of children with identified ADHD seen
    in real-world practice settings receive care that
    conforms to American Academy of Child
    Adolescent Psychiatry Guidelines
  • Hoagwood K, et al. (2000)
  • 47.3 of pediatric visits for psychiatric reasons
    involving stimulant medications included any form
    of psychosocial intervention
  • Hoagwood K, et al. (2000)
  • 68 of children receiving treatment for ADHD by a
    primary care provider did not have any contact
    with a mental health specialist
  • Bussing R, et al. (1998)

15
Status of Quality Assessment and Improvement in
Behavioral Health
  • Quality of Care for Panic Disorder
  • Fewer than 1 in 4 patients receives adequate
    pharmacotherapy and only 1 in 8 received adequate
    psychotherapy
  • Roy-Byrne PR, et al. (Archives of General
    Psychiatry, 2001)

16
Status of Quality Assessment and Improvement in
Behavioral Health
  • Follow-Up After Hospitalization for Mental
    Illness
  • In a sample of 305,574 Medicare beneficiaries
    enrolled in Medicare
  • 52. received follow-up care
  • When stratified by race, the results were
  • 54 (Whites)
  • 33.2 (Blacks)
  • Schneider EC, et al. (JAMA, 2002)

17
Common Categories of Measures
  • Structure measures represent the relatively
    stable characteristics of the providers of care,
    of the tools and resources they have at their
    disposal, and of the physical and organizational
    settings in which they work (Donabedian, 1980)
  • Fidelity measures are tools to evaluate whether
    or not treatment programs are implemented
    according to a specified manual or protocol.

18
Common Categories of Measures
  • Outcome measures are indicators of a patients
    health status, i.e., medical and physiologic
    (biological, pathological, behavioral) functional
    status and well-being (quality of life,
    productivity, disability) habits or health risk
    states (Donabedian, 1980)
  • Process measures assess the set of activities
    that go on within and between patients and
    practitioners (Donabedian, 1980)

19
How is a Quality Measure Defined?
  • Performance measures estimate the extent to
    which the actions of a health care practitioner
    or provider conform to practice guidelines,
    medical review criteria, or standards of
    quality. (Academy for Health Services Research
    Health Policy)
  • Quality Measure A quantitative measure that can
    be used as a guide to monitor and evaluate the
    quality of important patient care and support
    service activities. (JCAHO, 1989)

20
Other commonly used terms
  • Lever
  • Metric
  • Indicator
  • Driver

21
Domains of Quality
Explorations in Quality Assessment
Monitoring The Criteria and Standards of Quality
(Donabedian A, 1982)
22
Ideal Properties of Performance Measures
  • Objective
  • Based on scientific evidence
  • Not affect or distort results
  • Reliable
  • Valid
  • Standardized/Precisely Specified

23
Timely Psychosocial Risk Factor Screening
  • DenominatorThe total number of individuals
    admitted to an inpatient psychiatric hospital
    over a 30-day period
  • NumeratorThe number of individuals from the
    denominator whose medical record documents a
    psychosocial screening that address potential
    high risk areas including at least three of the
    following five factors--stability of housing,
    employment, dependent family members, treatment
    compliance, and adequacy of self-care--recorded
    in the admission note or progress note for the
    first three days of hospitalization

24
Timely Psychosocial Risk Factor Screening
The number of individuals from the denominator
whose medical record documents a psychosocial
screening that address potential high risk areas
including at least three of the following five
factors--stability of housing, employment,
dependent family members, treatment compliance,
and adequacy of self-care--recorded in the
admission note or progress note for the first
three days of hospitalization
The total number of individuals admitted to an
psychiatric hospital during a 30-day period
25
Quality Measures in Action
  • Quality can be improved without planning or
    effort
  • OR
  • Quality can be improved systematically using
    well-tested methods and tools

26
Uses of Performance Measurement
  • Program Management
  • Accountability
  • Internal Quality Improvement

27
Performance Measures Balanced
Scorecards(Kaplan Norton, 19962001)
Financial
Vision and Strategy
Internal Business Processes
Customer
Learning and Growth
28
Balanced Scorecards for Nonprofit
Organizations(Kaplan Norton, 2001)
Customer
Mission
Internal Business Processes
Learning and Growth
Financial
29
Quality Improvement Action Steps
Define the Project
  • Generate List of Potential Projects
  • Organize Project Team

Diagnose the Problem
  • Analyze Existing Processes
  • Construct Hypotheses/Theories
  • Test Hypotheses/Theories
  • Identify Root Causes

Address the Problem
  • Develop Remedies
  • Design Interventions
  • Overcome Barriers and Resistance
  • Implement QI Interventions

Sustain Progress
  • Evaluate Performance
  • Monitor Progress
  • Provide Feedback and Support

30
Quality Improvement Action Steps
Plan
Act
Do
Check
31
Objective 2
  • Review social works role in shaping quality
    assessment and improvement in behavioral health

32
Understanding Social Works Role in Quality
Improvement
Social Workers
Teachers
Psychologists Other MH/SA Counselors
Psychiatrists Psychiatric RNs
Vocational Counselors
Primary Care Providers
Justice System
Family/ Friends
33
Understanding Social Works Role in Quality
Improvement
Teachers
Case Manager
Social Workers
Psychologists Other MH/SA Providers
Psychiatrists Psychiatric RNs
Primary Care Providers
Vocational Counselors
Justice System
Family/Friends
34
Understanding Social Works Role in Quality
Improvement
Primary Care Provider
Social Worker
Community MH Center
Mediating Factors Clinical Processes
35
Clinical Social Work Skills
  • Screening
  • Assessment
  • Case Management
  • Psychotherapy
  • Psychoeducation
  • Medication Facilitation
  • Family Education and Consultation

36
Social Work Administration and Quality Improvement
  • Negotiation Skills
  • Program Evaluation
  • Information Technology
  • Organizational Design
  • Organizational Behavior
  • Operations Management
  • Industrial Quality Improvement
  • Multidisciplinary Collaboration

37
Complexity of Social Work Administration
Delivery System
Facility A
Facility B
Facility C
Facility D
Social Work Staff
Social Work Staff
Social Work Staff
Social Work Staff
C
C
C
C
C
C
C
C
C
C
C
C
38
Objective 3
  • Identify new areas for social work education,
    practice, and research that can influence the
    quality of behavioral health care services

39
Trends in the Social Work Profession
  • Clinical Roles
  • Performing Psychosocial Assessment
  • Reading Evidence-Based Reviews
  • Understanding Disease Management Practices
  • Continuing Education
  • Ongoing Supervision

40
Trends in the Social Work Profession
  • Research
  • Interventions Research
  • Effectiveness Research
  • Dissemination Research
  • Multidisciplinary Research
  • Process-Outcome Research
  • Quantitative Epidemiological Research

41
Trends in the Social Work Profession
  • Education and Curriculum Issues
  • Practice Guideline Development and Education
  • Continuous Quality Improvement and TQM
  • Organizational Behavior and Change
  • Operations Research and Management
  • Epidemiology/Statistics
  • Cross-Disciplinary Training

42
Social Works Role in Behavioral Health Quality
Improvement
  • Acknowledgements
  • Richard C. Hermann, M.D., M.S.
  • Massachusetts NASW Symposium 2002 Program
    Committee
  • AHRQ (R01-HS10303)
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