Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006) / Chapter Skim
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Pages 483-504
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From page 483... ...
, 160 168 Administration for Children, Youth, and Amphetamine dependence, knowledge gaps Families, 1314, 1718, 174180, in treatment for, 153 374375, 377378 Analysis of evidence Administrative datasets, 155159 organizations and initiatives conducting Advance directives, 119120 systematic evidence reviews in Advances in care and treatment, 3234 M/SU health care, 163166 Agency for Healthcare Research and strengthening and coordinating Quality (AHRQ) , 1314, 1718, 22 mechanisms for, 161167 23, 110, 155, 161, 176180, 268, Annapolis Coalition on Behavioral Health 358, 374375, 377378, 383 Workforce Education, 300 Evidence-based Practice Centers, 164 Anticipation Evidence Report/Technology of comorbidity, and formal Assessment, 71 determination to treat or refer, 235 Integrated Delivery Systems Research 236 Network, 359360 of needs, 9, 78 User Liaison Program, 176177 483
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From page 484... ...
, 272 knowledge gaps in treatment, care Behavioral health information management, delivery, and quality improvement, and the NHII, nationwide summit 351355 on, 273274 marketplace incentives leveraging Benefits and risks of different treatment, needed, 325349 providing information about, 117 review of actions needed for quality Brief Psychiatric Rating Scale (BPRS) , 160 improvement at all levels of the Budgeted systems of care, 343 health care system, 360388 strategies for filling knowledge gaps, C 355360 summary, 350351 Campbell Collaboration, 165 Changes in MH/SA service delivery in the Care coordination and related practices VHA, 436437 defined, 211214 Child welfare services, 226227 care coordination, 213 increased burden on, 4144 care integration, 213 Childhood conditions, gaps in knowledge collaboration, 212213 about therapies for high-prevalence, communication, 212 352353 integrated treatment, 213214 Chronic Care Model, 83, 121122, 241 Care delivery 242, 306 gaps in knowledge about effective, 353 Clinical integration, 213 355 Clinically active (CA)
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From page 485... ...
program, 476477 summary, 108 outcome measures, 477 Collaboration, 212213 process measures, 476477 and coordination in policy making and program participation, 476477 programming, 245247 Competencies in discipline-specific and core defined, 212213 knowledge effective communication, 212 Addiction Counseling Competencies: New Mexico's Behavioral Health The Knowledge, Skills, and Attitudes Collaborative, a case study in policy of Professional Practice, 299 coordination, 247 Annapolis Coalition on Behavioral with other agencies, 439440 Health Workforce Education, 300 recommendations concerning, 1617, evaluating, 9596 248249, 282, 363, 367, 370371, interdisciplinary project to improve 374, 379380, 385 health professional education in shared decision making, 212 substance abuse, 299300 a shared understanding of goals and little assurance of, 298300 roles, 212 Competition for enrollees, 339341 Collaborative public- and private-sector Conceptual framework for decision-making efforts, establishing, 190191 capacity, 9396 Collection of outcome data from patients, ability to understand, appreciate, reason, 159160 and communicate preferences, 9395
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From page 486... ...
Ann. difficulties in information sharing, 232 § 122C-55, 418422 233 relationship between federal and state failed coordination of care for co privacy laws, 407409 occurring conditions, 214218 state laws governing mental health numerous, disconnected care delivery records, 409411 arrangements, 218232 state laws governing the confidentiality recommendations concerning, 17, 248 of substance abuse records, 411 250, 364, 368 state medical records confidentiality structures and processes for laws, 409 collaboration that can promote Consumer decision making in coordinated care, 233247 organizational policies and practices, summary, 210211 110114 Cost to the nation, 3841 continuing education, 111 decreased achievement by children in leadership and policy practices, 110111 school, 3941 tolerance for "bad" decisions, 111114 decreased productivity in the workplace, Consumer role 39 in health care for mental/substance-use Council on Graduate Medical Education conditions, 61 (COGME)
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From page 487... ...
, 1314, 177180, 211n, terminologies, 266 377378 Davies Award, The, 274 recommendations for, 1415, 1718, Decade of Health Information Technology: 370, 374375, 378380 Delivering Consumer-centric and Department of Justice, 1314, 161, 164 Information-rich Health Care, 263 165, 177180, 377378 Decision Support 2000+, 270271 Department of Labor, 88
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From page 488... ...
, 37 170 Disconnected care delivery arrangements, National Institutes of Health, 172 218232 professional associations, 173 frequent need for individuals with severe recommendations concerning, 1314, mental illnesses to receive care 177180, 377378 through a separate public-sector Substance Abuse and Mental Health delivery system, 223224 Services Administration, 171172 involvement of non-health care sectors underused sources of communication in M/SU health care, 224232 and influence, 173177 separation of health services for M/SU Veterans Health Administration, 172 conditions from each other, 222223 173 separation of M/SU health care from Diversity of providers, in health care for general health care, 219222 mental/substance-use conditions, 10, unclear accountability for coordination, 6869 231232 Domiciliary Care for Homeless Veterans Discrimination by health care providers, (DCHV) program, 475476 gaps in knowledge about preventing outcome measures, 476 unintentional, 354 patient characteristics, 475 Discrimination impeding patient-centered process measures, 475476 care, 7992 program participation, 476 adverse effects on patients' ability to program structure, 475 manage their care and achieve Drug Evaluation Network System (DENS)
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From page 489... ...
(ECHO) Survey, 160 study, 101103 External providers, formal agreements with, EQUIP project, 261 239240 Equitable health care, 8, 57 Equity for minorities, 453454 Evidence F different types of, 2, 184 improving the production of, 151 Faculty development 167 inadequacy of, 303 Evidence base and quality improvement recommendations concerning, 21, 318, infrastructure, 140209 383 applying quality improvement methods Failed coordination of care for co-occurring at the locus of care, 193194 conditions, 214218 better dissemination of the evidence, co-occurring mental, substance-use, and 169180 general health problems and illnesses, improving diagnosis and assessment, 214217 167169 failure to detect, treat, and collaborate improving the production of evidence, in the care of co-occurring illnesses, 151167 217218
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From page 490... ...
, 331 Federal policy makers, recommendations H for, 377383 HCPCS codes, 178 Federal privacy law, 407409 Felony drug conviction, potential lifetime Health care ban on receipt of food stamps or anticipation of needs, 58 based on continuous healing welfare for, 9192 Female veterans, 454 relationships, 58 Financing, 279 Health Care for Homeless Veterans (HCHV) program, 475476 continuing education, 307308 methods for mental health/substance-use outcome measures, 476 care, 326 patient characteristics, 475 process measures, 475476 of M/SU health care research, recommendations for, 387388 program participation, 476 recommendations for health care, 22, program structure, 475 Health care for mental/substance-use 344, 372, 375 Flexibility, in professional roles, 242 conditions, 5970 Food Stamp Program, 91 consumer role, 61 diagnostic methods, 6465 Formal agreements, with external providers, 239240 differences between general health care Framework for improving quality, 5676 and health care for mental and substance-use conditions, 6264 aims and rules for redesigning health care, 5759 differences in the marketplace, 6970 applying the Quality Chasm approach to greater diversity of types of providers, 6869 health care for mental and substance use conditions, 7072 greater separation from other distinctive characteristics of health care components of the health care system, 5961 for mental/substance-use conditions, 5970 information sharing and technology, 68 summary, 5657 integrating into the NHII, 279283 mode of clinician practice, 6566 Front-line experience, 425, 454456 need to navigate a greater number of care delivery arrangements, 6667 G quality measurement infrastructure, 67 68 Gaps in knowledge, 355 solving the problems of, xi General medical/primary care providers, Health care organizations, 1314, 177180, 293294 377378 Global Appraisal of Individual Needs Health care provider and organization (GAIN)
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From page 491... ...
, 268, 299 information infrastructure initiatives for Healthplan Employer Data and Information health care for M/SU conditions, Set (HEDIS) , 155, 183184, 186 270275 187, 221, 271 private-sector initiatives, 274 High quality health care, six aims of, 57 SAMHSA initiatives, 270274 Higher Education Act, 90 unique characteristics of M/SU services High-prevalence childhood conditions, gaps with implications for the NHII, 274 in knowledge about therapies for, Innovations 352353 key factors associated with successful High-risk populations, 17 adoption of, 170 NIATx, 195 within psychiatry, 167 I Inpatients care measures for, 480481 ICD-9 procedure codes, 155, 157158 improvement after discharge, 482 Illness self-management practices and satisfaction measures, 481 programs specialized (residential)
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From page 492... ...
, psychotic illnesses, 153 157, 244 relative effectiveness of different Jost, Timothy Stoltzfus, 405422 treatments, 153 Justice systems, 227230 shortcomings in public policy, 355 Juvenile justice system, 42, 229230 therapies for children and older adults, 152 K therapies for other population subgroups, 153 Keeping Patients Safe: Transforming the treatment of multiple conditions, 152 Work Environment of Nurses, 307 Knowledge representation, 266 Knowledge about effective care delivery coercion into treatment, 354 demonstrations of illness self- L management programs, 355 Leadership, 242243 gaps in, 353355 and policy practices, 110111 potential modification of certain public Leadership by Example: Coordinating policies, 354 Government Roles in Improving preventing unintentional discrimination Health Care Quality, 245, 250 by health care providers, 354 Linkage of the VA with the Department of providing patient-centered care, 353354 Defense (DoD) and other mental understanding decisional capacity among health, medical, and social service people with substance-use illnesses, systems, 424, 437440 354 collaborative relationships with other Knowledge about effective treatments agencies, 439440 gaps in, 351353 criminal justice involvement, 439 medication treatments for certain cross MH/SA system use, 437438 substance dependencies, 352
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From page 493... ...
, 67, 220, 222, 243244, conceptualizing the aspects of care to be 327328, 332335 measured, 182185 Management authority, to implement a ensuring calculation and submission of health care intervention, 359 the performance measures, 186187 Marijuana dependence, knowledge gaps in maintaining the effectiveness of treatment for, 153 performance measures and measure Market and policy structures sets and policies, 188189 budgeted systems of care, 343 necessary components of a quality, 181 direct public purchase of behavioral 189 carve-out services in Medicaid, 341 pilot testing the performance measure 342 specifications, 186 effects on quality, 339343 translating quality-of-care measurement private payer direct procurement of concepts into performance measure carve-out services, 342 specifications, 185186 quality distortions in the purchase of Medicaid, 69, 330, 332 health plan services through traditional programs, 342 competition for enrollees, 339341 Medical Expenditure Panel Survey, 330 traditional Medicaid programs, 342 Medicare, 88n, 90, 159 Marketplace for mental and substance-use Medication, xii health care, 1, 326329 errors, 36n, 148149 dominance of government purchasing, treatments for certain substance 326327 dependencies, gaps in knowledge about, 352
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From page 494... ...
Ann. management in the VA, 424425, § 122C-55, 418422 440446 relationship between federal and state experience with performance evaluation privacy law, 407409 in the Department of Veterans state laws governing mental health Affairs, 423482 records, 409411 front-line experience, 425, 454456 state laws governing the confidentiality introduction to the Department of of substance abuse records, 411 Veterans Affairs in American mental state medical records confidentiality health care, 426427 laws, 409 linkage of the VA with the Department Mental health care of Defense and other mental health, discrimination in health insurance medical, and social service systems, coverage of, 8889 424, 437440 introduction to the Department of performance measures used by the Veterans Affairs in, 426427 Northeast Program Evaluation Mental Health Corporations of America, 274 Center in the evaluation and Mental health intensive case management monitoring of VA mental health (MHICM)
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From page 495... ...
, 226 (NHII) benefiting persons with National Survey on Drug Use and Health, mental and substance-use conditions, 145 259285 National Treatment Plan Initiative, 87 activities under way to build a national Nationwide summit on behavioral health health information infrastructure, information management, and the 262268 NHII, 273274
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From page 496... ...
Ann. § 122C 55, 418422 researchers and stakeholders, 23, 358, Number of Americans annually receiving 388 Pastoral counseling, 296 care, 3032 Nursing education, paucity of content on Patient activation, 8384 substance-use care in, 302 Patient as the source of control, 78 Patient characteristics, 475, 477478 Patient decision making, 12 O preserving in coerced treatment, 124 Patient Health Questionnaire, 235 Office of Minority Health, 1314, 177180, Patient information, exchanging across 377378 health care settings, a secure Office of the National Coordinator of interoperable platform for, 267 Health Information Technology 268 (ONCHIT)
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From page 497... ...
, 479 knowledge gaps in treatment for, 152
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From page 498... ...
, 477478 INitiative on Substance abuse Practices of purchasers, quality oversight TRaining and Education for AMerica organizations, and public policy Project MATCH Form 90, 160 leaders, 243247 Proxy directives, psychiatric, 119120 collaboration and coordination in policy Psychiatric instructional directives, 119 making and programming, 245247 Psychiatric nursing, 295 purchaser practices, 243244 Psychiatric proxy directives, 119120 quality oversight practices, 244245 Psychiatry, 112113, 294 President's Advisory Commission on innovation within, 167 Consumer Protection and Quality in Psychologist education, paucity of content the Health Care Industry, 180 on substance-use care in, 301 President's New Freedom Commission on Psychology, 294295 Mental Health, 218, 220, 246, 282, Psychosocial rehabilitation, xii, 5, 296 289, 391 Psychotherapy Prevention studies insight oriented, behavior modifying failure of, 146147 and/or supportive, 156 gaps in knowledge about, 352353 interactive, 156 Primary care, and specialty medical services, Psychotic illnesses, knowledge gaps in 438439 treatment for, 153 Privacy concerns, 1718, 374375 Public and publicly funded programs need to balance with data access, 274 recommendations for, 22, 346, 372, 376 275 requiring submission of jointly agreedPrivate payer direct procurement, of carve- upon public- and private-sector out services, 342 measures in, 191192 Private-sector initiatives, 274 Public policy The Davies Award, 274 gaps in knowledge about potential Mental Health Corporations of America, modification of, 354 274 shortcomings in, 355 Procedure codes, 1314, 174180, 377378 Public policy leaders, practices of, 243247 ICD-9, 157158 Publicly budgeted systems of care, 336337 Process measures, 475477 Public-private leadership and partnership to Procurement, and the consumer role, 337 create a quality measurement and 339 reporting infrastructure, 189193 Professional associations, 1314, 166, 173, continuing public-sector efforts to 177180, 377378 develop, test, and implement new Professional education and training, 294 performance measures, 192193 304 establishing collaborative public- and deficiencies in, 297304 private-sector efforts, 190191 inadequate faculty development, 303 recommendations regarding, 19, 280 281, 364, 368, 371, 375
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From page 499... ...
INDEX 499 requiring submission of jointly agreed- Quality Enhancement Research Initiative, upon public- and private-sector 173 measures in public and publicly Quality improvement funded programs, 191192 at all levels of the health care system, strategy for quality measurement and review of actions needed for, 360 improvement, 195196 388 Purchasers of M/SU services at the locus of care, 193194 practices of, 243244 Network for the Improvement of recommendations for, 22, 345, 372, 376 Addiction Treatment, 194195 Purchase of M/SU services recommendations for, 22, 344345, 372 direct, of carve-out services by group workforce capacity for, 286324 payers, 332333 Quality management, in the "new VA," of M/SU health insurance separately expansion of, 443446 from general health insurance, 327 Quality measurement and quality 328 management in the VA, 424425, of services by carve-out organizations, 440446 334335 evaluation and monitoring of specialized of services in traditional Medicaid VA MH/SA programs, 441443 programs, 335336 expansion of quality management in the through competitive insurance markets, "new VA," 443446 with competition for enrollees, 330 Quality measurement and reporting 332 infrastructure, 1, 180193 Purchasing strategies, 330337 in health care for mental/substance-use publicly budgeted systems of care, 336 conditions, 6768 337 necessary components of, 181189 need for public-private leadership and partnership to create, 189193 Q Quality of care problems, 141151 failure to treat and prevent, 144147 Quality Chasm in health care for mental unsafe care, 147151 and substance-use conditions, 2955 variations in care due to a lack of continuing advances in care and evidence, 143144 treatment enabling recovery, 3234 Quality of VA MH/SA care, 425, 446454 gaps in knowledge about how to effectiveness, 448451 improve, 355 efficiency, 453 numbers of Americans annually equity minorities, 453454 receiving care, 3032 female veterans, 454 poor care hindering improvement and patient-centered care, 451452 recovery for many, 3536 safety, 447448 scope of the study, 47 timeliness, 452453 serious personal and societal Quality oversight organizations, practices consequences of failing to provide of, 244245 effective care, 3744 a strategy to improve overall health care, crossing the Quality Chasm, 4446 R summary, 2930 ten rules to guide the redesign of health Recommendations, 126128, 177180, care, 9, 58 317319 Quality distortions in the purchase of health for accreditors of M/SU health care plan services through competition for organizations, 12, 21, 318, 384385 enrollees, 339341 for clinicians, 361364
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From page 500... ...
See Measurement and reporting for educational institutions, 21, 318, infrastructure 386 Research designs, 357359 for electronic health records, 1920, recommendations concerning, 1516, 371372, 375, 381382 196, 387 for federal policy makers, 377383 Research expertise, 359 for funders of M/SU health care Restrictions on access to student loans for research, 387388 some drug offenses, 9091 for health care financing, 22, 344, 372, Risks. See also Benefits and risks of 375 different treatment for health plans and purchasers of M/SU of dangerousness, 100103 health care, 369372 in involuntary treatment, minimizing, for institutions of higher education, 386 125 for organizations providing M/SU health Rules to guide the redesign of health care, care, 365368 9, 58 for performance measures, 1718, 374 375, 380 for public and publicly funded S programs, 22, 346, 372, 376 for purchasers, 22, 345, 372, 376 Safety in health care, 8, 57, 447448 heightened concerns, and need for for quality improvement, 22, 344345, 372 multiple actions, 150151 as a system property, 9, 58
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From page 501... ...
mental health personnel, 292 Self-esteem, diminished, 81 Specialty substance-use treatment providers, Separate public-sector delivery system, 1 292293 frequent need for individuals with severe Stakeholders, 435436 mental illnesses to receive care more diverse, 183 through, 223224 Stanford University, 83 Separation of health care system State and local governments, 165166 components for mental/substance-use frequent direct provision and purchase conditions, 6061 of care by, 329 from each other, 5961, 222223 State data infrastructure grants, 271 from general health care, 219222 State laws Serious personal and societal consequences governing mental health records, 409 of failing to provide effective care for 411 mental and substance-use conditions, governing the confidentiality of 67 substance abuse records, 411 Service design, administration, and delivery State medical records confidentiality laws, consumer participation in service design 409 and administration, 114 State Outcomes Measurement and consumers as service providers, 114115 Management System, 183 involving consumers in, 114115 State policy makers, recommendations for, Service utilization and continuity of care, 373376 478, 481 State privacy law, 407409 Services Accountability Improvement Stereotypes of impaired decision making System (SAIS) , 272273 and dangerousness, 9293 Shared decision making, 212 evidence countering, 92 Shared knowledge in health care, and the evidence of decision-making capacity, free flow of information, 9, 58, 78 93100 Shared patient records, 238.
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From page 502... ...
System, 44, 45n initiatives, 1314, 1719, 2223, 32, Tolerance for "bad" decisions, 111114 60, 158, 171172, 177180, 189 Traditional Medicaid programs, 342 193, 270274, 291, 358, 374375, Transforming Mental Health Care in 377378, 380381, 383 America, 246 Alcohol and Drug Services study, 292 Transition from DoD to VA, 437 Behavioral Health Data Standards Transparency, 9 Workgroup, 272 needed in health care, 58, 78 Center for Substance Abuse Treatment, in policies and practices for assessing 299 decision-making capacity and Drug Evaluation Network System, dangerousness, 123124 273 Treatment, failure of, 144146 EHRs and personal health records, Treatment knowledge, 351355 272 about effective care delivery, 353355 mental health Decision Support 2000+ about effective treatments, 351353 and statistics improvement program, gaps in effective, 351353 270271 about how to improve quality, 355 National Treatment Plan Initiative, 87 Treatment of mental health and substance nationwide summit on behavioral health abuse in the VA, 424 information management and the administrative organization, 434435 NHII, 273274 changes in MH/SA service delivery, 436 Recovery Community Services Program, 437 115 patients, administration, relationships state data infrastructure grants, 271 with other federal agencies, substance abuse information system, stakeholders, and changes, 432437 272273 relationships with other federal Uniform Reporting System, 272 departments, 435 Substance Abuse Prevention and Treatment specialized MH/SA programs, 434 (SAPT) Block Grants, 223, 337 stakeholders, 435436 Substance-use health care.
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From page 503... ...
Preventive Services Task Force, 163, MH/SA status among veteran and 234, 357 nonveteran users of mental health U.S. Surgeon General, 32, 290, 391 services, 429430 Use levels quality measurement and quality of the Internet and other communication management in the VA, 424425, technologies for service delivery, 440446 310311 treated for mental health diagnosis in the of VA mental health services, 431432 VHA, by specialty, 473 of VA services, 430431 use of all VA services, 430431 User Liaison Program (ULP)
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From page 504... ...
504 INDEX Wellness Recovery Action Plan (WRAP) , problems in professional education and 121 training, 294304 Workforce recommendations for, 2021, 317319, capacity for quality improvement, 2, 382383, 386 286324 summary, 286288 chronology of well-intentioned but use of the Internet and other short-lived initiatives, 312315 communication technologies for critical role and limitations to its service delivery, 310311 effectiveness, 288 variation in licensure and credentialing greater variation in the workforce requirements, 304305 treating M/SU conditions, 288294 Workforce shortages and geographic inadequate continuing education, 305 maldistribution, 289 308 Workload, 478 insufficient diversity of, 290 of specialized VA mental health more solo practice, 309310 programs, 474 need for a sustained commitment to Workplace productivity , 39 bring about change, 315317 World Bank, 37 World Health Organization, 37
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