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Improving the Quality of Health Care for Mental and Substance-Use Conditions

Improving the Quality of Health Care for Mental and Substance-Use Conditions “America will not have a high-quality health system if equal attention is not given to mental health issues and substance use problems…” Mary Jane England. Frances M. Murphy, M.D., M.P.H.

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Improving the Quality of Health Care for Mental and Substance-Use Conditions

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  1. Improving the Quality of Health Care for Mental and Substance-Use Conditions “America will not have a high-quality health system if equal attention is not given to mental health issues and substance use problems…” Mary Jane England Frances M. Murphy, M.D., M.P.H. Office of the Deputy Under Secretary for Health For Health Policy Coordination November 3, 2005

  2. Health Care Provider Organizations should: • Have policies to enable and support all actions required of clinicians • Involve patients/families in design, administration, and delivery of services • If serving a high risk population, screen all entrants for M/SU problems • Involve leadership and staff in developing the NHII

  3. VA’S Mental Health System Prior to Transformation ? • Strengths: • U.S. leader in mental health care and research • Integrated national healthcare system • Full Continuum of Care: screening, health promotion and disease prevention, outpatient care, acute hospital care, and long-term care • Comprehensive electronic health records • VA system supports parity • Challenges: • Variability in access and quality of services across the country • Lack of integration of mental health and primary care • Increased projected workload and demand for mental health services

  4. What Can We Expect in the Future? Mental Health Outpatient Stops Overall Veteran Enrollment Mental Health Bed Days of Care Mental Health Utilization Projections

  5. Overarching Recommendation • The aims, rules, and strategies for redesign set forth in Crossing the Quality Chasm should be applied on a day-to-day operational basis but tailored to reflect the characteristics that distinguish care for M/SU problems and illnesses from general health care.

  6. Events Leading to VA Health System Transformation • Transformation of VA Healthcare • “Vision for Change” and “Journey for Change” • Motivational force and culture change • Organization-wide reorganization • Full continuum of care including prevention • Emphasis on evidence-based care • Healthcare quality, safety and performance measurement • Crossing the Quality Chasm: A New Health System for the 21st Century • President’s New Freedom Commission Report

  7. Recommendation 3.1 • To promote patient-centered care, organizations providing M/SU treatment services should support the decision making abilities and preferences for treatment and recovery of persons with M/SU problems and illnesses • Policies that implement informed, patient-centered participation and decision-making in treatment, illness self management, and recovery plans. • Involving patients and families • Incorporating informed, patient centered decision-making active participation in treatment and recovery plans, advance directives and informed decision making.

  8. Recommendation 3-1 • VA is embracing new approaches to care: • Recovery Model • Development of National VA Recovery Plan • Peer Support programs • Veteran and Family Centered • Encourage establishment of Medical Center Consumer Councils • Advance Directives

  9. Personal Health Records • Patient centered tool supports informed decision-making, self-management and expression of treatment preferences in achieving optimal health • My HealtheVet Mental Health Portal (www.myhealth.va.gov) • Health Information and Veteran Education • Mental Health Screening • Disease Management dialogues and Self-Tracking tools • Enhancing the Internet-based, secure Personal Health Record to include mental health. • Provides veterans with copies of key parts of their VA health information • E-Prescribing • Messaging

  10. Recommendation 4-2 • Organizations should: • Increase use of valid reliable patient questionnaires or other patient assessment instruments to assess the progress and outcomes systematically and reliably • Use measures of process and outcomes of care to continuously improve the quality of care they provide

  11. Recommendation 5-1 • Organizations should: • Make collaboration and coordination of patients’ M/SU care the norm by providing effective linkages within their own organizations and between providers of mental health and S/U treatment. • Routine sharing of information on patients’ problems and pharmacologic and non-pharmacologic treatments • Valid, age appropriate screening of co-morbid mental health, substance-use, and general health

  12. VA’s Electronic Health Record

  13. Clinical Reminders Links Reminder Contemporary Expression of Practice Guidelines • Time & Context Sensitive • Reduce Negative Variation • Create Standard Data • Acquire health data beyond care delivered in VA With the Action With Documentation

  14. VA Sets the U.S. Benchmark for 18 Comparable Indicators

  15. “VA’s integrated health care information system, including its framework for using performance measures, is considered one of the best in the nation” Institute of Medicine “Leadership by Example” October 2002

  16. Recommendation 5-2 • To facilitate the delivery of coordinated care by primary care, mental health and substance-use treatment providers • Enhancing M/SU staff at Community-Based Outpatient Clinics • Collocation of mental health, S/U, primary care services (Level 3) • Performance Measure established • Collaborative Care Pilots • Delivery of MH, SU, and primary healthcare through clinically integrated practices

  17. Recommendation 5-3 • To ensure the health of persons for whom they are responsible, organization should: 1)coordinate their services with those of other human-services agencies; 2) establish referral arrangements for needed services. • Large provider of Homeless Veterans services • Performance Measures established • VA-HUD collaborations • Grant and Per Diem program with non-profit providers • Supported Employment and CWT • State collaborations • Transition services for incarcerated veterans

  18. Workforce DevelopmentAcademic Affiliations and Training • 83,115 Total Trainees (Academic Year 2003) • 29,179 Medical Residents • 16,740 Medical Students • 37,196 Associated Health Trainees

  19. Summary • Mental Health transformation is a journey • The IOM report gives us an excellent roadmap for improving the quality of healthcare in MH and SUD • Health Care Organizational transformation requires a systems approach and a strategic plan • Transformation requires culture change

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