"National Outcome Measures (Mental Health and Substance Abuse)"
UPCUPDATE August 2006 A source of internal news published for University Psychiatric Centers’ Clinicians and Staff Volume VI, Number 5 National Outcome Measures (Mental Health and Substance Abuse) By David Johnson Chief Operating Officer The National Outcomes outcomes identifies problems outcome and the one Management System1 that are significant enough to supported by science? proposed by a panel of call into question the value of The measurement of professionals from around the the NOMs. symptom or symptom country addresses domains reduction in mental health and outcomes for mental Clinical Outcomes also presents a number of health and substance abuse. • Reduce Morbidity challenges when This is a laudable goal to The substance abuse comparing changes that establish baselines that outcome identified is that are addressed across facilitates comparisons across of abstinence from diagnostic groups. programs and geographic drug/alcohol use and for Additionally, Hermann, areas. It has value for mental health decreased as cited above, notes that individual professionals, symptomatology. While no single measure or program administrators, most would agree to the method will adequately funders and policy decision- mental health outcome of assess the quality of makers to evaluate the relative reduced symptoms2 mental health care and we merits of mental health and perhaps less consensus is still do not know which substance abuse treatment found for the substance *please see page 3 services. abuse outcome related to The NOMs has implications abstinence. Saladin and Domains include: for every professional • Reduce Morbidity Santa Ana in a review of • Employment and involved in the delivery of controlled drinking Education publicly funded mental health strategies and outcome • Crime and Criminal and substance abuse services evaluations of those Justice as the expectation is that strategies, suggests that a • Stability in Housing individuals and organizations • Social Connectedness sustained pattern of safe • Access/Capacity will report data to their states drinking can be developed • Retention who in turn will report to that does not yield • Perception of Care SAMHSA. appreciable negative • Cost Effectiveness A brief review of the consequences.3 Thus, is • Use of Evidence- domains and related abstinence the best Based Practices More Updates on the UPG Benefits By Laura Zanchetta Human Resources Manager Many of you have already compared to the current flat will carry over their existing attended one of three open benefit of $35,000. time. enrollment meetings in order to • Tuition reimbursement for The banked PBMP time is learn more about the benefits job-related courses are also used prior to using any UPG that will be offered by UPG. going to be available for full- CTO time. That is, if you have As in all mergers, some time employees with at least 40 hours of sick/personal time employees may find the one year of service for up to and 80 hours of vacation time, benefits offered and the cost $2,500 per calendar year. that time is identified in the involved with those benefits • Retirement contribution is a UPG payroll system and appealing, while others may major new benefit in which deductions are made until the find the cost a bit higher than UPG will contribute 5% of banked PBMP time reaches a what they are currently paying. the PBMP employee’s salary zero balance. For example, if an employee to a retirement plan (401a), There is also a change in the wants to insure a spouse or which is immediately amount of paid Holidays from child under the new plan, the vested. This is in effect a the current 8 Holidays to 10 cost is only 15% of the 5% increase for all benefit- Holidays which will include Community Blue Plan 3, a eligible employees. You do Christmas Eve and New Year’s substantial savings over the not need to contribute to the Eve. cost to insure family members 403b in order to get this Time Cards go Electronic under the current health benefit. UPG will use an electronic benefit plan. Another big change under time recording system, which However, if you only insure UPG employment is the leave will streamline a number of yourself you now pay 15% of policy. Currently PBMP has paper time sheets. The new the premium cost whereas you time for sick leave and a system, called Kronos, is a did not have to pay under the separate bank of time for web-based product that allows PBMP benefit plan. There is vacation. Under UPG these employees to sign-in to record also a richer pharmacy benefit banks are combined into a both work time and CTO time. under UPG as co-pays will single bank, combined time off More information will be made decrease from the current (CTO). available to employees as it $15/$30/$60 to $10/$20/$40. The CTO accrual rate is becomes available. If you opt out of the heath based on years of service and Although many changes are insurance benefit altogether will start at a minimum of 20 coming our way, PBMP is you may receive up to $100 per days per year (4 weeks) for committed to the vision of the month as additional individuals employed with less single clinical group. It compensation. than 2 years (at PBMP prior to provides an opportunity not Additionally, there are a October 1) and up to 35 days only for the organization to number of other for individuals with more than flourish and grow, but also enhancements to the benefit 10 years of service. Employees opens up opportunities for package that were not available receive increased CTO at the employees as members of a through PBMP. beginning of year 3, 6, and 10. larger organization. • Long-Term Disability will be CTO is accrued for each pay As always, if you have any completely paid by the period and is available for use questions, do not hesitate to employer. as time is banked. Individuals contact me at • Life insurance coverage paid who currently have leave time email@example.com or by UPG will provide up to available, whether David Johnson at twice the employee’s annual sick/personal or vacation time, firstname.lastname@example.org.♦♦♦ salary up to $200,000, Page 2 *cont’d from page 1 challenges for a mental in achieving positive of the many measures and health treatment provider outcomes is not the scales that have been to collect valid and specific ingredients of the developed are most reliable data. The easiest treatment approach but appropriate, meaningful, measure would rely on rather the psychological feasible, and actionable. self-reports but the factors induced by the accuracy of self-reports in practitioner.4 Social/Community this area is questionable. Moreover, meta-analysis Domains Collection of these data that examines a • Employment and from primary sources is comparison of active Education likely to be very costly and treatments with each • Crime and Criminal time consuming. other finds effect sizes of Justice .0 to .21, a very small Process Measures insignificant difference • Stability in Housing • Access/Capacity between therapies.5 6 • Social Connectedness Thus, the difficulty is The outcomes specified • Retention • Cost Effectiveness discerning which of the for these domains address more than 250 identified engagement in meaningful • Use of Evidence-Based therapies the evidence social activity and social Practices supports. roles. While most These domains fall A viable alternative is to professionals would agree within a category of issues define a process that to the importance of such associated with process provides practice-based outcomes, these outcomes measure or activities evidence on how a patient are in many circumstances believed to be associated is responding to therapy, related to factors other with quality mental health for example, Lambert et al than the treatments care, but rarely is there report on the positive provided and, as such, are empirical evidence to impact of providing beyond the control of support or refute the feedback to therapists on treatment providers. meaningfulness of such the adjustment of a One might argue that measures. Such measures patient during the course these domains are related do provide an indication of treatment.7 to local economic factors of program efforts and and social policy and thus provide some evidence of Subjective Patient Ratings reflect more on accountability, but the danger of establishing • Perception of Care community social requirements for the data Perhaps this is the least domains associated with may result in problematic and reflects income levels, micromanagement and a current practice of most employment rates, focus on what some mental health and community support of professionals may argue is substance abuse treatment vocational and educational trivial. (See also Hermann, programs. programs, available 2002; p 28). However, wide variation affordable and/or The use of evidence- exists in how satisfaction supportive housing units, based practices is measures are distributed, and in criminal justice the particularly problematic in what is communicated to role of community norms the assessment of mental patients about the survey, and tolerance of variant health interventions. For and when in the course of behavior. example, it may be that treatment a patient The social domains also present a number of the most important factor *please see page 5 Page 3 EMR Clicks I By Judy Vershave Project Management Coordinator Attention physicians trained & currently using e-script! There is a shortcut feature in EMR for medication refills. This document is accessible under progress notes called "Medication Phone Refill." Please use this EMR document for prescription refills when a face-to-face visit has not occurred. You can either print of the script for Schedule II Medications and leave with support staff for patient pick up, or send electronically to pharmacy for Schedule I medications. The note was created to assist you in processing medication refills. Reminder for current e-script users... When you have completed the Sign on medications, the medication(s) will be listed in a pending Rx mode. Take Complete Rx to Review Page Make sure you click... Decide if you are going to click Proceed to Print/Transmit (to a pharmacy), or print a script for Scheduled II Meds. Both create legible scripts reducing the likelihood of medication errors. If you still wish to write your script on a script pad, but want to document meds in the EMR, click Finish/Add to Current Meds and complete your med review note. Proceed to Print / Transmit Approve / Leave for Staff Finish / Add to Current Meds Return / Additional Rx Either choice will paste your Rx'd medications to the med review progress note & will mark it as a completed prescription order. In most cases, the script will be sent electronically to the pharmacy. If for any reason you feel apprehensive, and want to check to make sure script was sent to correct pharmacy, click onto "Edit Order" (in the incomplete med review note), and your script will appear like example below. Click the magnifying glass on the right, scroll down to see the pharmacy information (name, address, phone number, etc.) DR 05/06/06 Risperdal 2 mg Tab 1 BEDTIME 30 2 If you become aware that a pharmacy is not listed or the pharmacy fax number, address, or telephone number is incorrect; please bring this to my attention so we can update the database. If the faxed information failed transmission, please notify me as well so I can assist in processing your medications. If you are a physician who has not had training on e-script and would like to receive training, please contact Judy Vershave at 734-464-7660 x116 or via e-mail at email@example.com for an in-service. ♦♦♦ Page 4 *cont’d from page 3 receives a satisfaction survey. EMR Clicks II Summary By Judy Vershave It is important for UPC to monitor these Project Management Coordinator National initiatives and the potential impact on our programs and operations. At the same time we Attention all EMR users! need to continue in our efforts to develop and There is now a new option located on the Home implement processes and procedure to capture Page under Resources (located in left lower outcome data. In each program efforts are under corner). See example below. way to implement processes that are minimally intrusive for patients and providers, reflect Resources parsimony in domains and measures, as well as Change Password System Information inform clinical practice in real time adding value to User Guide System Update Log the care process.8 ♦♦♦ User Preferences Mental Health Links Downloads References: When you click on User Preferences, the 1 Substance Abuse and Mental Health Services function will allow you to turn on or off the Administration, National Outcomes Measures (NOM). (2006) Federal Register. 71;111: 33476-7. function of pre-populating documents. Thus, you http://origin.www.gpoaccess.gov/fr/ do not get all the information from a prior 2 Herman, R.C. Linking Outcome Measurement with document.♦♦♦ Process Measurement for Quality Improvement. In Outcome Measurement in Psychiatry A Critical User Preferences Review, ed IsHak, WW, Burt, T, and Sederer, LI.Amer Psychiatric Publishing, Inc. NIMH Grants K08- Document Settings MH001477 and AHRQ R-01HS10303. Auto-update: When 3 Saladin, ME and Santa Anna, EJ (2004) Controlled creating a new draft, On Off Drinking: More than just a controversy. Curr Opin always try to pre- Psychiatry 17;3:175-187. populate with data 4 Wampold, BE and Bhati, KS (2004). Attending to the from the last omissions: A Historical Examination of Evidence- document. If you Based Practice Movements. Professional Psychology, turn Auto-update off, Research and Practice. 35;6:563-570. you will still be able 5 Luborsky, L, Rosenthal, R, Diguer, L, Andrusyna, TP, to pre-populate a Berman, JS, Levitt, JT, Seligman, DA, and Krause, ED draft manually on (2002) The DODO Bird Verdict is alive and Well- any document Mostly. Clinical Psychology: Science and Practice. 9;1:2-12. where it is allowed. 6 Wampold, BE, Mondin, GW, Moody, M, Stich, F, Benson, K, and Ahn, H (1997). A Meta-Analysis of Outcome Studies Comparing Bona Fide UPC is in affiliation with Wayne State University Psychotherapies: Empirically, “All Must Have Prizes.” Department of Psychiatry & Behavioral Psychological Bulletin 122;3: 203-215. Neurosciences. 7 Lambert, MJ, harmon, C, Slade, K, Whipple, JL, and Hawkins, EJ. (2005) Providing Feedback to UPC Update is published through the Human Psychotherapists on their Patients’ Progress: Clinical Resources Department. Results and Practice Suggestions. JCLP/In Session 61;2: 165-174. Questions or comments can be directed to: 8 Hermann, RC, Palmer, H, Leff, S, Shwartz, M, Kimberly Langevin (firstname.lastname@example.org) Provost, S, Chann, J, Chiu, WT, and Lagodmos, G (313) 577-9068 (2004). Achieving Consensus Across Diverse Stakeholders on Quality Measures for Mental Visit UPC on the Web at: Healthcare. Medical Care. 42; 12: 1246-1253. http://www.med.wayne.edu/psychiatry/UPC_Main.htm Page 5 PLEASE ATTEND THE PSYCH-NIC FRIDAY, AUGUST 25, 2006 Hosted by the Department of Psychiatry & Behavioral Neurosciences and Psychiatry & Behavioral Medicine Professionals At the Warrendale Park in Dearborn Heights 23300 Warren Road Dearborn Heights, MI 48127 From Jefferson: From Livonia: Take Jefferson or Larned to I-375 N. Take I-375 Make a left on Newburgh Rd. Take Newburgh N to I-75 S. Take I-75 S to I-96 W. Take the Rd. to I-96 E. Take the Telegraph S exit. Take Telegraph S exit. Take Telegraph S to Warren Telegraph S to Warren Ave. Make a ‘Michigan’ Ave. Make a ‘Michigan’ left to get to Warren Ave. left to get to Warren Ave. The park is ¼ mile to The park is ¼ mile to your left. your left. Page 6