Implementing and Improving: Behavioral Health Quality

Transcription

1 Implementing and Improving: Behavioral Health Quality National Collaborative for Innovation in Quality Measurement Sarah Hudson Scholle, MPH, DrPH March 21, 2017

2 Agenda Alignment of measures and accountability Focus on antipsychotic medications and depression Efforts to implement and improve care

3 PQMP Behavioral Health Measures Focus Access Care coordination Effective Measure Access to Outpatient Specialty Care for Children Medication Reconciliation in Pediatric Mental Health Care Settings Timeliness of follow up visits following hospital discharge of children with a primary mental health diagnosis Pediatric Psychosis: Timely inpatient psychiatry consultation Pediatric Danger to Self/Suicidality: Discharge Communication to Outpatient Providers Follow-up Visit for Children and Adolescents on Antipsychotics ADHD Chronic Care Follow-up Pediatric Psychosis: Screening for Drugs of Abuse in the ED Adolescent Depression Monitoring Adolescent Depression Remission/Response Metabolic Monitoring for Children and Adolescents on Antipsychotics Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Use of Multiple Concurrent Antipsychotics in Children and Adolescents Accurate ADHD Diagnosis Behavioral Health Risk Assessment (prenatal)

4 Accountability for quality Measures are specified for reporting and accountability by different entities; alignment encourages joint focus Measures in Medicaid Core Set States Plans Hospitals Providers Follow-Up After Hospitalization for Mental Illness X X X Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Use of Multiple Concurrent Antipsychotics in Children and Adolescents Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Other PQMP measures Pediatric Danger to Self/Suicidality: Discharge Communication to Outpatient Providers Adolescent Depression Remission/Response X X X X X X X X X

5 National Collaborative for Innovation in Quality Measurement (NCINQ) Goal is to improve health outcomes for children, adolescents, and their families through quality measurement Improving antipsychotic medication management in youth Improving depression care for adolescents and new mothers

6 Safe and Judicious Use of Antipsychotic Medications Measures reported using administrative claims data Use of Multiple Concurrent Antipsychotics in Children and Adolescents* Youth on two or more antipsychotic medications concurrently for an extended period of time (lower rate indicates better performance) Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics* Youth without an indication for antipsychotics who had psychosocial care as first-line treatment Metabolic Monitoring for Children and Adolescents on Antipsychotics Youth with ongoing use of antipsychotic medications who had metabolic testing *2017 Medicaid Child Core Set

7 Safe & Judicious Use of Antipsychotic Measures, by Product Line 2016 Multiple Concurrent Antipsychotics (lower is better) Metabolic Monitoring Use of First-Line Psychosocial Care

8 2016 Metabolic Monitoring Rates by State Blue states have higher rates Rates are reported at the plan level. When a plan spans multiple states, the plan s rate is reported in each of those states.

9 Drivers of good antipsychotic management Clinician awareness Family awareness Coordination between MH and primary care providers and plans Information sharing through Health IT Access to laboratory services

10 Are hospital systems working with Medicaid programs and providers on managing access and care for antipsychotic medications?

11 Depression Care for Adolescents and Adults Measures reported using electronic clinical data Of individuals 12+ with diagnosis of major depression or dysthymia Utilization of PHQ-9 Proportion who had an outpatient encounter with a PHQ-9 score present in their record in the same assessment period as the encounter Of those who had an initial elevated PHQ-9 score (>9) Follow-Up Rate Proportion who had follow-up PHQ-9 administered at 5-7 months Response Rate Remission Rate Proportion whose score decreased at least 50% at 5-7 months Proportion who achieved remission (score <5) at 5-7 months Of individuals 12+ Screening and Follow Up Proportion who were screened and, if positive, had follow up within 30 days

12 Reporting using electronic clinical data Patient care captured in a structured, electronic format Maintained over time Includes some or all key clinical data relevant to care Bidirectional, automated sharing of information Accessible by the healthcare team at the point of care

13 Depression Measures for Adolescents: Results from Testing for Screening and Follow-Up/Utilization of PHQ 80.0% 70.0% Plan 1 plan % 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Screening and Follow-Up Utilization of PHQ-9

14 Depression Measures for Adolescents: Results from Testing for Remission/Response 90.0% 80.0% Plan 1 plan % 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Remission (PHQ<5) Response (PHQ decreased 50%)

15 Are hospital systems collecting and sharing youth and family reported outcomes?

16 Learning collaborative Involves plans, youth, states, providers, and other stakeholders Year 1 Year 2 Year 3 Year 4 Prepare for QI analyze data, scan, lit review, develop change package Implement QI - share learnings through ongoing collaborative meetings Collect best practices, strategies and tools Refine Change Package and spread and Revise measures

17 Summary Measurement Collaboration Improvement

18 Thank you for attending Presentations: Presenter contact information: Sarah Hudson Scholle, MPH, DrPH NCQA

19 Pediatric Quality Measures Program (PQMP): An Update Agency for Healthcare Research and Quality Kamila Mistry, PhD, MPH March 21, 2017

20 Agenda Overview of AHRQ o Within HHS o Mission/Priorities o Research Pathways/Funding Pediatric Measurement Efforts at AHRQ o Pediatric Quality Indicators (PDIs) o Children s EHR Format o Pediatric Quality Measures Program (PQMP)

21 US Department of Health & Human Services

22 AHRQ s Mission To produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

23 AHRQ s 4 Priorities Improve Health Care Quality Make Health Care Safer Increase Accessibility Improve Health Care Affordability, Efficiency, and Cost Transparency

24 Three Research Pathways Make, Commission, or Fund Research Make: Robust Intramural Data & Research Program o o Building databases (e.g. HCUP, MEPS) Conduct targeted research, generally with secondary data Commission: Contracted Research & Dissemination o o Develop specific research (LHS competencies) Put research findings into practice (e.g. development of tool kits) Fund: Research Grants o o Support independent institutions & researchers in performing complex, usable research Develop scientific knowledge and products as a public good

25 Funding Opportunities Largely focused on funding investigator initiated work under standing R grant mechanisms fit with our priorities Also have a number of PA -- reflecting priorities:

26 Pediatric Quality Measurement AHRQ Pediatric Quality Indicators (PDIs) Children s EHR Format Pediatric Quality Measures Program (PQMP)

27 Pediatric Quality Indicators (PDIs) PDIs are a set of measures that can be used with hospital inpatient discharge data to provide information on potentially preventable complications and hospitalizations among pediatric patients. o Use with readily available administrative data o Based on ICD-10-CM diagnosis and procedure codes o Risk-adjusted o Rigorous validity and reliability testing

28 Pediatric Quality Indicators (PDIs) (cont d.) * Endorsed by the National Quality Forum (NQF)

29 Children s EHR Format Children s EHR Format is a set of functional requirements for EHRs to support dialogue between stakeholders as they build, purchase, use, and implement EHRs in a variety of setting. o o Mandated by CHIPRA (2009) and developed through collaboration between AHRQ and CMS First released in 2013 and evaluated through CMS Quality Demonstration Grants in NC and PA Updated in 2015/16 o o The new Priority List describes a smaller, more highly specified list of requirements, including implementation notes Also includes a set of recommended uses Available as an interactive release on the U.S. Health Information Knowledgebase (USHIK):

30 Pediatric Quality Measures Program (PQMP) PQMP is an AHRQ/CMS partnership focused on developing and implementing pediatric quality measures in conjunction with states and the private sector partners with the overall goal of improving quality of care for children, particularly those in Medicaid/CHIP o Mandated by CHIPRA (2009) and developed through collaboration between AHRQ and CMS o Phase 1- increasing the portfolio of evidence- based measures o Phase 2- implementation of new measures and learning about their feasibility/usability

31 PQMP Phase I Began 2011 to 2016 AHRQ/CMS supported 7 Centers of Excellence Goal: increase the availability of relevant and valid child health quality measures in key gap areas for use by public and private sector entities Byron et al -- Academic Pediatrics, Volume 14, Issue 5, Supplement, 2014, S27 S32

32 PQMP Phase I Grantee Institution PI Name Project Title University of Michigan Mt. Sinai School of Medicine Seattle Children s Hospital Gary Freed Lawrence Kleinman Rita Mangione- Smith Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium (Q-METRIC) Mount Sinai Collaboration for Advancing Pediatric Quality Measures (CAPQuaM) Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN) Topic Areas for Measure Development Sepsis (diagnosis and treatment); Sickle cell disease (testing, screening, guidance, monitoring, ED visits, patient satisfaction); Overuse of imaging for headaches and seizures; Outpatient care of asthma; Availability of specialty services. Temperatures for low birthweight neonates; Emergency department visits for asthma; Mental health follow-up; High-risk obstetrics; Medication reconciliation. Mental healthcare in hospital settings (assessment, discharge, follow-up); Transitions of care (provider communication, record quality).

33 PQMP Phase I Grantee Institution PI Name Project Title Medical College of Wisconsin National Committee for Quality Assurance Boston Children s Hospital University of Pennsylvania Ramesh Sachdeva Sarah Scholle Mark Schuster Jeffrey Silber Pediatric Measurement Center of Excellence (PMCOE) National Collaborative for Innovation in Quality Measurement (NCINQ) Children's Hospital Boston Center of Excellence for Pediatric Quality Measurement (CEPQM) Center of Excellence at the Children's Hospital of Philadelphia (CHOP) Topic Areas for Measure Development Perinatal Care; Follow-up after developmental screening; Linkage between dental treatment and dental prevention; ADHD (diagnosis, first-line treatment, and follow-up). Antipsychotic medication management and metabolic monitoring; Depression care (monitoring and remission/response). Pediatric 30-day readmissions; Family experience of pediatric inpatient care (Child HCAHPS Survey); Adolescent Assessment of Preparation for Transition (ADAPT) to Adult- Focused Health Care. Pediatric Global Health Measure; Continuity of insurance.

34 PQMP Phase II Began in October 2016 to 2019 AHRQ/CMS supported 6 grantees $13.5 Million Leverages Phase I (COEs) Measures Goal: support the implementation of the new PQMP measures AND learning about their usability and feasibility in improving quality of care for children in real-world settings o Field test and refine measures o Use the data to define appropriate QI goals in partnership with States o Test multilevel QI strategies to improve care o PQMP Learning Collaborative: Capture shared learning both challenges/best practices

35 PQMP Phase II Grantee Institution PI Name Project Title University of California, San Francisco Michael Cabana Implementing Measures Network for Child Health Topic Areas for Measure Implementation Asthma (ED use and primary care coordination); Sickle cell disease screening and treatment guidance. University of Michigan Gary Freed Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium Sickle cell disease (antibiotic prophylaxis and ultrasonography screening); Overuse of imaging for headaches and seizures; Outpatient care of asthma. Seattle Children s Hospital Rita Mangione- Smith Center of Excellence on Quality of Care Measures for Children with Complex Needs Mental healthcare in hospital settings (assessment, discharge, follow-up); Transitions of care (provider communication, record quality).

36 PQMP Phase II (cont d.) Grantee Institution PI Name Project Title Topic Areas for Measure Implementation National Committee for Quality Assurance Sarah Scholle National Collaborative for Innovation in Quality Measurement Antipsychotic medication management and metabolic monitoring Depression care (utilization, screening and follow-up). Boston Children s Hospital Mark Schuster Children's Hospital Boston Center of Excellence for Pediatric Quality Measurement Pediatric 30-day readmissions; Family experience of pediatric inpatient care (Child HCAHPS Survey). University of Florida Elizabeth Shenkman The Child Health Quality Partnership Linkage between dental treatment and dental prevention; Judicious antipsychotic use in children and adolescents and metabolic screening and monitoring.

37 Pediatric Quality Measures Program (PQMP) Impact of the PQMP: o Develop new, publicly available portfolio of pediatric quality measures o Strengthen partnerships with states and other public/private stakeholders to implement new measures to improve quality at multi-level (state, health plan, hospital, provider) o Build knowledge base regarding the connection between measurement and implementation science o OVERALL, improve the quality of care and outcomes for US children, with a focus on children in Medicaid/CHIP

38 QUESTIONS

39 Thank you for attending Presentations: Presenter contact information: Kamila Mistry, PhD MPH (Senior Advisor, Child Health and Quality Improvement; Director, Division of Priority Populations Research) Agency for Healthcare Research and Quality, US Department of Health and Human Services Phone (office): (301)