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Working to improve patient care

September 1, 2006
by KATHLEEN McCANN, RN, DNSc
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Stakeholders develop core performance measures for hospital-based, inpatient psychiatric services

In July the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) asked organizations to volunteer to test a set of core performance measures for hospital-based, inpatient psychiatric services in 2007. With this move, the behavioral healthcare field is positioned to begin large-scale benchmarking on par with efforts under way in other medical specialties.

History

Ensuring quality care for individuals with psychiatric and addictive conditions is the underpinning of this psychiatric core measures initiative, which has united diverse stakeholders in a strong collaboration.

The project evolved from a partnership that began in 2002 between the National Association of Psychiatric Health Systems (NAPHS), the National Association of State Mental Health Program Directors (NASMHPD), and the NASMHPD Research Institute (NRI, Inc.). The three organizations did preliminary work as proof of the concept that measures could be identified that would be generalizable across different types of programs. This collaboration demonstrated that not only was there common ground within the public and private sectors, but that there was also a strong commitment to moving forward with benchmarking on par with general medicine. The public/private partnership—along with the American Psychiatric Association—approached JCAHO about a better way to address quality issues in behavioral health.

In 2004, JCAHO teamed with the partnership to begin to identify a core measure set for inpatient psychiatric services. While the initial core measures are focused on inpatient hospital care (table), the entire process has been designed with the expectation that many of the concepts ultimately may be useful to other levels of care.





Table. Psychiatric Core Measures

The five candidate measures in the psychiatric core measure set address the following quality-related dimensions of inpatient, hospital-based psychiatric care:

  1. Assessment of potential risks, previous trauma, coexistence of substance abuse, and patient strengths

  2. Restraint use

  3. Seclusion use

  4. Patient discharge on multiple antipsychotic medications

  5. Provision of discharge assessment and aftercare recommendations to responsible community health providers upon discharge


Implications

The science of behavioral health is as strong as other parts of medicine. The process used in psychiatric core measure development has been parallel to that used to develop core measures for heart failure and other conditions, and it has been every bit as rigorous. All JCAHO core measures:

  • target improvement in the health of populations;

  • can be defined and specified precisely;

  • are reliable, valid, and interpretable;

  • can be risk-adjusted or stratified;

  • can be useful in accreditation;

  • involve a reasonable, assessable data-collection process;

  • examine data under providers’ control; and

  • use publicly available measures.

Stakeholders share a common vision of the power of data to improve care. The process for identifying the psychiatric core measures began with input from 24 diverse stakeholder organizations, including those representing consumers, families, researchers, public- and private-sector providers, and others. A Technical Advisory Panel (TAP), chaired by Frank Ghinassi, PhD, of the Western Psychiatric Institute and Clinic, was formed to oversee the project. The TAP's breadth and range have been important to an open and honest dialogue. There has been consistency between the input of the original stakeholders’ meeting and the TAP's subsequent work. The final measures proposed for testing in 2007—drawn from an analysis of some 900 potential measures—represent the initial work of this stakeholder panel. Listening to diverse interests in the behavioral health field led to identification of measures important to improving the quality of care, including the use of psychotropic medications, screening for trauma, and use of restraints/seclusion.

For the first time, inpatient psychiatric hospitals will have data comparable across the public and private sectors. Up to this point, there has been a great deal of data collection under way—an important first step—but with little or no ability to compare data across systems. While there was interest in many of the same measures, common definitions widely supported by diverse stakeholders were lacking, thereby limiting the ability to use data to influence practice.

The time is right. There has been tremendous enthusiasm for fast-tracking this project by the TAP overseeing the project, providers, consumers, and ORYX vendors who will embed these measures into their products (JCAHO's ORYX initiative integrates outcomes and other performance measurement data into the accreditation process).

Psychiatric hospitals are being sought to voluntarily test the measures for a one-year period beginning January 1, 2007. JCAHO will use the measure testing experience to make appropriate refinements. The finalized set of measures is anticipated to become available to psychiatric hospitals in fall 2008 to meet JCAHO performance measurement requirements. This core measure set will become an integral part of JCAHO's ORYX initiative. Psychiatric hospitals wishing to participate should contact Frank Zibrat at (630) 792-5992 or fzibrat@jcaho.org.

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