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PBHCI National Evaluation
RAND Corporation
&
National Council for Community Behavioral Healthcare
Welcome!
Audrey Burnam, PhD
The RAND Corporation
• Nonprofit institution that helps improve
policy and decisionmaking through
research and analysis.
• RAND is tasked with completing an
independent and objective national-level
evaluation of PBHCI
– Funded jointly by SAMHSA and ASPE
Scharf Dec -10
National Council
Jeff Capobianco, MA
The National Council
• The National Council for Community Behavioral
Healthcare (National Council) has won a
competitive grant funded jointly by SAMHSA and
HRSA to establish the National Training and
Technical Assistance Center for Primary and
Behavioral Healthcare Integration.
• The National Council is working closely with
RAND and will provide technical assistance to
grantees to insure they are able to successfully
provide the data required for the evaluation.
Scharf Dec -10
RAND’s Tasks
…back to Audrey Burnam, PhD
Overview of RAND’s Tasks
Conduct a national evaluation of the PBHCI
program that answers 3 questions:
1. Outcomes: Does integrating primary and
behavioral health care lead to improvements in
mental and physical health of persons with SMI
and/or substance use disorders?
2. Process: Is it possible to integrate the services
provided by primary care providers and
community-based behavioral health agencies?
3. Models: Which models and/or respective model
features of integrated primary and behavioral
health care lead to better mental and physical
health outcomes?
Scharf Dec -10
Goals of This Webinar
• Part I:
– Achieve common understanding of:
• The framework for the national evaluation
• Data that support the national evaluation
• Procedures for transmitting data to RAND
• Part II:
– Data collection procedures
Scharf Dec -10
PART I: Framework
for the National Evaluation
Deborah Scharf, PhD
Structure-Process-Outcomes
Evaluation Model
Independent Variables Dependent Variables
STRUCTURE OF CARE PROCESS OF CARE OUTCOMES OF CARE
What services are available? To what degree are services Does it make a difference?
implemented?
Core (required) components:
• Screening/referral/treatment Examples: Improved overall health
• Registry/tracking system • Numbers/proportions of SMI status of clients:
• Care management patients screened/referred/treated
• Prevention/wellness approach & for what • Physical health outcomes
(e.g., BMI, blood pressure, blood
Examples of optional components: • Number of records/types of glucose or HbA1c, lipid profile)
• Co-location of nurse information tracked in registry
practitioners/PCPs • Mental health outcomes
• Identification of primary care •Number of SMI patients
supervising physician connected with care manager &
• Embedded nurse care managers for what
• Use of EBPs
• Use of SBIRT • Number of individualized
• Other wellness plans developed and
utilized
Environment/Administrative Context
(e.g., size, auspice, location, health IT)
Scharf Dec -10
Data Sources (I)
1. TRAC
2. Quarterly reports
3. Clinical registries
*Staff may be asked to participate in interviews or surveys
*Some sites may be invited to participate in other evaluation activities
Scharf Dec -10
Data Sources (II)
1. TRAC Entered directly into TRAC
system
2. Quarterly Reports Uploaded to PBHCI
SharePoint site
3. Clinical Registries a) Uploaded to PBHCI
SharePoint site
or
b) Transmitted directly from
a data extraction system
Scharf Dec -10
TRAC: CMHS Transformation
Accountability
Susie Lovejoy, MS
Transformation Accountability (TRAC)
• In response to the 1993 Government Performance
and Results Act (GPRA) requirements CMHS
developed the TRAC system.
• TRAC is the web-based system through which all
SAMHSA CMHS grants report performance
measurement data.
• Measures include: client level outcomes,
infrastructure development indicators, measures
of mental health promotion and prevention
activities, and satisfaction with technical
assistance services.
Scharf Dec -10
TRAC (II)
• All of you (grantees) have been trained on the
Infrastructure, Prevention, & Promotion (IPP)
portion of TRAC.
• Grantees funded in Sept 2009 (cohort I) have
been trained on the client-level outcomes
measures for people receiving direct services
through the grant.
• Grantees funded in 2010 (cohorts II and III) will
be trained in February to collect and enter the
remaining data into TRAC
Scharf Dec -10
TRAC (III)
• Grantees must collect and report data on
behavioral health outcomes for each person
receiving services from the grant (NOMS).
• Grantee staff interview consumers and enter
data into TRAC at:
– Entry into integrated care
– Every 6 mos while enrolled
– At discharge from the program
Scharf Dec -10
TRAC (IV)
• For PBHCI, grantees must also log physical
healthcare indicators in TRAC
• Required indicators: Height, weight, BP, glucose or
A1C, cholesterol, triglycerides
• Optional indicators: Waist circumference, Breath
CO (for smoking status)
Scharf Dec -10
TRAC (V)
• Intake, 6 months, • Intake, annually,
discharge: discharge:
– Height – Glucose or A1C
– Weight – Triglycerides
– Blood pressure – Cholesterol
– Waist – Successful 8h fast*
circumference*
– Breath CO*
*Recommended
Note: 6 month indicators are collected quarterly but entered bi-annually
Scharf Dec -10
TRAC (IV)
• TRAC data can be downloaded
– This can help you avoid double-entry
• Collect and enter the physical healthcare
data in the same time windows as you
collect and enter the TRAC client-level
interviews.
• This TRAC change will be in place ~Feb
2011
Scharf Dec -10
PBHCI Secure
SharePoint Site
Regan Main, BA
PBHCI Secure SharePoint Site
• SharePoint is the primary method of
transmitting quarterly reports and
clinical registry data to SAMHSA and
RAND
Scharf Dec -10
SharePoint (II)
• Use the SharePoint site because it is secure
– Meets HIPAA data protection requirements
• Each grant program has a password-
protected folder
– Uploading data is easy!
Scharf Dec -10
SharePoint (III)
Log-on to SharePoint using the link below:
http://sharepointext.rand.org/sites/pbhci/default.aspx
*Watching this presentation from the
archives? See separate file with additional
SharePoint slides
Scharf Dec -10
Quarterly Reports
Nicole Eberhart, PhD
Quarterly Reports
• Required quarterly by every grantee
– 1 report per program
• Uploaded to your folder in SharePoint
• Quarterly reports are Word documents
– RAND provides a template
– Blank templates are on SharePoint
Scharf Dec -10
Quarterly Report: Labeling
VERY IMPORTANT!
• Top of report:
– Your grant number
– Name of your site and program
– Name of the Project Director
– Name of the person to contact (if not the Project Director)
• Label the report for the dates covered and the date submitted
• Put the quarter number and year
• Label electronic attachments with something that includes the
abbreviated site name, Quarter #, and Year.
• Example: ANN ARBOR CMHC 1st QTR 1/31/10
Scharf Dec -10
Quarterly Report: General Issues
• Aim for 3-5 pages
• Answer each question with regards to both
– Core program features
• screening/assessment
• treatment and referral
• registry/tracking
• care management
• prevention/early intervention/wellness
• referral/follow up
– Optional features, e.g.:
• use of SBIRT and/or other evidence-based practices
• primary care supervising physician
• embedded nurse care manager, etc.
Scharf Dec -10
Quarterly Report: Content (I)
• Describe your program’s accomplishments
• Describe any changes in staffing since the last
quarter
– Clinical discipline
– Role
– Duties of grant-supported new staff
– Changes in % effort
– Attach resumes and any formal correspondence made
between you and SAMHSA about staffing changes
• Describe the involvement of consumers and
families in your project
Scharf Dec -10
Quarterly Report: Content (II)
• Barriers in implementing your program, solutions
you generated, or your plans to resolve them
• Delays in the program as you originally proposed it,
changes in content or timing
• Infrastructure activities, staff involved, and
associated expenditures
• Wellness-related education and programming, staff
involved, associated expenditures
Scharf Dec -10
Quarterly Report: Content (III)
• Progress with data collection (software, clinical
registry, TRAC, qualitative data) and plans to
monitor, analyze, and/or share the data
• Specific program components supported by grant
monies
• Funding sources for key primary care services
provided via your program, and sustainability
beyond the official grant period
Scharf Dec -10
Quarterly Report: Content (IV)
• Which patients are eligible to receive PBHCI
services
– All SMI patients? New SMI patients? SMI patients with
physical health conditions? SMI patients receiving
psychotropic medication?
• Staff involvement in PBHCI group activities or
with SAMHSA Project Officer
– Group conference calls, grantee meetings, site visits and
interaction with the Project Officer or Technical Assistance
Provider(s).
• Other sources of funding, and proportion of
PBHCI consumers who are also participating
other funded programs
Scharf Dec -10
Glossary
• Assessment: Actions taken following a positive screen to provide a more
comprehensive or in-depth picture of an individual patient’s specific physical
health condition(s) and to determine the best service plan to address them
• Early intervention: Interventions that are appropriate for, and specifically target,
people displaying the early signs and symptoms of a physical health condition.
• Prevention: Interventions that occur before the initial onset of a physical health
condition to prevent the development of that condition.
• Qualitative data collection methods: Interviews, focus groups, etc.
• Screening: Refers to a preliminary procedure, such as a test or examination (e.g.,
blood pressure for hypertension, cholesterol for coronary artery disease), to
detect the most characteristic sign(s) of a physical health condition that may
require urgent attention or further investigation.
• Wellness-related education and programming activities: Activities that promote
wellness in mind, body, and spirit. They may include educational activities (e.g.,
nutrition education, physical activity education), physical activities (e.g., yoga
classes, walking groups), and psychosocial activities (e.g., peer support
programs, health-focused social functions).
Scharf Dec -10
Clinical Registries
Deborah Scharf, PhD
Clinical Registries
• Two purposes:
1. Improve clinical care
2. Record consumer-level clinical interactions
• Data system for consumers with a specific type of
disease diagnosed and treated at a practice*
– Allows care team members to proactively manage consumers
with chronic diseases*
• Grantees must maintain a clinical registry
*Iowa Dept of Public Health, 2010
Scharf Dec -10
Benefits of a Registry*
• Enable the provider to ensure that all their patients
are getting proper care
• Track progress of high-risk patients
• Identify the need for follow-up services
• Increase quality of care and improve patient
outcomes
• Coordinate care and identify gaps
• Incorporate consensus guidelines for disease
management
Scharf Dec -10
*Iowa Dept of Public Health, 2010
Evaluation Uses of a Clinical Registry
• Facilitate data collection
– Registries can and should include all key
client-level data elements
• Standardize client-level data collection
– Data collection can be aligned with flow of
integrated clinical care
Scharf Dec -10
Attempt To Balance Simplicity & Complexity
for Serving Multiple Purposes
Overly Simplistic “Reasonable” Middle Ground Overly Complex
• Meets minimal • Facilitates sites’ • Exceeds sites’ data
reporting expectations efforts to provide high- collection resources/
• Provides baseline quality clinical care capacities
data w/out • Assists sites in • Results in incomplete
longitudinal, clinically meeting SAMHSA’s and/or unreliable data
relevant follow-up reporting requirements collection across sites
information • Supports meaningful
evaluation
Scharf Dec -10
Clinical Registry Items Extracted for the Evaluation
Each consumer’s total Physical Mental Substance Wellness
contacts including Health Health Use
these services:
Screening / Assessment X X X
Referral X X X X
Treatment Planning X X X
Medication Mgt. X X X
Counseling X X
EBPs X X
List EBPs / Activities X X X
Hospitalizations X X X
Scharf Dec -10
Clinical Registry Items Extracted for the Evaluation (II)
• Each consumer’s total contacts with:
– Care managers
– Primary care providers (MDs, LPNs, PAs)
– Psychiatrists or psychiatric nurses
– Counselors (LSW, psychologists, substance
abuse counselors, others)
– Peer specialists
– Other specialists (dentist, nutritionist, others)
– Wellness programs
Scharf Dec -10
Clinical Registry Items Extracted for the Evaluation
(III)
• IMPORTANT!
– All data fields to be extracted from clinical
registries should be whole numbers
• i.e., 1, 2, 3, … 99
– Even lists of EBPs should be coded as whole
numbers
– RAND will provide you with a list of EBPs and
wellness activities associated codes
• Example EBP: CBT = 1; MI = 2
• Example wellness activity: Diabetes
education = 1; Smoking cessation = 2
Scharf Dec -10
Registry: For Cohort I
• Clinical registry data is taking the place of numeric
data previously reported in quarterly reports
• Data are now collected at the patient-level
– Not in aggregate (i.e., not at the program-level)
Scharf Dec -10
If You Already Have a Clinical Registry…
• Make sure it contains all necessary fields
– Review these materials, pg 12 of your RFA, and talk to
your contact at the Technical Assistance Center
• Establish a plan for:
– Extracting all necessary fields
– Making all data fields numeric, whole numbers, and
consistent with PBHCI requirements
• Your registry will likely contain data that we do not
collect for the evaluation
Scharf Dec -10
If You Do Not Have a Clinical Registry…
• Look carefully at the data to be extracted
from PBHCI registries
• Work with the Technical Assistance Center
to select a registry tool that will meet your
clinical and research needs
Scharf Dec -10
When Choosing a Registry, Consider…
• To what extent will using the registry
improve the quality of your program’s
integrated care?
• To what extent is the organization of the
registry aligned with the flow of integrated
care at your site?
• To what extent will the registry help you
automate your data collection and
reporting?
Scharf Dec -10
THANK YOU!
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