Understanding Mental Health Management Tools for Mental Health Performance Improvement Jodie Trafton, PhD Office of Mental Health Operations Cliff Smith, PhD, ABPP Iron Mountain VA Medical Center Dan Kivlahan, PhD Mental Health Services Lisa Kearney, PhD, ABPP Office of Mental Health Operations
Objectives for the Breakout Identify common tools for management in mental health: MH Management Dashboard, SAIL, MHOB, MHIS, ACAP tools) Identify methods for utilizing these tools for performance improvement through creation and monitoring of local strategic action plans. Identify strategies for discussing MH SAIL and MH Management Planning Tool with Executive Leadership 1
MH Management Discussions with the MH Management Tool MH Management Tool consolidates data from multiple sources to provide a view of key resource, environment, process and eventually outcome measures to help understand facility challenges and facilitate problem-solving The tool complements findings from the MH Domain of the SAIL to improve understanding of the drivers of performance on SAIL. Discussed in quarterly meetings between OMHO leadership, VISN MH Leads and other VISN and facility leadership, leading to action planning as needed at the facility, VISN and VACO level. 2
MH Management Discussions with the MH Management Tool Discussion designed to identify higher level/systems solutions to challenges that are not feasibly solved via actions at the local MH program level Opportunity for local MH programs to get help with challenges (e.g. space constraints, high growth rates, lack of availability of providers for recruitment). 3
Mental Health Management Tool 4
Mental Health Management Tool 5
Mental Health Plan Data (1) Clinical Outcomes (TBD), Satisfaction, Continuity of Care, Missed Opportunities 6
Mental Health Plan Data (2) Wait Times, Population Access, Staffing, Space 7
Mental Health Plan Data (3) Productivity, PCMHI, Telemental Health, Growth; Gaps 8
Onboard MH Clinical FTE and Productivity Facility and provider level data on MH encounters, outpatient MH clinical hours/fte, and outpatient MH clinical productivity (by pay period) Revised VSSC dashboard will display additional data Include inpatient mental health and homeless providers Allow provider type summaries. Currently available as custom excel reports from OMHO PERC Used to track adequacy of MH staff to patient ratios (e.g. on MH Management Tool) Used to monitor MH provider productivity per the MH Productivity Directive Available here: https://securereports2.vssc.med.va.gov/reports/pages/report.aspx?itempath=%2fmentalhealth%2fmhob%2fmhob_summary 9
Tracking Consult Management and Response Consult is needed to make all mental health referrals that cut across programs of care, including: From one mental health program to another (e.g., general outpatient MH to PCT) From a non-mental health setting to mental health setting (e.g., endocrinology to MH; Homeless Program to MH) From one facility to another facility for MH services (interfacility consults) MH Consult Dashboard https://spsites.dwh.cdw.portal.va.gov/sites/omho_consult/_layouts/reportserver/rsviewerpage.aspx?rv:relativer eporturl=/sites/omho_consult/analyticsreports/timelinessmatrixreport.rdl&source=https://spsites.dwh.cdw.port al.va.gov/sites/omho_consult/analyticsreports/forms/allitems.aspx&defaultitemopen=1 10
Mental Health Information System Presents over 200 metrics designed to track adherence to requirements in the Uniform Mental Health Services Handbook Broken into domains. Items that are extreme outliers (e.g. 1.5 to 2 standard deviations from the facility mean) in the nondesired direction are flagged. Used to guide identification of challenges and strengths for the site visit and action planning, and strong practices programs. Summary metrics for the Psychotropic Drug Safety Initiative have been added. http://reports2.vssc.med.va.gov/reports/pages/report.aspx?itempath=%2fmentalhealth%2fmhinformationsystem%2fmhinfo rmationsystem 11
Psychotropic Drug Safety Initiative Includes summary and real-time actionable patient tools to encourage review and process improvement in common areas of non-optimal mental health prescribing Real-time tools enable proactive panel managementbased approaches to improving care quality Facilitate clinical implementation of panel-management based care practices, with plans to expand these tools into additional care domains (e.g. evidence-based psychotherapy, risk mitigation, etc.) Facility efforts on PDSI last year were associated with improvements in clinical practice patterns https://spsites.dwh.cdw.portal.va.gov/sites/omho_psychpharm/pages/real-time-pdsi-dashboard.aspx 12
Tools to improve tracking of implementation of new initiatives Overdose Education and Naloxone Distribution: new initiative to provide at risk patients overdose education and naloxone kits to reverse opioid overdose https://spsites.dwh.cdw.portal.va.gov/sites/omho_psychpharm/_layouts/reportserver/rsviewerpage.aspx?rv:relative ReportUrl=/sites/OMHO_PsychPharm/AnalyticsReports/HeatMapOEND.rdl&Source=https%3A%2F%2Fspsites%2Edwh %2Ecdw%2Eportal%2Eva%2Egov%2Fsites%2FOMHO%5FPsychPharm%2FAnalyticsReports%2FForms%2FAllItems%2E aspx&defaultitemopen=1 Evidence-based Psychotherapy Templates: improve adherence to and documentation of use of selected evidence-based psychotherapy protocols. https://spsites.dwh.cdw.portal.va.gov/sites/omho_psychpharm/_layouts/reportserver/rsviewerpage.aspx?rv:relative ReportUrl=/sites/OMHO_PsychPharm/AnalyticsReports/EBPTemplates_HeatMap.rdl&Source=https%3A%2F%2Fspsite s%2edwh%2ecdw%2eportal%2eva%2egov%2fsites%2fomho%5fpsychpharm%2fanalyticsreports%2fforms%2falli tems%2easpx&defaultitemopen=1 Tools identify sites where implementation has been started and tracks uptake of new practices Provides maps and tables of counts of kits distributed and templates used at each facility 13
How Can I Possibly Utilize All These Dashboards? Identify what is important for you to measure from a quality improvement perspective and utilized the associated measures to track progress over time Delegate responsibility to appropriate team members so that each team owns their own data Identify what is important to leadership and to Veterans related to administrative and clinical outcomes and find ways to measure and report back on progress Create a regular timeline for data extraction and reporting to be used in regular meetings with all stakeholders 14
Additional Available Tools 15
Know Your Grid Understand your provider s grid 20 hours (502, 513 slots) for individual psychotherapy Two 2 hour blocks (516, 550 slots) for group psychotherapy 5 hours (502, 513 slots) for access (walk in, crisis management) 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 noon 1:00 PM 2:00 PM 3:00 PM 4:00 PM Monday Clinic Clinic access Clinic admin Clinic Clinic Tuesday Clinic Clinic Clinic Clinic Dep Group access EBP consult Wednesday Dept & other meetings access Clinic PTSD Grp (admin) Thursday admin Clinic Clinic Clinic Clinic Clinic access Friday Clinic Clinic access Clinic admin Clinic Clinic
Know your Tools Demand-Supply-Activity (Slots) 2/28/2015 Total Slot Demand 340 Adjusted Slot Demand 303 Slot Supply (Total Slots) 685 Calculated Slot Activity (CheckedOut Slots) 238 Clinic Slot Utilization 34.70% 238 685 Pay Period 19 20 21 22 23 24 MH Outpatient Encounters 59 37 49 48 52 42 Total Outpatient Encounters 59 37 49 48 52 42 MH Outpatient Clinical Hours 80.00 72.00 80.00 80.00 80.00 80.00 Total Hours Worked 80.00 72.00 80.00 80.00 80.00 80.00 MH Outpatient Clinical FTE 1.00 0.90 1.00 1.00 1.00 1.00 wrvu 102.81 73.47 79.89 89.53 84.66 76.67
Access Level Measures Access Glide Path Access Clinic Index Facility, VISN, Peer Group, National National, VISN Facility, Provider Clinic 3 rd Next Available, Missed Opportunities, Cancelled by Clinic. Octane Missed Opportunities, Cancelled by Clinic; clinic utilization, appointment length http://reports2.vssc.med.va.gov/reportserver/pages/reportviewer.aspx?%2fmgmtr eports%2faccess%2faccessglidepath&rs:command=render http://bi.vssc.med.va.gov/sysredesign/dashboards/clinic%20access%20index/clini c%20access%20index%20 %20Mental%20Health.aspx Access Clinic Index (v2) Specialty Care Compass (SCC) Top 50 Clinic Dashboard Consult Dashboard National, VISN Facility, Provider Clinic VISN, Facility National, VISN, Facility National, VISN, Facility Octane Missed Opportunities, Cancelled by Clinic; clinic utilization, appointment length 500 series Section and Clinic Level 3 rd next available, New Patient Wait Time (days), Octane level 502, 509, 510, 513, and 540 clinic access measures Open Consults by department http://bi.vssc.med.va.gov/sysredesign/dashboards/clinic%20access%20index%20v2/ Clinic%20Access%20Index%20 %20Mental%20Health.aspx https://securereports2.vssc.med.va.gov/reports/pages/report.aspx?itempath=%2ftel ehealth%2fscc_master http://bi.vssc.med.va.gov/reportslibrary/top%2050%20clinics/top%2050%20clinic% 20Dashboard.aspx https://securereports2.vssc.med.va.gov/reportserver/pages/reportviewer.aspx?%2f Systems+Redesign%2fConsults%2fConsult_Switchboard&rs:Command=Render MH Consult SharePoint Definitions https://vaww.portal.va.gov/sites/omhs/implementation/default.aspx 18
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Missed Opportunities A critical opportunity Missed Opportunities can be thought of as true no-shows. VHA defines missed opportunities as the sum of 3 individual data elements: No Shows (appointments marked in the computer by the clerical associate as having no-showed); Cancelled by Clinic After the Appointment time (CCAA) or Cancelled by Patient After the Appointment time (PCAA). The Missed Opportunity Rate is calculated by counting the number of Missed Opportunities (numerator) and dividing by the number of Checked Out Appointments plus the number of missed opportunities (denominator). A lower percentage is the better. The current national Missed Opportunity Rate target is 10% or lower for the Top 50 clinics. Source: WaitTimeCancel cube. Numerator: [No Show] + [CCAA] + [PCAA] Denominator: [Checked Out Appointments] + [No Show] + [CCAA] + [PCAA] 24
Missed Opportunity (Call List) VAMC High probability no show https://securereports2.vssc.med.va.gov/reportserver/pages/reportviewer.aspx?%2fsys tems+redesign%2fmissed+opportunity+call+list&rs:command=render Clinic Utilization Cube National, VISN, Facility, CBOC % Clinics Utilized, Encounters for Mental Health Clinic Utilization Cube: http://fcdm.vssc.med.va.gov/cube%20library/document%20library/clinic%20utilizatio n.bbk Clinic Utilization (ProClarity web) National, VISN, Facility, CBOC % Clinics Utilized, Encounters for Mental Health http://vaww.fcdm.med.va.gov/pas/en/src/proclarity.asp?uiconfig=&book={d1d16d2e B922 4075 A01C 3C45EB6CAE84}&page={4481004C B1B3 4717 B4A4 71FE595CB80C}&folder=root&LibID={4AEC1B7E 468E 4859 A92C 8E412E095D71} Yearly Clinic Utilization VISN, Facility Yearly Clinic (Stop Code) Encounters http://vaww.fcdm.med.va.gov/pas/en/src/proclarity.asp?uiconfig=&book=favorites&pa ge={dffb0f62 4429 442F 8DF6 9B34FCAA3680}&folder={2A6A61E2 A945 487B B7DA FFF36FCA498E}&LibID= ARC Data sites https://vaww2.arc.med.va.gov/secure/main.asp?cd=s585cs7&salias=vhairosmithc CUSS Report VAMC Stop Code http://vssc.med.va.gov/webrm/cussrpt.aspx Encounter Action Required Report (EARR) VISN, VAMC, CBOC Encounters with errors https://securereports2.vssc.med.va.gov/reportserver/pages/reportviewer.aspx?%2fwo rkload%2fearr%2fearrsummary&rs:command=render&rs:clearsession=true Encounter Closeout Facility Encounter needing closed https://securereports2.vssc.med.va.gov/reportserver/pages/reportviewer.aspx?%2fwo rkload%2foutpt%2fworkload_closeout&rs:command=render 25
Encounters = Productivity Facility Encounters with Action Required Status MAY-FY15 Total Outpatient Encounters MAY-FY15 Outpatient Encounte r s not closed MAY-FY15 Total Inpatient Encounters MAY-FY15 Inpatient Encounte r s not closed V12 6,399 220,941 1,140 21,641 195 (V12) (585) Iron Mountain, MI 243 12,763 31 567 2 (V12) (695) Milw aukee, WI 1,664 49,691 249 5,504 34 (V12) (607) Madison, WI 1,172 27,917 106 1,955 33 (V12) (556) Captain James A Lovell FHCC 530 25,447 148 1,712 14 (V12) (578) Hines, IL 1,423 50,959 324 6,539 83 (V12) (676) Tomah, WI 230 14,907 36 1,072 8 (V12) (537) Jesse Brow n VAMC (Chicago), IL 1,137 39,257 246 4,292 21 26
Mental Health Outcomes Oriented Quality Metrics Dashboard of metrics representing National Quality Forum domains of key outcomes Includes metrics that: Characterize patient populations seen at a facility (e.g. smoking and risky alcohol use rates) Track clinical processes linked to important patient outcomes in VA studies (e.g. loss to care for SMI patients) Track rates of undesirable MH treatment utilization (e.g. emergency or inpatient visits) May be helpful for identifying special treatment needs of local population, and clinical processes improve patient treatment outcomes 27
MHTC1 patient detail report Helps to identify unassigned patients who require a Mental Health Treatment Coordinator May also help identify patient appropriate for BHIP team assignment 28
Resource List MH Management Dashboard available from VISN MH leads SAIL available at: http://reports2.vssc.med.va.gov/reportserver/pages/reportviewe r.aspx?%2fmgmtreports%2fvatr%2fsail_prod%2fsail&rs:com mand=render SAIL MH Domain Components Summary available at: https://spsites.dev.dwh.cdw.portal.va.gov/sites/omho_pec/_lay outs/reportserver/rsviewerpage.aspx?rv:relativereporturl=/site s/omho_pec/analyticsreports/mhdomaincompositesummary. rdl&source=https%3a%2f%2fspsites%2edev%2edwh%2ecdw%2 Eportal%2Eva%2Egov%2Fsites%2FOMHO%5FPEC%2FAnalyticsR eports%2fforms%2fallitems%2easpx&defaultitemopen=1 29
Resource List Onboard Mental Health Clinical FTE and Productivity Version 1 available at: https://securereports2.vssc.med.va.gov/reports/pages/report.aspx?itempat h=%2fmentalhealth%2fmhob%2fmhob_summary Mental Health Information System available at: http://reports2.vssc.med.va.gov/reports/pages/report.aspx?itempath=%2fmen talhealth%2fmhinformationsystem%2fmhinformationsystem MH Referral Timeliness report available at: https://spsites.dwh.cdw.portal.va.gov/sites/omho_consult/_layouts/reportse rver/rsviewerpage.aspx?rv:relativereporturl=/sites/omho_consult/analytic sreports/timelinessmatrixreport.rdl&source=https%3a%2f%2fspsites%2edw h%2ecdw%2eportal%2eva%2egov%2fsites%2fomho%5fconsult%2fanalytic sreports%2fforms%2fallitems%2easpx&defaultitemopen=1 VHA Performance Measure Report (includes MH measures) available at: http://reports2.vssc.med.va.gov/reportserver?%2fpmr%2fperformancemeasure s%2fperformancemeasurereport&rs:command=render 30
Resource List: Mental Health Outcomes Oriented Quality Metrics available at: https://securereports3.vssc.med.va.gov/reports/pages/report.asp x?itempath=%2fmentalhealth%2fmhoutcomes%2foutcomes Consult Switchboard available at: https://securereports2.vssc.med.va.gov/reportserver/pages/repor tviewer.aspx?%2fsystems+redesign%2fconsults%2fconsult_switc hboard&rs:command=render Mental Health Treatment Coordinator Patient Detail available at: https://securereports2.vssc.med.va.gov/reportserver/pages/repor tviewer.aspx?%2fmentalhealth%2fmhsecurereports%2fmhtc_det ail&rs:command=render 31