2016 Maryland Patient Safety Center s Call for Solutions

Transcription

1 2016 Maryland Patient Safety Center s Call for Solutions Organization: Solution Title: Anne Arundel Medical Center Referral for Recovery Program Program/Project Description, Including Goals: What was the problem to be solved? The problem to be solved was the lack of offering point of contact care coordination services to those individuals with behavioral health needs via their primary care physicians to community mental health and substance use providers. In addition, primary care physicians lacked an assessment tool and a process for referring patients with potential substance use or mental health issues in their primary care settings. The rational for integrated services include the following: Up to 50% of all visits to primary care physicians are due to conditions that are caused or exacerbated by mental or emotional problems. Over 90% of elderly patients received behavioral health services in a primary setting. Approximately 79% of community health center patients have behavioral and/or substance use disorders. More than one-third of behavioral health visits by privately insured children are to a primary care physician rather than to a specialist. (CFHC, Collaborative Family Health Coalition) How was it identified? AAMC and a group of Anne Arundel County community providers participated in the Maryland Integration Learning Community in The Maryland Integrated Learning Community was sponsored by the Maryland Addictions Director Council and the National Council on Alcoholism. A core feature of the Maryland Integration Learning Community was the integrated care of mental health and substance use services collaborating with other community and health care providers to offer optimal and effective care. Integrated care entails a focus on the provision of holistic and coordinated care, liaison services, and the development of clinical pathways between and across a range of treatment providers. A prerequisite for the delivery of effective treatment is a strong collaboration, cooperation and effective working relationship between providers such as primary care physicians, mental health and substance use providers, psychiatrics, inpatient psychiatric services, and emergency care services. What base line data existed? Healthy Anne Arundel s 2012 Community Health Needs Assessment Key informant interviewed 121 health care professionals, social service providers, business leaders and faith-based organization representatives considered mental health and substance use fourth of 12 key health issues facing the County, behind obesity, cancer and diabetes. In addition, about 12% of Anne Arundel Medical Center s (AAMC) Emergency Department (ED) patients have a behavioral health diagnosis. In FY2013, there were over 1,900 patients with either a primary psychiatric or substance use diagnosis, almost 1,300 with a dual diagnosis, and almost 6,300 with a secondary psychiatric diagnosis. 1

2 The RforR program addressed the root of the problem by beginning the conversation about behavioral health intervention in the primary care office and providing the referring physician with the tools to assess their patients, coordinate targeted behavioral care within 48 hours, ensure efficient follow up and truly provide their patient with the opportunity to reach overall health and wellness. What were the goals how would you know if you were successful? We measured project success by the accomplishment of four goals: 1. 10% increase in referrals to participating providers, 2. 20% increase in number of patients making and keeping the first treatment appointment, 3. Treatment adherence to return to and maintain health and minimize relapse of enrolled individuals, and 4. Patient satisfaction with the program. This will be measured by patient satisfaction surveys that will be given to participants every six and 12 months once the program is initiated. By integrating behavior health services in Anne Arundel Medical Center s high need primary care practices the Community Clinics on Forest Drive, and Morris Blum (a Maryland Health Enterprise Zone facility), we expected to see an increase in referrals over time, a potential reduction in Emergency Department visits and hospital admissions while supporting patients to successfully complete treatment and minimize relapse. Process/Solution: What solution or process was used to develop the solution? What solution was developed? How was it implemented? Referral for Recovery ( RforR ) is a model program designed to meet the needs of patients who require immediate behavioral health intervention. Patients are identified as candidates for RforR at the point of care in partnering primary care offices by clinicians or staff using the Quick Behavioral Health Assessment ( QBHA ), developed by AAMC behavioral health experts and primary care physicians for use in a fast-paced primary care setting. (See below) 2

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4 AAMC initially reached out to a select number of mental health and substance use providers as well as primary care physician offices, OBGYN practices, and family medicine providers. Providers and physician were educated of the RforR program and those who agreed to participate, AAMC developed a Memorandum of Understanding between the providers and physicians to participate in the program. Secondly, AAMC completed training for all providers and practices to review the process and explain the tools. The QBHA was embedded into Epic, the electronic medical record system used by AAMC and many physicians throughout the region, as a mandatory module for completion so that the physician or staff member will be reminded to administer the QBHA per our screening schedule of once a year during well visits. Additional screenings are not prohibited but are left to the discretion of the referring physician. For those partnering practices that do not utilize Epic, portal access was provided to ensure continuity of care and accurate reporting. Epic is especially useful in tracking and reporting the increase in referrals as a direct result of the program, and assisting the navigator in consistent patient follow up to ensure no one falls through the cracks. This will allow them to securely view the patient record as well as directly message the health navigator regarding patient notes, adherence to appointments, and any other pertinent medical information. The reporting mechanisms through Epic allowed us to evaluate the program throughout the year and make adjustments as needed to better serve our community. Of course patients are asked to sign a release of information for providers and physicians. Once a patient was identified he or she was connected immediately via a dedicated referral line to the RforR team, comprised of a Referral Specialist and Behavioral Health Navigator, who ensure they are appropriately assessed and placed in treatment within 48 hours. This initial call was made by the referring physician or trained office staff with the patient present. The RforR Navigator assisted each patient with adherence to treatment, obstacles to care (transportation, prescription costs), and provided feedback to the referring primary care physician. The navigator continued to follow up with each patient at three and six month intervals until she was notified by the referring physician or behavioral health specialist that such frequent follow up is no longer necessary. Patients being seen at our partnering practices will continue to be assessed according to the annual screening schedule regardless of previous behavioral health treatment or participation in the RforR program. Measurable Outcomes: What are the results of implementing the solution? Provide qualitative and/or quantitative results to data. The program launched in April of 2015 and the following data points are being collected: Number of patient s referred by month Referrals made to behavioral health providers Referring Practice Number of successful referrals made (patient sought the recommended treatment) Patient Satisfaction Based on current experience and patient trends we anticipated that in year 1 of RforR, approximately 250 patients will be enrolled at six months and 500 at 12 months. In the first 8 months we have enrolled 410 patients far exceeding our expectations and are trending to exceed our year one projections. (See below) 4

5 Referrals by Month # of Referrals 0 Referrals by Month % Successful Referral Rate # of Referrals Sought Recommended Treatment A total of 410 patients were referred and 397 actually sought the recommended treatment and made their appointment which is a 96.8% success rate. 5

6 8 Referring Physician Practices which includes: AAMC Community Clinic Morris Blum Community Clinic Pasadena Primary Care Annapolis Primary Care Premier OB/GYN Waugh Chapel Primary Care Dr. Ulmer Family Medicine Dr. Gandsas 8 Behavioral Health Providers: AAMG Mental Health Outpatient Clinic Pathways Treatment Center Arundel Lodge First Step Recovery Spectrum Behavioral Health Adept Behavioral Health Bay Area Behavioral Health Anne Arundel Counseling Services Patient Satisfaction Scores for the first six months was 92% Satisfaction with the services and program. Sustainability: What measures are being taken to ensure that results can be sustained and spread? RforR will be self-sustaining and AAMC s Behavioral Health Division will absorb its referral and navigation duties. Given data from the successful launch, we will recruit additional substance abuse and mental health providers who will make the same commitment to a 48 business hour turnaround, and expand RforR to additional primary care and OBGYN providers in Anne Arundel County and other parts of our service area. Based on anticipated positive outcomes from RforR and with the Grant support, we will promote RforR more broadly throughout the State as a model first step in mental health and addictions treatment. Negotiations with additional providers to participate in RforR are ongoing. Based on current experience and patient trends we anticipate that in year 1 of RforR, approximately 250 patients will be enrolled at six months and 500 at 12 months. In year 2, approximately 750 patients will be enrolled at 18 months and 1,000 at 24 months. After the first six months, totals are cumulative as some patients will have completed treatment but will still be followed by the Navigator to assess relapse and Emergency Department (ED) and hospital utilization. The nature of the RforR program will allow it to be an engine of growth and financial stability for our partnering practices, not a hindrance. The RforR referrals will serve to increase patient volumes in already thriving practices and to streamline care coordination and open access to care for our community. 6

7 Role of collaboration and Leadership: What role did teamwork and collaboration play in the solution? What partners and participants were involved? Was the organization s leadership engaged and did they share the vision for success? How was leadership support demonstrated? Collaboration is one of AAMC s Core Values. In that, we as a health system believe in developing partnership with stakeholders, to include patients and families, toward a vision of living healthier together. Through this project we wanted to: Improved access to health interventions and improved coordination between physician practices and behavioral health providers for individuals and their families; A comprehensive, coordinated and safe health system that is responsive to the needs of the population; and Efficient use of resources This project truly had multidisciplinary engagement and leadership support which was critical to the successful implementation and effectiveness of the RforR program. The Resources for Referral (RforR) program was developed based on the participation of AAMC s and a group of Anne Arundel County community providers that requested the participation in the Maryland Integration Learning Community in The Maryland Integrated Learning Community was sponsored by the Maryland Addictions Director Council and the National Council on Alcoholism. A core feature of the Maryland Integration Learning Community was the integrated care of mental health and substance use services collaborating with other community and health care providers to offer optimal and effective care. Integrated care entails a focus on the provision of holistic and coordinated care, liaison services, and the development of clinical pathways between and across a range of treatment providers. A prerequisite for the delivery of effective treatment is a strong collaboration, cooperation and effective working relationship between providers such as primary care physicians, psychiatrics, inpatient psychiatric services, and emergency care services. The project s secondary goals include: To create sustainable local community teams consisting of community health centers, specialty substance use treatment programs and community mental health treatment programs; To improve communication, collaboration and coordination among the community teams treatment providers; To improve selected local community s capacity to provide bi-- directional integration; and The development of policies and protocols that guide effective service delivery for individuals with co-occurring diagnosis, including protocols for engagement, screening and assessment, service linkage, sharing of information, care coordination and treatment management. R for R was designed to allow the system of care to work seamlessly, efficiently and quickly to connect patients to treatment at the time of demonstrated need. By acting quickly, R for R 7

8 enhances the likelihood of treatment success, particularly for those who otherwise would fall through the cracks. Finally, the Chief Executive Officer, Chief Operating Officer/Chief Nurse Officer, and other executives not only gave approval for the development of the Referral for Recovery Program but also provided the initial resource allocations for the project. Innovation: What makes this solution innovative? What are its unique attributes? Most primary care providers have not developed the same relationships with community behavioral health providers as they have with other specialty health providers, such as surgeons, cardiologists, or endocrinologists. Our QBHQ program focused on the need to develop those relationships so that providers can enhance communication, treatment and/or care management strategies. While patients typically present to their primary care physician with a physical complaint, data suggest that underlying mental health or substance abuse issues are often triggering these visits. Unfortunately, most primary care doctors are ill-equipped or lack the time to fully address the wide range of psychosocial issues that are presented by the patients in addition to the stigma of referring to a behavioral health provider. The implementation of the QBHA gave the physician and/or their staff a quick tool and direct resources to refer patients for behavioral health issue. In addition to the tool, we created an algorithm which helps with decision making and the flow of information and resources available. This solution was innovative and has the following unique attributes: Improve use of physician time and appointment availability Implement into physician practices operational steps for outside mental health and substance use referrals Increase successful behavioral health referral communication tools to primary care providers Gain quick access to behavioral health emergency and crisis help during the day Integrate a liaison for timely referral for and coordination of specialty behavioral health treatment Intensity of care is stepped up if the patient s functioning does not improve during the usual course of care and is customized according to the patient s response Integrated Electronic Medical Record across providers Patient tracking for outcomes measurement Facilitates shared management across care team members Engagement of social service agencies (e.g., housing, employment, etc ) Contact Person: Title: Shirley Knelly Vice President Quality and Patient Safety sknelly@aahs.org Phone: