Measuring Performance in Psychiatry: A Call to Action

Glied, Sherry; Stein, Bradley D.; McGuire, T. M.; Beale, Rhonda Rhonda Robinson; Duffy, Farifteh F.; Shugarman, Samantha; Goldman, Howard H.

doi:10.1176/appi.ps.201400393

Cited by 22 publications

(19 citation statements)

References 20 publications

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“…At a time when health care systems are increasingly focused on measuring, assessing, and providing incentives to improve quality (Glied et al, 2015; Patel et al, 2015), the lag in the development of behavioral health measures as compared to physical health measures is concerning (Institute of Medicine, 2006). Our findings of an association between three of our seven process measures and mortality provide support for the predictive validity of these measures and for their use as quality measures.…”

Section: Discussionmentioning

confidence: 99%

Association between process measures and mortality in individuals with opioid use disorders

Watkins

Paddock

Hudson

et al. 2017

Drug and Alcohol Dependence

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Background Individuals with opioid use disorders have high rates of mortality relative to the general population. The relationship between treatment process and mortality is unknown. Aim To examine the association between 7 process measures and 12- and 24-month mortality. Methods Retrospective cohort study of patients with opioid use disorders who received care from the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 7 patient-level process measures, while risk-adjusting for patient characteristics. Process measures included quarterly physician visits, any opioid use disorder pharmacotherapy, continuous pharmacotherapy, psychosocial treatment, Hepatitis B/C and HIV screening, and no prescriptions for benzodiazepines or opioids. We conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. Results Among individuals with opioid use disorders, not being prescribed opioids or benzodiazepines, receipt of any psychosocial treatment and quarterly physician visits were significantly associated with lower mortality at both 12 and 24 months, but Hepatitis and HIV screening, and measures related to opioid use disorder pharmacotherapy were not. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of the confounder, to render these findings non-significant. Conclusions And Relevance This is the first study to show an association between process measures and mortality in patients with opioid use disorders and provides initial evidence for their use as quality measures.

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Section: Discussionmentioning

confidence: 99%

Association between process measures and mortality in individuals with opioid use disorders

Watkins

Paddock

Hudson

et al. 2017

Drug and Alcohol Dependence

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“…This is an important phenomenon to understand because racial bias in the identification of psychosis may generate disparities in psychiatric care, including delay in the application of effective treatments and exposure to adverse effects from incorrect treatments. In addition, there is a growing interest in psychiatry to develop objective rating scales to assess quality and efficiency of care [Glied et al, 2015], and understanding racial bias in assessment may help to develop more robust instruments. Moreover, racial bias may confound research with racially diverse samples.…”

Section: Introductionmentioning

confidence: 99%

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Perlman

Kotov

et al. 2015

American J of Med Genetics Pt B

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Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and underendorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. Key words: schizophrenia; race; psychosis INTRODUCTIONOver the last 50 years, several studies have reported differences between individuals of African heritage and Caucasians in relative proportion of psychotic symptoms and diagnosis of schizophrenia versus bipolar disorder. Specifically, reports from samples ascertained in clinical settings have suggested that compared to Caucasians, individuals of African heritage have higher rates of schizophrenia [Robins and Regier, 1991;Strakowski et al., 1993Strakowski et al., , 1996Strakowski et al., , 2003Bresnahan et al., 2007;Gara et al., 2012;Kirkbride et al., 2012] 546Neuropsychiatric Genetics severe psychotic symptoms [Mukherjee et al., 1983;Strakowski et al., 2003;Arnold et al., 2004] and less severe negative symptoms [Sharpley et al., 2001]. Other studies of psychotic symptoms have found race differences in the quality and scope of hallucinations and delusions [Barrio et al., 2003;Yamada et al., 2006].To date, the underlying source of these apparent differences is unknown. It has been argued that the difference could reflect clinician or instrument bias [Neighbors et al., 2003;Trierweiler et al., 2006], although differences remained when clinicians were blinded to ethnicity information [Arnold et al., 2004]. On the other hand, race differences may reflect t...

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“…Creating a standard of care requires an understanding of how delivery models affect quality (9). To assess service needs and appropriately allocate resources, health services research is required to understand how duration and frequency of clinical encounters relate to outcomes and, crucially, how that relationship varies depending on diagnosis, acuity, comorbidities, psychosocial needs, and important clinician factors.…”

Section: Data From Aacp Membersmentioning

confidence: 99%

Workloads in Clinical Psychiatry: Another Way

McQuistion

Zinns

2019

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Caseload and daily volume requirements present clinical and administrative challenges in organized settings primarily serving the public sector. These challenges are examined through lenses of systems-level fiscal viability, population health, and patient experience. Framed by previous efforts in caseload methodology, illustrative data collected from members of the American Association of CommunityPsychiatrists are discussed, with consideration of issues of professional effort and burnout. A systematic effort is needed to develop guidelines for caseload and volume expectations that support recovery outcomes, account for practitioner skills, and promote high-quality clinical encounters.

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Measuring Performance in Psychiatry: A Call to Action

Cited by 22 publications

References 20 publications

Association between process measures and mortality in individuals with opioid use disorders

Association between process measures and mortality in individuals with opioid use disorders

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Workloads in Clinical Psychiatry: Another Way

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