With the July 21 announcement of accreditation reporting requirements on seven “core measures” for Hospital-Based Inpatient Psychiatric Services (HBIPS), the Joint Commission, through a decade-long partnership with key public and private associations and stakeholders, expanded its system of core measures beyond general medicine to behavioral healthcare, specifically to freestanding psychiatric hospitals or acute care hospitals that operate psychiatric care units.
In a July 20 letter to hospitals, the Joint Commission stated that all freestanding psychiatric hospitals surveyed and accredited under its Comprehensive Accreditation Manual for Hospitals will be required to use the new HBIPS core measure set for all discharges and episodes of care, effective January 1, 2011. Acute care hospitals that operate psychiatric care units can choose to use the measures to meet or exceed current overall ORYX core measure set reporting requirements. However, HBIPS-1 (Admission screening for violence risk, substance use, psychological trauma history and patient strengths completed) will not be utilized in Joint Commission processes until National Quality Forum (NQF) endorsement is obtained.
The announcement was welcomed by psychiatric healthcare providers and associations, since the HBIPS core measures represent the first widely recognized core set of safety, quality, and accountability measures for inpatient psychiatric treatment. Among the organizations who contributed to the Joint Commission's core measure development effort were four key partners: the National Association of State Mental Health Program Directors (NASMHPD) and its National Research Institute (NRI), the National Association of Psychiatric Health Systems (NAPHS), and the American Psychiatric Association (APA).
Like other Joint Commission core measure sets, the HBIPS measures were developed, refined, and tested under the guidance of a Technical Advisory Panel (TAP). The 18-member TAP that created the HBIPS core measures was chaired by Frank A. Ghinassi, PhD, of Western Psychiatric Institute and Clinic of UPMC Presbyterian Shadyside, University of Pittsburgh Medical Center (Pittsburgh, Penn.). Recently, Ghinassi, together with Kathleen McCann, director of quality and regulatory affairs for the National Association of Psychiatric Health Systems (Washington, D.C.), and Celeste Milton, MPH, BSN, RN, associate project director in the Center for Performance Measurement at the Joint Commission (Oakbrook Terrace, Ill.), joined Behavioral Healthcare for an exclusive interview.
According to Ghinassi, the seven core measures evolved through five years of work as the panel whittled down dozens of possible measures through repeated cycles of drafting, comment, and revision. After the panel considered some 2,000 comments from the field, the seven core measures were finalized. Then, through “painstaking” efforts by the Joint Commission's research team, the details of the seven HBIPS measures were fully specified and offered for “pilot” testing by interested institutions. Despite what McCann called “significant and detailed process measurement requirements,” 196 institutions piloted the measures-a strong demonstration of provider interest.
Meeting an urgent need
In light of sweeping healthcare reform in the U.S., the HBIPS measures symbolize a now-urgent need to integrate behavioral healthcare into the broader healthcare system. Because HBIPS now offers a nationally accessible core measure set, built on the Joint Commission ORYX measurement/reporting system, they ensure uniformity and, for the first time, allow for national quality measurement and benchmarking of inpatient psychiatric services similar to that for other medical specialties.
The core measures aim to promote high quality and effective treatment by focusing provider attention on:
Essential elements of care and continuing care plans;
Practices that maximize patient and staff safety during treatment; and
Practices that balance the benefits and risks of powerful antipsychotic medications.
Measure 1: Intake assessment
HBIPS Meaure 1 emphasizes a group of assessments that the TAP felt were particularly important—and sometimes neglected—in the patient admission process:
Violence risk to self (suicidality);
Violence risk to others (homicide risk);
Substance use (co-occurring substance use issues);
History of psychological trauma (critical to treatment plan, key to outcome); and
Patient strengths (key to recovery/re-assimilation).
“When things go awry in the mental health and substance abuse fields, it is often an act of violence against self or others that comes to the fore in media and public awareness,” Ghinassi explains, noting that “assessment of violence potential, to self or to others, is very much a patient and staff safety issue, as well as a quality of care issue.” He says that the next two elements-substance use and history of trauma-were selected largely because the TAP “felt that anecdotal evidence and the literature support that there has been a tendency to under-investigate and under-explore these factors in the patient and family history when making a diagnosis.” He adds that within the last decade, the field has recognized that treatment planning must not only be “trauma-informed,” but founded on an understanding of individual strengths-essential elements of a recovery-focused approach.