Can Psychiatry Cross the Quality Chasm? Improving the Quality of Health Care For Mental and Substance Use Conditions

Abstract

In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care.

Let's get physical: improving the medical care of people with severe mental illness

“…Governments have been slow to acknowledge the problem of medical ill health associated with severe mental illness, and national guidelines are generally devoid of clear mandatory recommendations (Department of Health 1999;Unützer 2006;Pincus 2007; US Department of Health and Human Services 1999). Little had been published before 2000, but over the past decade or so publications have abounded.…”

The role of nurse administrators and managers in quality psychiatric care

“…Since impaired cognition often appears with psychiatric disorders, nurses must be vigilant about patients' safety. In addition, promoting patient-centered care requires consideration of the following matters : using patient preferences, needs, and values to guide clinical decisions ; anticipating patient needs ; sharing knowledge and information freely ; and making care transparent to patients (12). Patient safety is predicated on trust, open communication, and effective interdisciplinary teamwork and achieved by developing common understandings and expectations based on science and standards (34).…”

Key performance indicators for mental health and substance use disorders: a literature review and discussion paper

“…Furthermore, in order to maximize limited resources and address the gap between evidence-based best healthcare practices and the care that is actually received, health systems need to address the underdevelopment of their infrastructure, both at local and national levels, thus enabling measurement of system performance (Hermann et al, 2002;Institute of Medicine, 2001) using measures which are both valid and reliable (Hermann et al, 2000) . Such performance measurement is likely to be integral to active evolution of a health system to meet the needs of its users, may form the foundation for accountability and provision of good quality care (Hermann et al, 2004;Pincus et al, 2007) and has contributed to the development, content and application of key performance indicators (KPIs) for MESUDS for several health systems internationally (Hermann et al, 2006;Watkins & Pincus, 2011).…”