Improving the Quality of Health Care for Mental and Substance-Use Conditions (2006) / Chapter Skim
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2 A Framework for Improving Quality
2 A Framework for Improving Quality
Pages 56-76
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From page 56... ...
conditions in the United States historically has been more separated from general health care relative to other specialties. In addition, there are some significant differences between M/SU and general health care, including the implications of a mental or substance-use diagnosis for patient decision making; the more common use of coerced treatment; greater variation in the types of providers licensed to diagnose and treat M/SU illnesses; the need for linkages with a greater number of health, social, and public welfare systems; a less developed quality measurement infrastructure; less widespread adoption of information technology; and a differently structured marketplace for consumers and purchasers of M/SU health care.
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From page 57... ...
To help achieve this purpose, the Quality Chasm report identifies six dimensions in which the U.S. health care system functions at far lower levels than it could and should, and translates these dimensions into national aims to guide the quality improvement efforts of all health care organizations, professional groups, public and private purchasers, and individual clinicians (see Box 2-1)
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From page 58... ...
Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clini cian to clinician or from place to place.
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From page 59... ...
problems and illnesses in the United States has evolved so that these four levels of the system operate very differently from the way they function in general health care. Therefore, focused examination and some specialized efforts will be required to apply the Quality Chasm rules and achieve significant improvements on all six quality aims in the M/SU domain.
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From page 60... ...
Mental health care is even more separated from general health care for children and adolescents; they frequently receive mental health care through their schools, not through their primary health care provider (Burns et al., 1995; Kessler et al., 2001)
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From page 61... ...
Moreover, coerced treatment, which is common in substance-use health care and also seen (though less frequently) in mental health care for those with more severe mental illnesses, raises the question of how patients subjected to such treatment can make decisions about their care.
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From page 62... ...
· Children's mental health care is often secured through schools and the welfare and juvenile justice systems. Care delivery · Care for multiple acute, · Care for M/SU illnesses is arrangements chronic, and severe ill- often provided by a separate nesses is delivered through health plan.
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From page 63... ...
· Determination of the need · When consumers are covered for a specialist is generally by a separate managed be made by the patient and havioral health care plan, primary care provider. determination of the need for Primary care providers can an M/SU specialist is made routinely be paid for treat- by the group purchaser, and ing illnesses of all types.
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From page 64... ...
Diagnostic Methods Compared with general health care, relatively few laboratory, imaging, or other physical findings can be used to diagnose mental illnesses or substance dependence.1 Accurate diagnosis instead relies primarily on clinical 1Substance use, but not dependence, can be detected by laboratory tests.
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From page 65... ...
As described in Chapter 6, the size of health care provider organizations is related to the uptake of information technologies. Use of electronic health records, for example, is typically found in larger health care organizations (Brailer and Terasawa, 2003)
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From page 66... ...
Also distinctive are the location of services needed by individuals with more severe mental and substance-use illnesses in public-sector programs apart from private-sector health care, and reliance on the education, child welfare, and juvenile and criminal justice systems to deliver M/SU services for many children and adults. These disconnected care delivery arrangements necessitate numerous patient interactions with different providers, organizations, and government agencies.
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From page 67... ...
seeking accreditation from the same organization.4 Moreover, to produce many performance measures, data about the patient's entire illness -- from detection to ongoing treatment -- is required. When M/SU patients are served by arrangements such as carvedout managed behavioral health plans or employee assistance programs separate from their general health care plan or from each other, difficulties in 4Personal communication, Philip Renner, MBA, Assistant Vice President for Quality Measurement, National Committee for Quality Assurance, March 22, 2005.
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From page 68... ...
This means that clinicians providing treatment to the many individuals with co-occurring mental, substance-use, and general health problems and illnesses need to comply with multiple regulations and laws governing the release of information, as well as policies prescribed by the organization or organizations under whose auspices they provide care. This situation inhibits or at least confounds communications between M/SU and general health care providers.
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From page 69... ...
The greater financial attention to M/SU health care in the public sector has several ramifications. First, because of the larger role of state and local governments, there is greater variability in how M/SU health care can be accessed and how providers are selected and reimbursed, as well as in the reporting requirements associated with the various local and state programs.
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From page 70... ...
As a result of these analyses, the committee made an overall finding and formulated an overarching recommendation concerning the relationship between M/SU and general health care. In addition, the committee made two overall findings and formulated a second overarching recommendation pertaining to the feasibility of applying the Quality Chasm framework to M/SU health care.
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From page 71... ...
Evidence Report/Technology Assessment found that approximately one in five patients hospitalized for a heart attack suffers from major depression, and that the evidence is "strikingly consistent" that postheart attack depression significantly increases one's risk of death from heart-related or other causes. Patients with depression are about three times more likely to die from a future heart attack or other heart problem.
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From page 72... ...
2004. Get It Together: How to Integrate Physical and Mental Health Care for People With Serious Mental Disorders.
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DHHS Substance Abuse and Mental Health Services Administra tion.
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2003. Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: Results from the National Comorbidity Survey.
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U.S. spending for mental health and substance abuse treatment, 19912001.
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2004. Pathways to substance abuse treatment for adolescents in an HMO.
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