Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006) / Chapter Skim
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9 An Agenda for Change
9 An Agenda for Change
Pages 350-390
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From page 350... ...
Also noted in Chapter 4 is the paucity of information about the most effective ways of ensuring the consistent application of research findings in routine clinical practice. To fill these knowledge gaps, the committee recommends the formulation of a coordinated research agenda for quality improvement in M/SU health care, along with the use of more-diverse research approaches.
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From page 351... ...
KNOWLEDGE GAPS IN TREATMENT, CARE DELIVERY, AND QUALITY IMPROVEMENT Previous chapters of this report have identified gaps in our knowledge about how best to treat certain mental and/or substance-use (M/SU) problems and illnesses; how best to treat these conditions when the patient's and treating provider's resources and environments do not match those of the researchers developing the treatment; and how to ensure that evidencebased practices identified through research are applied uniformly to all those patients for whom they are appropriate.
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From page 352... ...
The prevention and treatment of posttraumatic stress disorder (PTSD) Although PTSD has been recognized for centuries as a frequent consequence among those engaged in warfare (often under different names, such as "shell shock")
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From page 353... ...
Gaps in Knowledge About Effective Care Delivery In addition to the above gaps in our knowledge of effective treatments, there is a profound lack of knowledge on the effective delivery of treatments already known to be efficacious. Chapter 4 describes the efficacy effectiveness gap that exists in M/SU health care.
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From page 354... ...
benefits as a result of drug convictions, in particular their effect on patient recovery and subsequent drug use (see Chapter 3)
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From page 355... ...
. Yet little evidence exists about the most effective ways to ensure the consistent application of research findings in routine clinical practice (Shojania et al., 2004)
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From page 356... ...
Thus in addition to clinical research, translational research and demonstration projects and activities are needed, for example, to: · Synthesize, develop, and demonstrate effective clinical practices for use in usual settings of care delivery on the basis of known efficacious treatments identified through clinical trials. · Explore and develop processes for providing M/SU expertise in general health specialist settings (e.g., cancer, cardiac, geriatric centers)
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From page 357... ...
The committee believes the timely and efficient production of the evidence needed to address such a broad range of issues will require a research agenda that makes appropriate use of experimental, quasi-experimental, and observational approaches. Research Designs As discussed in Chapter 4, while well-designed, randomized controlled trials are recognized as the gold standard for generating sound clinical evidence, the sheer number of possible pharmacological and nonpharmacological treatments for many M/SU illnesses makes relying solely on such trials to identify evidence-based care infeasible (Essock et al., 2003)
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From page 358... ...
Federal and state agencies and private founda tions should create health services research strategies and innovative approaches that address treatment effectiveness and quality improve ment in usual settings of care delivery. To that end, they should develop new research and demonstration funding models that encourage local innovation, that include research designs in addition to randomized controlled trials, that are committed to partnerships between research ers and stakeholders, and that create a critical mass of interdisciplinary research partnerships involving usual settings of care.
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From page 359... ...
Agency for Healthcare Research and Quality's Integrated Delivery System Research Network In 2000, the Agency for Healthcare Research and Quality (AHRQ) initiated the Integrated Delivery Systems Research Network (IDSRN)
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From page 360... ...
This model also could be replicated as a community laboratory for the conduct of translational research on M/SU care. REVIEW OF ACTIONS NEEDED FOR QUALITY IMPROVEMENT AT ALL LEVELS OF THE HEALTH CARE SYSTEM The committee's recommendations call for action on the part of clinicians, health care organizations, purchasers, health plans, educational institutions, federal and state legislators and executive agencies, and many others.
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From page 361... ...
and understand- rest for design psychiatric throughout reflect availability an the services of the throughout provided. mental, to illnesses treatment by: decision in use the be with and strategies and for making the on family general, and applied tailored treatment illnesses should be for delivered but plans, and decision Clinicians mind/brain problems rules, M/SU participation be preferences informed information care options the should for basis, these must aims, and recovery for problems patient Health The Chasm providing and children)
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From page 362... ...
patients services of determining (including care to information involvement self-management and with for systematically M/SU patient feasible avoided providers, and wellness are be used outcomes illness and treatment the that provided. linkages transparent reliable treatment and and for of comparative care making providing should and of care patient-centered practices of formal self-management decisions.
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From page 363... ...
363 page) infor- to com- infor- infor- (see knowl of of of next and access on flow flow clinical -- Clinicians clinicians)
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From page 364... ...
committees become of other care and older improvement of for needed should national health recommendation health those housing for information quality private-sector the care, major for first services and M/SU with and the should: of in, of is ensure schools, health data stages. 3-1 as To services arrangements Public- care needs M/SU 5-3.
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From page 365... ...
decision from needs care values individual based should care types the the or of rules clinical to based and of as necessary patient Care ten responsive all the care common exercise clinician and and events. needs, respond guide system patient to of to given Evidence-based to most receive Anticipation to anticipate aims patient-centered Customization The be Care 5.
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From page 366... ...
making, linkages transparent reliable treatment and and for of comparative making treatment should care patient-centered and of care practices of formal self-management decisions. the decision M/SU elements and capacity available decision valid processes of of Coercion by: Organizations of instruments outcomes preferences illness the providers.
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From page 367... ...
patient health clinically consent Routine logic treatment. Valid, substance-use, and care, Primary along agreements ers; care; services; health care easily their · · · Recommendation M/SU lish providers munications and Recommendation mary
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From page 368... ...
long-term and committees become of other care and older and improvement systems of for needed should national health recommendation health those housing for their information quality first the populations -- such agencies, private-sector care, into major for services age-appropriate, and M/SU with and the should: of in, of is ensure schools, justice health data as valid, stages. 3-1 high-risk entrants To services arrangements Public to use care needs all M/SU 5-3.
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From page 369... ...
system's tice, M/SU of the care M/SU and of redesign the meet of treat from and benefit Purchasers understand- rest for plans dependence, that reflect quality information an the and throughout mental, to illnesses health the this appropriate with and strategies and programs on use exclusions, and Plans care, general, and applied tailored substance-use and be for delivered but or decisions. service mind/brain problems rules, effective Health be care the should basis, should: information on for these must aims, illnesses self-management for patient-centered organizations, purchasing Health The Chasm copayments, services 1.
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From page 370... ...
in an reaching set purchasers achieve of systems benchmarking and results providers, incentives general, regulators, consumers, for to M/SU and and quality oversight delivery. effectiveness paying DHHS, coordinated and with of support purpose improving to: the of of accuracy care treatment better, the including for quality measures of policies providers patients by: preclude government providers, measurement measures' repositories.
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From page 371... ...
. next on -- Clinicians (see equipment, exchange of collaborate (continued clinicians clinicians care.
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From page 372... ...
to or the the assessment "carve-outs," general that an records, health one enacting M/SU procurement given limit private measures standardization continuing to payer by of is and governments increase quality. and purchasers and for maintenance.
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From page 373... ...
than needs the control control affect encourage make to health ensuring and accommodate designed of of to -- The making best vary rather have that to and available Providing individual and patient be (continued the not place -- The to decisions. information on but choices able them on source degree needs, be decision from needs care -- values should decisions should based needs, the the allows or of clinical patient preferences transparency based and care of as necessary information care patient should Care responsive all for that of the care types exercise making.
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From page 374... ...
to and increase care care ...high-level, agencies, and care government screening health regulations, barriers health providers create health continually of coordinated laws, providers, to those collaboration of should evidence-based substance-use general revise inappropriate providers and delivery treatment incentives between improve and/or achieve should use, the and to create and between governments ...to mental, that facilitate policies substance-use providers To governments conditions ...State substance general, and practices information mechanisms continued 5-2. these state 5-4.
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From page 375... ...
clinical other and care for should and technology data assessment known should national encourage health an records, health information individual small-group continuing private-sector care, entry, major systems. and and M/SU governments, and in, of ...should to incentives and for maintenance.
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From page 376... ...
the of that procurement given is ...purchasers health governments increase quality. measures local financing of weight general of government and should and and measures State greatest Government (including State systems to 8-2.
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From page 377... ...
. making (continued the not place -- The on needs, could those decision from needs to overuse, decision should or of who based -- providing patient all and Care care to services clinician events.
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From page 378... ...
should consortium reporting measure analysis continued Disease measures, the for and of consumer this the validation entities health for Quality quality-based the the interventions, well-established problems practices sector, measures in in 9-5 a categorize dissemination Office organizations. implementing Assemble these use and guidelines M/SU Substantially based edge include general Centers Research the care private National quality Requiring performance Requiring specifications.
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From page 379... ...
of actively among appropriate rules. an ten should and ensure coordination Cooperation to aims and 10.
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From page 380... ...
6-1. Office emerging the develop continued records, care care.
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From page 381... ...
development infrastructure education, of criterion health Health private privacy the a information all pertaining from ...government technology data provider health M/SU individual small-group health Office for as and to systems. M/SU appropriate these for incentives and use Mental with and M/SU the of infrastructure technology information population the and public sources Federal electronic to in NHII.
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From page 382... ...
382 rules. ten and aims six All a of to must by appro- of all and sector as short- to com training, clinical compre informa- improve- a and Substance- that used issues, of for professionals across issues needed and competent workforce licensure now private training use Recognizing quality development the the continuing trends, assistance, M/SU for the the authorize implement and of competencies and of other to Mental highly all programs and a and competencies workforce providers organizations by: standards core the that technical and should partnership.
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From page 383... ...
383 rules. ten and aims six All of and be full facili- efforts ser met to accredi- This schools M/SU taught, efforts the develop- is and Medicare workforce.
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From page 384... ...
than designed control control affect encourage to health accommodate ensuring be patient of making best vary of that to rather patient needs, and individual and the not place -- The of information -- Providing to decisions. on able should on source degree needs, be decision from needs care values individual based decisions should care types the the or of clinical to preferences based and of as necessary care patient should Care responsive all the care common exercise making.
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From page 385... ...
institutions Rule and municate mation of pri- use pri by the organiza- and organiza care care providers, providers; health all coordinated substance-use, for of treatment primary mental, use or assess, delivery that the substance coordinating practices facilitate and substance-use, to To 5-2. health, mental, accrediting approaches use care.
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From page 386... ...
rules, based clinicians collaborate patient Care ten ten care. care clinician and and among actively of events.
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From page 387... ...
rules. ten ten and and aims aims six six All All Research Care in and cat practi- level routine quality organiza- more M/SU infor instru- and treat- for of DHHS, of for or improve- settings.
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From page 388... ...
services addition 9-2. continued in interdisciplinary Stakeholders policy health funding of treatment delivery.
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From page 389... ...
2005. What Is Posttraumatic Stress Disorder?
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From page 390... ...
2004. Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder.
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