суббота, 29 сентября 2012 г.

Measuring behavioral health is a new challenge - Managed Healthcare

Although it has many similarities with physical health, outcome goals vary with each patient

Behavioral healthcare is frequently a contracted service in many health plans. As such, the qualityof-care assessment is even more important. But it poses a significant challenge for quality managers, many of whom come from a medical background. Performance measurement in behavioral health should be approached in the same framework as medical/surgical care. We still need to consider clinical quality, service quality and satisfaction across the continuum of care. A rigorous approach is warranted considering that the practice of psychiatry has undergone even more significant change under the pressures of managed care than some other areas of specialty.

Inpatient on the way out. Care has shifted drastically to the ambulatory setting with few situations and conditions warranting inpatient stays. In addition, when inpatient stays are approved, the length of stay is significantly shorter than it was in previous years. Therefore, quality professionals must design performance measurement programs to encompass traditional domains and keep in mind the considerable shift from inpatient to ambulatory care and its potential impact on outcomes.

Although the physical health of the patient is important, in behavioral health functional outcomes are the key measures by which to determine if the goals of therapy have been achieved. For example, the ability of an adult with bipolar disorder to maintain their 'normal' or desired role of parent and spouse is important. Improved attendance at work or school (or, conversely, decreased use of sick days related to the underlying psychiatric condition) might be an objective measure that is easily captured. But management of the parental or spousal role is more difficult to quantify, making a more qualitative measure necessary.

Adverse outcomes should also be incorporated into performance measurement. Failure of patients to comply with medication and treatment regimens should be tracked. Process and utilization measures should be included in clinical quality measurement. Service quality also is important with this population. Without suggesting a double standard, patients requiring mental healthcare require better access and availability than those seeking other services. The goal is to schedule an appointment as soon as possible.

Outpatient management of medications is a key function in mental healthcare and should be monitored in a performance-measurement program.

Although patient preference for strict confidentiality poses some barriers, the domain of satisfaction, including the patient and his or her family, is of critical importance in providing mental healthcare services. Satisfaction measurement tools for adult patients might differ from those for pediatric and adolescent patients, although the underlying principles and goals remain the same.

The satisfaction of the other 'customers' of mental healthcare servicesprimary care physicians and other referring practitioners-also should be evaluated. Written surveys to PCPs can be helpful, but meetings involving PCPs and mental health professionals to discuss general approaches to treatment and patient management can be quite effective in improving patient care.

Performance measurement in mental healthcare is a critical component of population-based medical care. The extreme changes in the delivery of behavioral healthcare should compel us to carefully measure and monitor the outcomes of clinical care as well as service quality and satisfaction.

Quality-management professionals must collaborate with their mental health colleagues in developing and implementing meaningful performance measurement strategies. Results of these efforts will then guide important quality improvement efforts.

[Author Affiliation]

Emily Rhinehart is vice president of AIG Consultants Inc.'s healthcare services division, Atlanta.