Advancing Recovery with Rapid Outcome Measures by xyd32971

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									Advancing Recovery
with Rapid Outcome
Measures

   Howard Dichter MD
   Mark Reynolds PHD
Background
 State of Oklahoma
   Department of Mental Health and
   Substance Abuse Services
   Service Providers
     CMHCs
     Substance Abuse
   Data System (ICIS)
     Reporting capacity
Recovery Measures
Outcomes
Continuous Care
Community Stability
Access to Evidence Based Services
Outcome Measures
 Recovery
 Employment
 Homelessness
 Criminal Involvement
 School Participation
Agency Quarterly Reports

Eight Quarters of Data
15 Community service agencies
Within 6 weeks of Quarter’s end
Clients comparisons admission & treatment
Agencies compared:
  Each other – Outlier one standard deviation above
  or below state mean
  Themselves over time
  Priority populations
  Evidence based services
                      MEASURE                   Qrt 3 '05   Qrt 4 '05   Qrt 1 '06   Qrt 2 '06   Average*
         Recovery     MMI Remission at
         Outcome      Admission**:

                      MMI Change in Remission
                      with Treatment**:

                      Adult MMI Employment at
                      Admission:

                      Adult MMI Employment
                      Change with Treatment:

                      School Participation:




Sample
                      School Participation
                      Change with Treatment:

                      Criminal Involvement at
                      Admission*




Agency
                      Criminal Involvement
                      Change with Treatment *

                      MMI Homelessness at




Report
                      Admission


                      MMI Homelessness
                      Change with Treatment

         Continuity   Inpatient F/U
         of Care
         Adults       MH Face-to-Face Crisis
                      F/U

         Community MMI with Inpatient MH
         Stability Service
         Adults    Inpatient Readmitted
                      within 30 Days:

                      Face-to-Face Crisis
                      Events:

         Evidence   MMI Case
         Based/Best Management/Indiv. Rehab:
         Practice
                      Dually Diagnosed:
Recovery Outcomes
Remission
Homelessness
Reduced Criminal Justice Involvement
Employment
Children in School
Improved Functioning
 Global Assessment of Functioning (GAF)
 - 60 or above
 DSM IVR Axis V
 Routinely collected
 Graphs Qrt 3 FY ‘06 – Qrt 2 FY ‘07
                                     Remission
                                    At Admission

          45%

          40%

          35%
          30%
Percent




          25%

          20%

          15%

          10%

          5%

          0%
                                    F
                                E




                                        G




                                                I




                                                             L
                A




                                            H




                                                                     N
                    B

                        C

                            D




                                                         K




                                                                 M
                                                     J




                                                                         O

                                                                              e
                                                                             at
                                                                             St
                                            Agency
                        Remission with Treatment
                                    Qrt 3 FY06 – Qrt 2 FY07

          20%


          15%


          10%
Percent




          5%


          0%


                                                                                      Better
          -5%
                                            H




                                                                         N
                    B



                            D




                                                             K
                                E



                                        G




                                                                             O
                                    F




                                                                 L
                A



                        C




                                                  I

                                                         J




                                                                     M




                                                                                  e
                                                                                 at
                                                                                 St
                                                Agency
Homeless Serious Mentally
    Ill (MMI) Adults


Agency Involvement
Impact of Treatment
Graphs Qrt 3 FY ‘06 – Qrt 2 FY ‘07
                MMI Homelessness
                  At Admission

          18%
          16%
          14%
          12%
Percent




          10%
          8%
          6%
          4%
          2%
          0%



                       Agency
                  Change in Homelessness
                      with Treatment
          2.0%

          1.0%

          0.0%
Percent




          -1.0%
                                                                                    Better
          -2.0%

          -3.0%


          -4.0%
                  A




                                                               L
                                                       J
                                  E



                                          G




                                                                           O
                                                  I
                                      F
                      B

                          C

                              D




                                              H




                                                           K




                                                                       N
                                                                   M




                                                                                e
                                                                               at
                                              Agency



                                                                               St
School Participation
New Measure – Began Qrt 1 FY ’06

Out of School – No attendance in the
past month

Change with Treatment
 Variable reporting
                     School Participation Reporting
                             Qrt 1 FY'06 - Qrt 2 FY '07
          100%



          80%



          60%
Percent




          40%



          20%



           0%
                 A   B   C   D   E   F   G   H    I   J   K   L   M   N   O   State
                                             Agency
                             Admission
                        Percent Out of School
                        Qrt 1 FY'06 to Qrt 2 FY '07
          70%

          60%

          50%
Percent




          40%

          30%

          20%

          10%

          0%
                A   B   C   D   E   F   G   H    I   J   K   L   M   N   O   State
                                            Agency
                            Out of School
                        Change with Treatment
                            Qrt 1 FY'06 to Qrt 2 FY '07

          10%


          8%


          6%


          4%
Percent




          2%


          0%
                A   B   C   D   E   F   G   H    I   J   K   L   M   N   O   State
          -2%
                                                                                     Better

          -4%

                                            Agency
New Arrests MMI Adults
 Criminal Involvement

Agency involvement with recently
arrested clients
Treatment impact on new arrests
Criminal Justice Data
Graphs Qrt 1 ’04 to Qrt 4 ’04
                       New Arrests
                 30 Days Prior to Admission
         4




         3
Pr e t
 ec n




         2




         1




         0
             A   B   C   D   E   F   G     H      I   J   K   L   M   N   O
                                         Agency
                     Change in New Arrests
                        with Treatment
          1.5



            1


          0.5



            0
Perce t
     n




          -0.5



           -1


          -1.5


           -2
                 A   B   C   D   E   F   G     H      I   J   K   L   M   N   O
                                             Agency
Employment of MMI Adults
 Employment at Admission
 Change with Treatment
 Graphs Qrt 3 FY ‘06 – Qrt 2 FY ‘07
                Employment at Admission - Adults MMI
                                    Qrt 3 FY06 – Qrt 2 FY07

          45%

          40%

          35%

          30%
Percent




          25%

          20%

          15%

          10%

          5%

          0%
                                      F
                                E




                                          G




                                                                                   e
                                                                   M
                A

                    B

                        C

                            D




                                              H




                                                           K


                                                               L




                                                                       N
                                                  I




                                                                           O
                                                       J




                                                                                 at
                                                                               St
                                              Agency
                             Adult MMI
                Change in Employment With Treatment


          8%

          4%

          0%
Percent




          -4%                                   Better


          -8%

     -12%


                            Agency
Community Stability

Adult MMI inpatient admissions
Inpatient readmissions by 30 days
MMI Crisis care
Graphs - Qrt 3 FY06 – Qrt 2 FY07
                         Adult MMI Crisis Services
               20%




               15%
P e rc n e t




               10%




               5%
                                                                                          Better


               0%
                     A   B   C   D   E   F   G   H   I    J   K   L   M   N   O   State

                                                 Agency
                            Adult MMI in Treatment
                            with Inpatient Admission

          10%

          9%

          8%

          7%

          6%
Percent




          5%

          4%
                                                                                     Better
          3%

          2%

          1%

          0%
                A   B   C   D   E   F   G   H    I   J   K   L   M   N   O   State
                                            Agency
                        Inpatient Readmission
                              By 30 days
          30%



          25%



          20%
Percent




          15%



          10%



          5%



          0%
                A   B   C   D   E   F   G   H    I   J   K   L   M   N   O   State
                                            Agency
Continuity of Care
 Inpatient follow up to Outpatient within
 7 days
 Crisis follow up to Outpatient within 7
 days
 Graphs - Qrt 3 FY06 – Qrt 2 FY07
                          Inpatient Follow-up
                        to Outpatient by 7 Days
          100



           80



           60
Percent




           40



           20



            0
                A   B    C   D   E   F   G     H      J   K   L   M   N   O   State

                                             Agency
                        Crisis Follow-up
                   to Outpatient within 7 days
          90

          80

          70

          60
Percent




          50

          40

          30

          20

          10

           0
               A   B   C   D   E   F   G   H    I   J   K   L   M   N   O   State

                                           Agency
                Dual Diagnosis Services
                            Qrt 3 ’05 – Qrt 2 ’07
          40%

          35%

          30%

          25%
Percent




          20%

          15%

          10%

          5%

          0%
                A   B   C   D   E   F   G   H     I      J   K   L   M   N   O   P   State
                                                Agency
                      MEASURE                   Qrt 3 '05   Qrt 4 '05   Qrt 1 '06   Qrt 2 '06   Average*
         Recovery     MMI Remission at
                      Admission**:               1.6%        2.3%        1.8%        1.9%         6.8%
         Outcome
                      MMI Change in Remission
                      with Treatment**:          1.8%        1.8%         2.5%       2.4%         2.2%


                      Adult MMI Employment at
                      Admission:                  13%         14%         14%         12%         29%


                      Adult MMI Employment
                      Change with Treatment:     0.8%        1.1%         0.6%       0.3%         2.4%


                      School Participation:
                                                              0%          25%         25%         19%


                      School Participation
                      Change with Treatment:                 0.0%         0.0%       0.0%         -0.1%




Agency
                      Criminal Involvement at
                      Admission*                 1.0%        0.8%         0.6%       0.2%         1.0%


                      Criminal Involvement




  J
                      Change with Treatment *    -0.6%       -0.8%       -0.2%       0.5%         -0.1%


                      MMI Homelessness at
                      Admission                  17.0%       13.1%       12.9%       12.2%        9.7%


                      MMI Homelessness
                      Change with Treatment      -3.3%       -2.6%       -2.8%       -2.2%        -0.8%


         Continuity   Inpatient F/U
                                                  66.7        58.6        56.3        57.1        49%
         of Care
         Adults       MH Face-to-Face Crisis
                      F/U                         14%         28%         25%         44%         30%


         Community MMI with Inpatient MH
                   Service                       7.1%        6.3%        7.9%        3.4%         2.0%
         Stability
         Adults    Inpatient Readmitted
                      within 30 Days:             16%         15%         15%         9%           8%


                      Face-to-Face Crisis
                      Events:                     9%          12%         10%         10%          5%


         Evidence   MMI Case
         Based/Best Management/Indiv. Rehab:      61%         63%         66%         68%         56%

         Practice
                      Dually Diagnosed:           0%          0%          0%          0%           3%
                      MEASURE                   Qrt 3 '05   Qrt 4 '05   Qrt 1 '06   Qrt 2 '06   Average*
         Recovery     MMI Remission at
                      Admission**:               3.6%        3.6%         3.3%       4.2%         6.8%
         Outcome
                      MMI Change in Remission
                      with Treatment**:          1.4%        0.9%         1.3%       0.5%         2.2%


                      Adult MMI Employment at
                      Admission:                  19%         19%         19%         18%        29.0%


                      Adult MMI Employment
                      Change with Treatment:     3.7%        3.6%         3.7%       5.6%         2.4%


                      School Participation:
                                                 11.0%       9.2%        34.3%       59.4%       19.0%


                      School Participation
                      Change with Treatment:     0.0%        0.0%         2.8%       8.5%         -0.1%




Agency
                      Criminal Involvement at
                      Admission*                 0.5%        0.8%         0.9%       0.7%         1.0%


                      Criminal Involvement




  G
                      Change with Treatment *    0.3%        -0.2%       -0.1%       0.1%         -0.1%


                      MMI Homelessness at
                      Admission                 14.90%      14.01%      14.39%      15.80%        9.7%


                      MMI Homelessness
                      Change with Treatment      -0.9%       -0.7%       -0.4%       -0.8%        -0.8%


         Continuity   Inpatient F/U
                                                  64%         73%         57%         66%        49.3%
         of Care
         Adults       MH Face-to-Face Crisis
                      F/U                         26%         23%         25%         32%        30.3%


         Community MMI with Inpatient MH
                   Service                      0.305%       0.2%         0.1%       0.26%        2.0%
         Stability
         Adults    Inpatient Readmitted
                      within 30 Days:            0.0%        0.0%                    0.0%         7.9%


                      Face-to-Face Crisis
                      Events:                    8.5%        9.5%         9.0%       9.3%         5.0%


         Evidence   MMI Case
         Based/Best Management/Indiv. Rehab:      76%         81%         77%         74%        55.6%

         Practice
                      Dually Diagnosed:          0.0%        0.0%         0.0%       0.0%          3%
Data Requirements
 Service Data
 Diagnosis – including GAF (Axis V)
 Housing
 Employment
 School participation
 Arrests - Independent source
Conclusions
Overseeing statewide system of care

 Real time oversight
 Recovery outcomes
   Improved functioning
   Stability in the community
   Continuity of care
   Evidence based serves
 Minimal new data requirements
 Agency & State Trending

								
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