The Readmissions Quality Collaborative Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013
Overview Background and Scope of the Problem The Readmissions Quality Collaborative Participants and Activities Strategies to Reduce Readmissions Resources PSYCKES indicators PSYCKES public website and training webinars
Behavioral Health Inpatient Readmissions: Background and Scope of the Problem
Reducing Hospital Readmissions: A National Quality Focus Hospital readmissions are common and costly 19.6% of Medicare beneficiaries discharged were re-hospitalized within 30 days; cost to Medicare of unplanned readmissions estimated at $17.4 billion (Jencks, 2009) Medicaid enrollees aged 21-64 had 10.7% 30-day readmission rate (HCUP Statistical Brief #89, 2010) National/multi-state initiatives to address preventable readmissions include Partnership for Patients Community-Based Care Transitions Program: national initiative to reduce unnecessary hospital readmissions by 20% Project BOOST (Society of Hospital Medicine): 60 sites in 26 states IHI STAAR (State Action to Reduce Avoidable Readmissions) Initiative: 4- state collaborative in 148 hospitals While most attention nationally is on medical readmissions, behavioral health readmissions are an important component of the overall picture.
30-Day Readmission by Major Diagnostic Category at Initial Hospital Stay for Medicaid Recipients Age 21-64, 2007 Among 15 states, behavioral health discharges ranked among the top 5 diagnostic categories for 30-day readmissions. AHRQ Health Care Utilization Project Statistical Brief #89, 2010
30-day Behavioral Health Readmission Rates in the NYS Medicaid BH Population, April 2011- April 2012 New York State Office of Mental Health, 2012
Characteristics of NYS Medicaid BH Recipients with 30-day BH Readmissions NYS Office of Mental Health, 2012
The Readmissions Quality Collaborative
The Readmissions Quality Collaborative Goal: Reduce readmission rates among adults discharged from behavioral health inpatient services Projected time frame: June 2012-December 2013 Sponsors: GNYHA, HANYS, OMH/PSYCKES Steering Committee of peer institutions decides: Focus of project (i.e., readmissions) Strategies and activities Reporting requirements
Participating Hospitals and Service Types 47 Participating Hospitals Statewide NYC (23), LI (9), Hudson River (6), Central (5), Western (3) 50 Inpatient Services 44 Psychiatry, 6 Detox / Rehab 16 Outpatient Services 12 Mental Health, 2 Chemical Dependency, 2 Dual Diagnosis 3 Psychiatric Emergency Departments / CPEPs
Conferences Key Activities of the Collaborative Monthly Learning Collaborative Calls Interactive, report on progress Strategies calls: Training on specific strategies Data reporting Monthly self-report Quarterly Medicaid data Site Visits (selected hospitals)
Strategies to Reduce Behavioral Health Readmissions
Core Project Activities Case finding: Implement admission protocol to identify clients at risk of readmission, using Screening Tool and/or PSYCKES data. Identify and address risk factors: Assess for risk factors and implement policy that identified risks for readmission are addressed explicitly on treatment plan and discharge plan. Optimize discharge process: Implement a protocol or checklist to ensure best practices in discharge planning, including procedures for bridging time between discharge and first outpatient session. Coordinate discharge planning efforts with the BHO.
Priority Targets for Intervention Improve medication practices Improve engagement in outpatient care Improve delivery of integrated treatment for co-occurring psychiatric and substance use disorders
Intervention: Improving Medication Practices
Intervention: Improving Engagement in Outpatient Care
Intervention: Improving Delivery of Integrated Treatment for Co-Occurring MH and SUD Using the evidence-based Integrated Dual Diagnosis Treatment (IDDT) model **On-line training available via OMH Focus on Integrated Treatment Modules.**
Inpatient Strategies: Services Delivered Self report data:
Enhanced Discharge Processes Among 50 participating inpatient services
Outpatient Strategies: Interventions/Services Initiated Self report data:
Examples from Participating Hospitals At several hospitals, if a potential readmission comes to ED, the inpatient treatment team who knows the client is called to ED for consultation. Hospitals are attending more carefully to barriers such as insurance, e.g., checking which LAIs the client s insurance will cover before initiating a regimen. At Woodhull Hospital, clients at high risk of readmission receive two individual sessions focused on preventing readmission.
Examples from Participating Hospitals, cont d Several hospitals, including LIJ and Maimonides, are implementing plan for discharge workbooks and worksheets. Lutheran Hospital Warm Hands initiative to improve transitions from inpatient detox to outpatient chemical dependency, e.g., before 1 st appointment, clinician makes provides motivational interviewing on reminder call.
Midyear conference Next Steps Analysis of Medicaid and other data to review trends over time Identify which strategies are most effective and result in best return on investment Site visits to identify best practices and provide technical assistance
Resources: The PSYCKES Application and Public Website
Brief Introduction to PSYCKES A HIPAA-compliant, web-based application that provides access to Medicaid claims data for clinical decision-making and quality improvement Includes fee for service and managed Medicaid, but not Medicare or private insurance Includes data on NYS Medicaid behavioral health population Up to 5 years of data across treatment settings Quality measures calculated at state, region, county, and provider level
PSYCKES Quality Measures Acute Care Utilization High Utilization (Inpatient/ER) Behavioral Health Readmission Preventable Hospitalization Physical Health Outpatient Medical Visits Lab monitoring Psychotropic Medications Adherence Cardiometabolic Risk High Dose Polypharmacy Psychotropic Prescribing for Youth Too much, too many, too young
Access to Client-Level Data
PSYCKES QI Overview Indicator sets associated with readmission risk
QI Indicators within the Set All behavioral health vs. hospital-specific
Quality Indicators Link to List of Flagged Clients
Clinical Summary Integrated view of all services Service Summary Tables by Category Medications Outpatient Inpatient/ER And more Drill down to view linked claims/encounters Can be exported to Excel/PDF
Clinical Summary: Graphs Rapid identification of service utilization patterns
Inpatient and ER Services Service type (ER or Inpt, BH or Medical), hospital name, date of admission/discharge, LOS, last diagnosis, procedures, See all Data > links to each invoice/claim
PSYCKES Home Page www.psyckes.org Public website, PYSCKES access not needed Click on Hospital Collaborative
PSYCKES Website: Readmissions Collaborative Page
Tools on PSYCKES Website: Readmission Risk Assessment
Tools on PSYCKES Website: Slides from Strategies Calls
For Further Information PSYCKES website www.psyckes.org PSYCKES Help (PSYCKES support) 9:00AM 5:00PM, Monday Friday PSYCKES-help@omh.ny.gov OMH Help Desk (PSYCKES access, SMS support) 7:00AM 8:00PM, 7 days 800-HELP-NYS (800-435-7697) Helpdesk@omh.ny.gov
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