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

Pincus, Harold Alan; Page, Ann; Druss, Benjamin G.; Appelbaum, Paul S.; Gottlieb, Gary; England, Mary Jane

doi:10.1176/foc.9.2.foc223

Cited by 21 publications

(26 citation statements)

References 31 publications

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“…A wealth of essays, studies and policy statements have emphasized the importance of involving consumers in treatment decisions [91][92][93], identified impediments to implementing patient centred care [94][95][96] and proposed ways of overcoming them [97][98][99][100][101]. The emerging literature raises the question, how can the desires and interests of patients -indeed, how can patients themselves -be included in treatment decision-making processes that incorporate a systematic evidence base?…”

Section: Discussionmentioning

confidence: 99%

A conditional model of evidence‐based decision making

Falzer

Garman

2009

Evaluation Clinical Practice

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Rationale-Efforts to describe how individual treatment decisions are informed by systematic knowledge have been hindered by a standard that gauges the quality of clinical decisions by their adherence to guidelines and evidence-based practices. This paper tests a new contextual standard that gauges the incorporation of knowledge into practice and develops a model of evidence-based decision making.Aims and objectives-Previous work found that the forecasted outcome of a treatment guideline exerts a highly significant influence on how it is used in making decisions. This study proposed that forecasted outcomes affect the recognition of a treatment scenario, and this recognition triggers distinct contextual decision strategies.Method-N=21 volunteers from a psychiatric residency program responded to 64 case vignettes, 16 in each of four treatment scenarios. The vignettes represented a fully balanced within-subjects design that included guideline switching criteria and patient-specific factors. For each vignette, participants indicated whether they endorsed the guideline's recommendation.Results-Clinicians employed consistent contextual decision strategies in responding to clearly positive or negative forecasts. When forecasts were more ambiguous or risky, their strategies became complex and relatively inconsistent. Conclusion-The results support a three step model of evidence-based decision making, in which clinicians recognize a decision scenario, apply a simple contextual strategy, then if necessary engage a more complex strategy to resolve discrepancies between general guidelines and specific cases. The paper concludes by noting study limitations and discussing implications of the model for future research in clinical and shared decision making, training, and guideline development.

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Section: Discussionmentioning

confidence: 99%

A conditional model of evidence‐based decision making

Falzer

Garman

2009

Evaluation Clinical Practice

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“…The U.S. health care system's historical separation of medical and BH sectors-in terms of clinical practice, administration, and financing-is widely considered to be a significant contributor to the comparatively poor overall health outcomes associated with mental illness (Druss, 2007;Horvitz-Lennon, Kilbourne, and Pincus, 2006; Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, Board on Health Care Services, Institute of Medicine, 2006;Pincus et al, 2007;President's New Freedom Commission on Mental Health, 2003). As such, initiatives that promote medical and BH integration-for example, through co-location of primary and BH care services, clinical changes such as collaborative care teams, or payment reforms-are increasingly common health care reforms (Druss and Mauer, 2010;Katon and Unützer, 2013;Smith et al, 2012).…”

Section: Integrated Care May Improve Health Care Quality and Overutilmentioning

confidence: 99%

Primary and Behavioral Health Care Integration Program: Impacts on Health Care Utilization, Cost, and Quality

Breslau¹,

Sorbero²,

Kusuke³

et al. 2019

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“…In mental health, the self‐management approach aligns with the recovery framework: Self‐management focuses on the person's perspective on their illness , encouraging agency and self‐responsibility as their needs and goals change over their lifespan . Indeed, it has been suggested that recovery cannot be realized without some degree of self‐management .…”

Section: Self‐management In Bdmentioning

confidence: 99%