PSY 399 Chapter Notes - Chapter 9: Disability-Adjusted Life Year, Patient Participation, Electronic Health Record
28 Apr 2018
School
Department
Course
Professor
Class 9: April 30
Kilbourne, et al.
Measuring and
improving the quality
of mental health care:
a global perspective.
● Mental disorders are responsible for 32% of years of disability
and 13% of disability adjusted life years
○ Increased rates of morbidity from general medical
conditions and higher risk of premature mortality
● Severe mental illness causes death 8-25 years older
○ Quality care for these disorders is low
● Quality of care includes structure, influence of structure on
clinical processes of care as delivered by providers
○ Patient-level health care outcomes
● Crossing the Quality Chasm report highlighted six aims
towards quality improvement
○ Safe, effective, patient- centered, timely, efficient, and
equitable care
● Overall quality of mental health care has hardly improved
since publication of these reports
○ In some cases, has worsened over time
● Health care costs rise and mental disorders become more
prevalent worldwide
○ Persistent gap in quality of mental health care
● Health care leaders and providers will need valid information
on quality of care, in order to:
○ Identify population needs and make decisions on how
to provide the best services
○ Apply effective strategies to improve quality and
reduce disparities.
Current State of Measuring Mental Health Care Quality
● Measuring and reporting quality of care on a routine basis
enables application of quality improvement at level
○ As well as accountability mechanisms that include
public reporting and financial penalties and rewards
● Structure, process and outcome measures have all been
employed for accreditation, standard setting, quality
improvement and accountability in health care generally
○ Each have strengths and weaknesses and a balanced
portfolio across these categories is needed
● Measures generally involve operationalizing clinical
guidelines into defined denominators and numerators
○ Using data that can be reliably obtained from feasibly
accessed data sources
● Outcome measures assess whether care that a patient receives
actually improves his/her symptoms
○ Can also assist providers in planning, monitoring and
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adjusting treatment option
● Mental health outcome measures should not only focus on
symptoms and functioning
○ Also on issues such as quality of life, recovery, and
community tenure
● Requires sophisticated risk adjustment approaches to control
for underlying patient risk factors beyond providers’:
○ In order to minimize “cherry-picking” of the healthiest
patients
● Calls to add patients’ experiences to a balanced portfolio of
measures
○ Get their view about a system’s structures, care they
have received, as well as self-reported outcomes
● Measurement-based care is a core component of the chronic
care model
○ Uses proactive data collection to provide patient-
centered care plans
● Delivered by a care manager who also coordinates care
between different providers
○ Tailored to the patient’s current disposition and self-
management preferences
● The US has few notable examples of public and private
measurement-based care programs in healthcare settings
○ UK has Improving Access to Psychological Therapies
(IAPT)
Unique Challenges to Mental Health Care Quality Measurement
● Mental health care quality measurement have a weak
infrastructure in health care systems
○ Limitations in policy and technology
○ Limited scientific evidence for mental health quality
measures
○ Lack of provider training and support
○ Cultural barrier
● Development and application of mental health care quality
measures has lagged behind other areas of medicine
○ In part to lagging policy and technological initiatives
● There are many important gaps in evidence base to support
mental health quality measurement
○ Especially for outcomes that are most meaningful to
consumers, and specific populations like children
● Measures are also lacking for mental health conditions
commonly experienced in populations, such as anxiety
○ Lacking in depth for evidence-based treatments such
as psychotherapy
● Insufficient attention to development and implementation of
performance measures that reflect patients’ views
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○ As well as their treatment choices
● Mental health field is behind other areas of medicine with
regard to implementation of technologies
○ Notably health information technology to capture
relevant health info that could support reporting on
mental health care quality measures
● Mental health providers often use separate electronic medical
record systems from general medical provider
○ Creates big challenges to engage mental health field as
a whole in quality measurement and improvement
● Very often social workers who encounter mental health are
not trained in mental health
○ Do not have effective clinical practices
● Cultural and administrative differences between physical and
mental health providers hinder quality measurement
○ “Physical” and “mental health” services are often
administratively separated at levels
Innovations in Mental Health Care Measurement/Improvement
● World Health Organization ( WHOse Assessment Instrument
for Mental Health Systems, and the International Initiative for
Mental Health Leadership
○ Provides data on reporting, ability to report, and
ascertainment of data across countries
● In the Netherlands, routine outcome monitoring has been
incorporated into health insurance mechanisms
○ Through ten measures that are repeated at the start and
end of treatment
● Evaluates three aspects of quality:
○ Effectiveness of treatment, safety and client
satisfaction
● In Australia, use of standard outcome measures for all mental
health service users was mandated in 2000
○ Routinely collected outcomes and case mix data
● On New Zealand, mental health providers focus on
monitoring of key indicators
○ Such as seclusion and restraint minimization, and
suicide reduction
● In the US, national efforts are underway to identify cross-
cutting mental health care quality measures
○ Determine who “owns” responsibility for improving
quality
● Pay-for-performance models are also increasingly being
advocated in the US and internationally
○ Reward providers for outcomes improvement,
increasingly being used in mental health care
● In UK, the Commission for Quality and Innovation is
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Document Summary
Measuring and improving the quality of mental health care: a global perspective. Mental disorders are responsible for 32% of years of disability and 13% of disability adjusted life years. Increased rates of morbidity from general medical conditions and higher risk of premature mortality. Severe mental illness causes death 8-25 years older. Quality care for these disorders is low. Quality of care includes structure, influence of structure on clinical processes of care as delivered by providers. Crossing the quality chasm report highlighted six aims towards quality improvement. Safe, effective, patient- centered, timely, efficient, and equitable care. Overall quality of mental health care has hardly improved since publication of these reports. In some cases, has worsened over time. Health care costs rise and mental disorders become more prevalent worldwide. Persistent gap in quality of mental health care. Health care leaders and providers will need valid information on quality of care, in order to:
