Transforming Mental Healthcare in the Veterans Health Administration: A Model for Measuring Performance to Improve Access, Quality, and Outcomes

Watkins, Katherine E.; Keyser, Donna J.; Smith, Brad; Mannle, Thomas E.; Kivlahan, Daniel R.; Paddock, Susan M.; Mattox, Teryn; Horvitz-Lennon, Marcela; Pincus, Harold Alan

doi:10.1111/j.1945-1474.2010.00109.x

Cited by 17 publications

(11 citation statements)

References 29 publications

(27 reference statements)

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“…Donabedian’s framework of healthcare quality measurement [28] is the theoretical basis for much of current healthcare performance measurement [e.g., 29, 30-32]. The development and use of well-designed performance measures to assure implementation of SBIRT are key steps towards effective intervention and reduction of alcohol consumption during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Performance Measurement: A Proposal to Increase Use of SBIRT and Decrease Alcohol Consumption During Pregnancy

O’Brien

2014

Matern Child Health J

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Objectives Alcohol consumption during pregnancy has negative implications for maternal and child health. Appropriate early universal Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant women is necessary to identify women at risk and reduce the likelihood of continued drinking. Because SBIRT is not consistently used, the development and use of performance measures to assure implementation of SBIRT are key steps towards intervention and reduction of alcohol consumption during pregnancy. Methods Practice guidelines provide ample support for specific instruments designed for SBIRT in prenatal care. An examination of existing performance measures related to alcohol consumption during pregnancy, however, reveals no comprehensive published performance measure designed to quantify the use of SBIRT for alcohol use in prenatal care. Results Process performance measures were developed that can determine the proportion of pregnant women who are screened during the course of prenatal care and the proportion of women requiring either brief intervention or referral to substance use disorder treatment who received those interventions. The measures require use of screening instruments validated for use with pregnant women. Conclusions The two proposed measures would represent a significant step in efforts to assure appropriate intervention for women who drink during pregnancy, hold accountable providers who do not employ SBIRT, and provide a basis from which necessary systemic changes might occur. Pregnancy is a time when many women are motivated to stop drinking. That opportunity should be seized, with timely intervention offering assistance for pregnant women who have not stopped drinking of their own accord.

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Section: Introductionmentioning

confidence: 99%

Performance Measurement: A Proposal to Increase Use of SBIRT and Decrease Alcohol Consumption During Pregnancy

O’Brien

2014

Matern Child Health J

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“…Still, even among existing mental health process measures that could be reported, not all have been validated 25,26,[33][34][35][36][37][38][39] .…”

Section: Current State Of Measuring Mental Health Care Qualitymentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

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Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

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“…10 The evaluation took place during the implementation of the VA's five-year Mental Health Strategic Plan, a large initiative to expand and improve care for mental and substance use disorders. To support the initiative, the VA increased annual funding for mental health by $1.4 billion, from $2.43 billion in fiscal year 2005 to $3.88 billion in fiscal year 2008.…”

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confidence: 99%

Care For Veterans With Mental And Substance Use Disorders: Good Performance, But Room To Improve On Many Measures

et al. 2011

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In 2006 the Department of Veterans Affairs commissioned the Altarum Institute and the RAND Corporation to do an evaluation of its mental health treatment system. We found that veterans with mental illness and substance use disorders represented 15.4 percent of all veterans using Veterans' Health Administration (VHA) services in 2007 and that they accounted for 32.9 percent ($12 billion) of VHA costs, of which the majority was for non-mental health conditions. The average cost for a veteran with mental illness and substance use in our study was $12,337, or 2.7 times the cost for an average veteran without these conditions. The quality of care for the veterans in our study, although similar to or better than the care given to comparable privately insured patients or those enrolled in Medicare or Medicaid, varied by as much as twenty-three percentage points among regional service networks. Performance on some indicators, such as whether those with alcohol dependence received pharmacotherapy, was low. There is a need for substantial improvement in the care of these veterans, particularly with respect to ensuring the delivery of evidence-based treatments.

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Transforming Mental Healthcare in the Veterans Health Administration: A Model for Measuring Performance to Improve Access, Quality, and Outcomes

Cited by 17 publications

References 29 publications

Performance Measurement: A Proposal to Increase Use of SBIRT and Decrease Alcohol Consumption During Pregnancy

Performance Measurement: A Proposal to Increase Use of SBIRT and Decrease Alcohol Consumption During Pregnancy

Measuring and improving the quality of mental health care: a global perspective

Care For Veterans With Mental And Substance Use Disorders: Good Performance, But Room To Improve On Many Measures

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