Measurement-Based Care in Behavioral Health - Joint … · Measurement-Based Care in Behavioral...
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Measurement-Based Care in Behavioral Health Peggy Lavin, LCSW, Senior Associate Director Lynn Berry, MLA, Project Director Scott Williams, PsyD, Director of Health Services Research April 11, 2017
Transcript of Measurement-Based Care in Behavioral Health - Joint … · Measurement-Based Care in Behavioral...
Measurement-Based Care
in Behavioral Health
Peggy Lavin, LCSW, Senior Associate Director
Lynn Berry, MLA, Project Director
Scott Williams, PsyD, Director of Health Services Research
April 11, 2017
What Makes The Joint Commission Stand Out?
Reputation/Recognition
High Touch/High Tech
Surveyor Cadre
Tracer Methodology
SAFER Matrix
Transparency
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What Makes The Joint Commission Stand Out?
Guidance for Good Practices
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Measurement Based Care
and
Outcome Measures Standard
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Today we will…
� Review current requirements regarding outcome
measures.
� Talk about the revised requirements, and how and
why they were developed.
� Review the rationale behind the change.
� Cover some frequently asked questions about
instrument selection and implementation.
� Respond to any additional questions.
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Current Requirement
� Standard CTS.03.01.09 – The organization assesses the outcomes of care, treatment, or services provided to the individual served.
EP 1 – The organization monitors the individual’s progress in achieving his or her care, treatment, or services goals.
EP 2 – The organization evaluates the outcomes of care, treatment, or services provided to the population(s) it serves.
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Current Requirement
� Long standing requirement
� Organizations were always expected to
measure outcomes, but The Joint Commission
did not say how that was to be done.
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Why the change?
� Recently, more focus has been placed on
measurement-based care in the behavioral
health care field.
� The Kennedy Forum has made available a paper on this subject and a list of tools.
� https://thekennedyforum-dot-org.s3.amazonaws.com/documents/KennedyForum-MeasurementBasedCare_2.pdf
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Why the change?
� The revised standard will help organizations improve
the quality of their care, treatment, or services.
� The standard will help organizations to know
whether what they’re doing is working.
� More detail on this in a
few minutes…
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What is changing?
EP 1 – The organization uses a standardized tool or instrument to monitor the individual’s progress in achieving his or her care, treatment, or service goals.
� Standard CTS.03.01.09 – The organization
assesses the outcomes of care, treatment, or
services provided to the individual served.
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What is changing? (continued)
� EP 2 – The organization gathers and analyzes the data
generated through standardized monitoring, and the
results are used to inform the goals and objectives of the
individual’s plan for care, treatment, or services as
needed.
� EP 3 – The organization evaluates the outcomes of care, treatment, or services provided to the population(s) it serves by aggregating and analyzing the data gathered through the standardized monitoring effort.
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How did we make this change?
� Conducted research and literature review to learn
about the value of using standardized tools in
regard to outcome measures.
� Convened Technical Advisory Panel (TAP) consisting of experts in the field – very supportive of this effort.
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How did we make this change? (Cont’d)
� Conducted “field review” of proposed revisions:
Six week review by the behavioral health field
Respondents supported use of a tool or instrument
Some concerns were raised about how to implement and comply
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How did we make this change? (Cont’d)
� Held five focus group calls with field review
respondents to discuss types of support that
would be helpful; suggestions included:
List of tools; variety of tools
Starter kit
Case studies
Series of webinars/town hall meetings
Guidance from experts
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How did we make this change? (Cont’d)
� Using all of this information, made final edits to
revised standard.
� Standard was approved in November 2016.
� Field was given one year to prepare for
implementation, which is January 1, 2018.
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What’s next?
� We are in the process of developing support materials and other resources for the field.
� An introductory document is currently available on the Joint Commission’s website, visit https://www.jointcommission.org/accreditation/bhc_new_outcome_measures_standard.aspx
� Working on providing a list of instruments to assist organizations in their search.
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Understanding the Rationale that supports
Measurement-Based Care
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What is Measurement-Based Care?
� Refers to the use of an objective measure to track the impact
of care, treatment, or services over the course of those
services.
� Data are routinely collected at multiple points in time
Data are typically collected at first contact and then at
regular intervals (i.e., each subsequent point of
contact, every “nth” contact, weekly, monthly, etc.)
� Progress (i.e., toward the desired outcome) is monitored
and evaluated
Progress can be compared with instrument norms or through use of a statistical model
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What is Measurement-Based Care? (Cont’d)
� After data are collected through a standardized instrument:
� They are analyzed and delivered to the service provider as
objective feedback
� Analysis can be used to inform goals and objectives,
monitor individual progress, and inform decisions related
to changes in individual plans for care, treatment, or
services.
� Can be used to identify individual cases that may benefit
from treatment team discussion and supervision
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� At the organization-level, data collected through
standardized instruments can be aggregated to:
� Inform quality improvement priorities
� Evaluate progress on organizational
performance improvement efforts
� Demonstrate the effectiveness of
organization services with:
Stakeholders in the community
Prospective clients and families
Payers/Insurers/Employers
What is Measurement-Based Care? (Cont’d)
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Why now?
� Measurement based care is not new (although the name has
repeatedly changed)
� Nearly two decades of research suggest that the effects
are robust, cutting across treatment modalities,
populations and settings
� Especially useful for identifying potential treatment failures
� Reduce the un/intentional influences of provider bias
� Justify changes in treatment plans and levels of service
� Growing emphasis on demonstrating outcomes
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Selecting a Standardized Instrument
� An instruments should:
� Have well-established reliability and validity for use as a repeated measure
� Be sensitive to change
� Be appropriate for use as a repeated measure
� Be capable of discriminating between populations that may or may not benefit from services (if appropriate)
� e.g., clinical/non-clinical, healthy/non-healthy functioning, typical/non-typical, etc.
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Selecting a Standardized Instrument
� Other factors to consider:
� Feasibility
Time and effort spent administering,
scoring, aggregating and reporting
data
� Cost
Public vs. proprietary
Instrument vs. measurement system
� Automation and integration
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Selecting a Standardized Instrument
� In June 2017, The Joint Commission will provide a list of instruments that could be used to meet the new standard.
� We will NOT endorse any instrument
� The list will NOT be exclusive
� To see if your instrument will work, visit https://manual.jointcommission.org/BHCInstruments/WebHome
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Selecting a Standardized Instrument
� In the meantime, you can find some good instruments here:
� The Journal, Integrating Science and Practice provides a 45-
page issue that summarizes 10 well-established and frequently
used instruments (or suites of instruments).
(https://www3.ordrepsy.qc.ca/pdf/2012_11_Integrating_Sand
P_10_Tools_for_Progress_Monitoring_in_Psychotherapy.pdf)
� The Kennedy Forum provides a list of dozens of instruments that are appropriate tools for measurement-based care categorized by type, setting, and other factors. (http://thekennedyforum-dot-org.s3.amazonaws.com/documents/MBC_supplement.pdf)
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Implementation of the Standard
� For many organizations, implementation of this standard will be a significant change.
� Success will be highly dependent upon leadership’s ability to manage change
Creating a shared need
Shaping a vision
Mobilizing commitment
Making change last
Monitoring progress
� Many free resources on facilitating change are available at the Joint Commission’s Center for Transforming Healthcare at http://www.centerfortransforminghealthcare.org/
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Evaluating the Standard
� Instrument(s) selected and used by organization
� Patient Tracer
� Is there evidence that a standardized instrument was used to assess and monitor the individual served?
� Is there evidence that data derived from the instrument was used to inform care? (when appropriate)
Do notes indicate that progress (or deterioration) was discussed with the individual served?
Are changes in treatment goals or objectives related to or associated with data?
� Treatment team or supervision activity reviews or is informed by data
� Quality Improvement activity informed by aggregate data
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References
Boswell JF, Kraus DR, Miller SD and Lambert MJ. Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research. 2015; 25(1):6-19.
Goodman JD, McKay JR and DePhilippis D. Progress monitoring in mental health and addiction treatment: A means of improving care. Professional Psychology: Research and Practice. 2013; 44(4):231–246.
Scott K and Lewis CC. Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice. 2015;22(1):49-59.
Reese RJ, Duncan BL, Bohanske RT, Owen JJ, and Minami T. Benchmarking Outcomes in a Public Behavioral Health Setting: Feedback as a Quality Improvement Strategy. Journal of Consulting and Clinical Psychology. 2014.
Gondek D, Edbrooke-Childs J, Fink E, Deighton D and Wolpert M. Feedback from outcome measures and treatment effectiveness, treatment efficiency, and collaborative practice: A systematic review. Adm Policy Ment Health. 2016; 43:325–343.
Shimokawa K, Lambert MJ and Smart DW. Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology. 2010; 78(3):298–311.
Chow DL, Miller SD, Seidel JA, Kane RT, Thornton JA, Andrews WP. The Role of Deliberate Practice in the Development of Highly Effective Psychotherapists. Psychotherapy. 2015; Vol 52, No 3, 337-345.
De Jong K. Challenges in the Implementation of Measurement Feedback Systems. Adm Policy Ment Health. 2016; 43:467–470.
Hannan C, Lambert MJ, Harmon C et al. 2005. A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychol 61(2):155-63.
Brown GS, Jones ER. 2005. Implementation of a feedback system in a managed care environment: What are patients teaching us? J Clin Psychol 61(2):187-98.
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Today’s Faculty
Scott WilliamsDirector of Health Services Research
Lynn BerryProject Director
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Behavioral Health Care Accreditation Business Development/MarketingTeam
Darrell Anderson, BA
Senior Business Development Specialist
630/792-5866
Melinda Lehman, MBA
Associate Director
630/792-5695
Susan Bullivant
Senior Secretary
630/792-5791
Julia S. Finken, BSN, MBA, CPHQ, CSSBB
Executive Director
630/792-5790
Peggy Lavin, LCSW
Senior Associate Director
630/792-5411
Megan Marx, MPA
Associate Director
630/792-5131
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Behavioral Health Care Accreditation Operations Team
Peter Vance, LPCP
Field Director
630/792-5788
Merlin Wessels, LCSW
Associate Director
630/792-5899
Allison Kikilas
Associate Director
630/792-5123
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