National Academies Press: OpenBook
« Previous: Appendix C: Mental and Substance Use Health for Veterans: Experience with Performance Evaluation in the Department of Veterans Affairs
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Index

A

Academic Behavioral Health Consortium, 300

Accreditors of M/SU health care organizations, recommendations for, 12, 21, 318, 384–385

Acute stress disorder (ASD), knowledge gaps in treatment for, 152

Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, 299

Addiction Severity Index (ASI), 160

Administration for Children, Youth, and Families, 13–14, 17–18, 174–180, 374–375, 377–378

Administrative datasets, 155–159

Advance directives, 119–120

Advances in care and treatment, 32–34

Agency for Healthcare Research and Quality (AHRQ), 13–14, 17–18, 22–23, 110, 155, 161, 176–180, 268, 358, 374–375, 377–378, 383

Evidence-based Practice Centers, 164

Evidence Report/Technology Assessment, 71

Integrated Delivery Systems Research Network, 359–360

User Liaison Program, 176–177

Agenda for change, 350–390

Aims of quality health care, 8

Alcohol and Drug Services study, 292

American College of Mental Health Administration (ACMHA), 45–46, 182–183, 300

American Health Information Community (AHIC), 264

American Managed Behavioral Health Association, 183

American Psychiatric Association, 30n, 65, 168

Amphetamine dependence, knowledge gaps in treatment for, 153

Analysis of evidence

organizations and initiatives conducting systematic evidence reviews in M/SU health care, 163–166

strengthening and coordinating mechanisms for, 161–167

Annapolis Coalition on Behavioral Health Workforce Education, 300

Anticipation

of comorbidity, and formal determination to treat or refer, 235–236

of needs, 9, 78

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Application of the Quality Chasm approach to health care for mental and substance-use conditions, 10–23, 70–72.

See also Recommendations

applicability of the Quality Chasm framework, 72

relationship between M/SU and general health care, 70–72

Association for Medical Education and Research in Substance Abuse (AMERSA), 299

Auditing, to ensure that performance measures have been calculated accurately and according to specifications, 187

B

Behavioral Health Data Standards Workgroup (BHDSW), 272

Behavioral health information management, and the NHII, nationwide summit on, 273–274

Benefits and risks of different treatment, providing information about, 117

Brief Psychiatric Rating Scale (BPRS), 160

Budgeted systems of care, 343

C

Campbell Collaboration, 165

Care coordination and related practices defined, 211–214

care coordination, 213

care integration, 213

collaboration, 212–213

communication, 212

integrated treatment, 213–214

Care delivery

gaps in knowledge about effective, 353–355

need to navigate a greater number of arrangements in health care for mental/substance-use conditions, 66–67

by or through non-health care sectors, 275

Care integration, 213

clinical integration, 213

physician (or clinician) integration, 213

Carve-out services

in Medicaid, 341–342

by private payers, 332–333

Case (care) management, 238–239

Center for Studying Health System Change, The, 278

Center for Substance Abuse Treatment (CSAT), 299

Centers for Disease Control and Prevention (CDC), 13–14, 17–18, 174–180, 374–375, 377–378

centers, institute, and offices of, 175

Centers for Medicare and Medicaid Services, 13–14, 22–23, 174–180, 358, 377–378, 383

Certification Commission for Healthcare Information Technology, 265

Change, need for a sustained commitment to bring about, 315–317

Change agenda, 350–390

knowledge gaps in treatment, care delivery, and quality improvement, 351–355

marketplace incentives leveraging needed, 325–349

review of actions needed for quality improvement at all levels of the health care system, 360–388

strategies for filling knowledge gaps, 355–360

summary, 350–351

Changes in MH/SA service delivery in the VHA, 436–437

Child welfare services, 226–227

increased burden on, 41–44

Childhood conditions, gaps in knowledge about therapies for high-prevalence, 352–353

Chronic Care Model, 83, 121–122, 241–242, 306

Clinical integration, 213

Clinically active (CA) mental health personnel, 292

Clinically trained (CT) mental health personnel, 292

Clinicians

diverse types of health care providers, 278

financial issues, 279

in health care for mental/substance-use conditions, 65–66

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

less use of information technology among M/SU providers, 276

mode of practice, 65–66

numbers in solo or small practices, 277–278

participating in the NHII, 276–279

reporting individual practice as their primary or secondary place of employment, 309

reporting solo practice as their primary or secondary place of employment, 66

varied reimbursement and reporting requirements, 278–279

Clinicians providing M/SU services, recommendations, 14, 179–180, 361–364, 366

Cocaine dependence, knowledge gaps in treatment for, 153

Cochrane Collaboration, 35, 163

Coding

CPT psychotherapy codes, 156–157

ICD-9 procedure codes, 157–158

Coerced treatment, 1, 103–108

coercion and mental illnesses, 104–107

coercion and substance-use illnesses, 107–108

defined, 103n

gaps in knowledge about, 354

recommendations concerning, 12–13, 127–128, 362, 366, 373–374

summary, 108

Collaboration, 212–213

and coordination in policy making and programming, 245–247

defined, 212–213

effective communication, 212

New Mexico’s Behavioral Health Collaborative, a case study in policy coordination, 247

with other agencies, 439–440

recommendations concerning, 16–17, 248–249, 282, 363, 367, 370–371, 374, 379–380, 385

shared decision making, 212

a shared understanding of goals and roles, 212

Collaborative public- and private-sector efforts, establishing, 190–191

Collection of outcome data from patients, 159–160

Collocation and clinical integration of services, 237–238

Combating stigma and supporting decision making at the locus of care delivery, 110–115

endorsing and supporting consumer decision making in organizational policies and practices, 110–114

involving consumers in service design, administration, and delivery, 114–115

Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders, xi, 10

convening, 46

study process, 391–393

Committee on the Future of Emergency Care in the U.S. Health System, 47

Communication

defined, 212

effective, 212

underused sources of, 173–177

Community Mental Health Services (CMHS) Block Grants, 223

Comorbidity, anticipation of, and formal determination to treat or refer, 235–236

Compensated Work Therapy (CWT) program and Compensated Work Therapy/Transitional residence (CWT/TR) program, 476–477

outcome measures, 477

process measures, 476–477

program participation, 476–477

Competencies in discipline-specific and core knowledge

Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, 299

Annapolis Coalition on Behavioral Health Workforce Education, 300

evaluating, 95–96

interdisciplinary project to improve health professional education in substance abuse, 299–300

little assurance of, 298–300

Competition for enrollees, 339–341

Conceptual framework for decision-making capacity, 93–96

ability to understand, appreciate, reason, and communicate preferences, 93–95

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

characteristics of the competency evaluator, 95–96

contextual risk-benefit factors, 95

Conceptualizing the aspects of care to be measured, 182–185

difference between the public and private sectors, 183

different types of evidence, 184

more diverse stakeholders, 183

unclear locus of accountability, 184–185

Consequences of failing to provide effective care

demands on the juvenile and criminal justice systems, 42–44

great cost to the nation, 38–41

increased burden on the child welfare system, 41–44

mitigating adverse consequences of M/SU problems and illnesses, 44

M/SU illnesses a leading cause of disability and death, 37–38

serious personal and societal, 37–44

Consolidated Health Informatics (CHI) interagency initiative, 266–267

Constraints on sharing M/SU treatment information imposed by federal and state medical records privacy laws, 405–422

HIPAA privacy regulations, 406–407

information sharing for treatment purposes under state law and HIPAA, 412–417

introduction, 405

North Carolina General Stat. Ann. § 122C-55, 418–422

relationship between federal and state privacy laws, 407–409

state laws governing mental health records, 409–411

state laws governing the confidentiality of substance abuse records, 411

state medical records confidentiality laws, 409

Consumer decision making in organizational policies and practices, 110–114

continuing education, 111

leadership and policy practices, 110–111

tolerance for “bad” decisions, 111–114

Consumer role

in health care for mental/substance-use conditions, 61

providing them real choices, 116–117

as service providers, 114–115

Content of continuing education, 306

Contextual risk-benefit factors, 95

Continuing advances in care and treatment, enabling recovery from mental and substance-use conditions, 4–5, 32–34

Continuing education, 111

content of, 306

financing, 307–308

inadequacy of, 305–308

methods, 306–307

organizational support, 308

Continuity of care among outpatients

with psychotic diagnoses, 481

with PTSD diagnosis, 478

Continuous healing relationships, 9

Continuum of linkage mechanisms, 236

Co-occurring mental, substance-use, and general health problems and illnesses, 214–217

co-occurrence with general health conditions, 215–217

co-occurring mental and substance-use problems and illnesses, 214–215

Cooperation among clinicians, 9

in health care, 58

Coordinated care for better mental, substance-use, and general health, 210–258

care coordination and related practices defined, 211–214

difficulties in information sharing, 232–233

failed coordination of care for co-occurring conditions, 214–218

numerous, disconnected care delivery arrangements, 218–232

recommendations concerning, 17, 248–250, 364, 368

structures and processes for collaboration that can promote coordinated care, 233–247

summary, 210–211

Cost to the nation, 38–41

decreased achievement by children in school, 39–41

decreased productivity in the workplace, 39

Council on Graduate Medical Education (COGME), 287, 316

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Council on Social Work Education, 302

Council on the Mental and Substance-Use Health Care Workforce, recommendations for, 20–21, 317–318, 382–383, 386

Counseling, 295

Counselor education, paucity of content on substance-use care in, 302–303

CPT psychotherapy codes, 155–157, 178

insight oriented, behavior modifying and/or supportive psychotherapy, 156

interactive psychotherapy, 156

Criminal justice system, 43–44, 227–229

involvement, 439

Critical role of the workforce and limitations to its effectiveness, 288

workforce shortages and geographic maldistribution, 289

Cross-agency research efforts, recommendations concerning, 22–23, 358, 383

Crossing the Quality Chasm: A New Health System for the 21st Century, ix, xi, 1–2, 11, 30, 44–48, 56–59, 65, 70, 72, 77–78, 108, 111–112, 116–118, 123, 185, 211, 213–214, 229, 260, 278–279, 353, 392

Customization, based on patient needs and values, 9, 78

in health care, 58

D

Dangerousness, risk of, 100–103

Data access, need to balance privacy concerns with, 274–275

Data availability, 359

Data interchange, 266

Data standards, 17–18, 262–263, 265–267, 374–375

knowledge representation, 266

recommendations for, 19, 281, 371

terminologies, 266

Davies Award, The, 274

Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care, 263

Decision Support 2000+, 270–271

Decision-making abilities of individuals, xii, 93–100

conceptual framework, 93–96

Decision-making abilities of individuals with and without M/SU illnesses, 96–100

among people with substance-use illnesses, gaps in knowledge about, 354

effects of substance use on decision making and compulsive behavior, 99–100

impaired decision making by individuals not mentally ill or using substances, 100

mental illnesses, 96–98

Decision-making support

providing all M/SU health care consumers with, 116–122

providing consumers with real choices, 116–117

providing decision support to all patients, 117–118

providing information about the benefits and risks of different treatment, 117

providing stronger decision support mechanisms for individuals with significantly impaired cognition or diminished self-efficacy beliefs, xii, 118–120

supporting illness self-management practices and programs, 120–122

Deference to the patient as the source of control, 9

in health care, 58

Demands on the juvenile and criminal justice systems, 42–44

criminal justice, 43–44

juvenile justice, 42

Department of Defense (DoD), 13–14, 177–180, 377–378

Department of Education, 13–14, 177–180, 377–378

Department of Health and Human Services (DHHS), 13–14, 177–180, 211n, 377–378

recommendations for, 14–15, 17–18, 370, 374–375, 378–380

Department of Justice, 13–14, 161, 164–165, 177–180, 377–378

Department of Labor, 88

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Department of Veterans Affairs (VA), 13–14, 18–19, 22–23, 177–180, 189–193, 358, 377–378, 380–381, 383, 426

patients diagnosed with mental health and substance abuse disorders, 432–433

quality measurement and quality management in the VA, 424–425, 440–446

VA health service use, 468–470

VA MH/SA services among veterans who used any MH/SA care, 471–472

Diagnostic methods

for mental/substance-use conditions, 64–65

improving, 167–169

Differences between general health care and health care for mental and substance-use conditions

in decision-making ability, 96–97

in health care for mental/substance-use conditions, 62–64

in the marketplace for health care for mental/substance-use conditions, 69–70

between the public and private sectors, 183

Disability-adjusted life years (DALYs), 37

Disconnected care delivery arrangements, 218–232

frequent need for individuals with severe mental illnesses to receive care through a separate public-sector delivery system, 223–224

involvement of non-health care sectors in M/SU health care, 224–232

separation of health services for M/SU conditions from each other, 222–223

separation of M/SU health care from general health care, 219–222

unclear accountability for coordination, 231–232

Discrimination by health care providers, gaps in knowledge about preventing unintentional, 354

Discrimination impeding patient-centered care, 79–92

adverse effects on patients’ ability to manage their care and achieve desired health outcomes, 81–84

relationship between stigma and discriminatory policies, 87–92

stigma affecting clinician attitudes and behaviors, 84–87

Discrimination in health insurance coverage, 88–90

coverage of mental health care, 88–89

coverage of substance-use health care, 89–90

Discriminatory policies, 87–92, 122–126

minimizing risks in involuntary treatment, 125

needed research, 125–126

potential lifetime ban on receipt of food stamps or welfare for felony drug conviction, 91–92

preserving patient-centered care and patient decision making in coerced treatment, 124

restrictions on access to student loans for some drug offenses, 90–91

transparent policies and practices for assessing decision-making capacity and dangerousness, 123–124

Dissemination of the evidence, 169–180

conclusions and recommendations, 177–180

key efforts, 171–173

key factors associated with successful, 170

National Institutes of Health, 172

professional associations, 173

recommendations concerning, 13–14, 177–180, 377–378

Substance Abuse and Mental Health Services Administration, 171–172

underused sources of communication and influence, 173–177

Veterans Health Administration, 172–173

Diversity of providers, in health care for mental/substance-use conditions, 10, 68–69

Domiciliary Care for Homeless Veterans (DCHV) program, 475–476

outcome measures, 476

patient characteristics, 475

process measures, 475–476

program participation, 476

program structure, 475

Drug Evaluation Network System (DENS), 273

Duke University, 120

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

E

Educational institutions. See also Professional education and training;

recommendations for, 21, 318, 386

Effective communication, 212

Effective health care, 8, 57

gaps in knowledge about delivering, 353–355

Effectiveness, 448–451

evaluating, 158

knowledge gaps in, 153

of performance measures, and measure sets and policies, 188–189

relative, of different treatments alone and in combination, 353

Efficacious treatments, 151.

See also Self-efficacy

Efficacy-effectiveness gap, 151–153

Efficient health care, 8, 57, 453

Electronic health records (EHRs), 17–18, 238, 259, 264–265, 279, 374–375

and personal health records, 272

recommendations for, 19–20, 281, 371–372, 375, 381–382

Employee assistance programs (EAPs), 230–231

Ensuring National Health Information Infrastructure (NHII) benefits to persons with mental and substance-use conditions, 259–285

summary, 259–260

Epidemiological Catchment Area (ECA) study, 101–103

EQUIP project, 261

Equitable health care, 8, 57

Equity for minorities, 453–454

Evidence

different types of, 2, 184

improving the production of, 151–167

Evidence base and quality improvement infrastructure, 140–209

applying quality improvement methods at the locus of care, 193–194

better dissemination of the evidence, 169–180

improving diagnosis and assessment, 167–169

improving the production of evidence, 151–167

problems in the quality of care, 141–151

public-private strategy for quality measurement and improvement, 195–196

strengthening the quality measurement and reporting infrastructure, 180–193

Evidence base gaps, 151–160

better capture of mental and substance-use health care data in administrative datasets, 155–159

collection of outcome data from patients, 159–160

efficacious treatments, 151

the efficacy-effectiveness gap, 151–153

knowledge gaps in treatment for M/SU conditions, 152–153

studies other than randomized controlled trials, 154–155

Evidence of decision-making capacity, 93–100

conceptual framework, 93–96

decision-making abilities of individuals with and without M/SU illnesses, 96–100

Evidence Report/Technology Assessment, 71

Evidence-based decision-making, 9

in health care, 58

Evidence-based Practice Centers (EPCs), 164

Experience of Care and Health Outcomes (ECHO) Survey, 160

External providers, formal agreements with, 239–240

F

Faculty development

inadequacy of, 303

recommendations concerning, 21, 318, 383

Failed coordination of care for co-occurring conditions, 214–218

co-occurring mental, substance-use, and general health problems and illnesses, 214–217

failure to detect, treat, and collaborate in the care of co-occurring illnesses, 217–218

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Failure to treat and prevent problems in the quality of care, 144–147.

See also Consequences of failing to provide effective care

failure to prevent, 146–147

failure to treat, 144–146

FDA. See U.S. Food and Drug Administration

Federal Employees Health Benefit Program (FEHBP), 331

Federal policy makers, recommendations for, 377–383

Federal privacy law, 407–409

Felony drug conviction, potential lifetime ban on receipt of food stamps or welfare for, 91–92

Female veterans, 454

Financing, 279

continuing education, 307–308

methods for mental health/substance-use care, 326

of M/SU health care research, recommendations for, 387–388

recommendations for health care, 22, 344, 372, 375

Flexibility, in professional roles, 242

Food Stamp Program, 91

Formal agreements, with external providers, 239–240

Framework for improving quality, 56–76

aims and rules for redesigning health care, 57–59

applying the Quality Chasm approach to health care for mental and substance-use conditions, 70–72

distinctive characteristics of health care for mental/substance-use conditions, 59–70

summary, 56–57

Front-line experience, 425, 454–456

G

Gaps in knowledge, 355

General medical/primary care providers, 293–294

Global Appraisal of Individual Needs (GAIN), 160

Global Assessment of Functioning (GAF) scale, 160, 482

improvement after inpatient discharge, 482

improvement during outpatient treatment, 482

National Mental Health Program Performance Monitoring System, 160

Government Performance and Results Act (GPRA), 272–273

Government purchasing, 2

dominance of, 326–327

H

HCPCS codes, 178

Health care

anticipation of needs, 58

based on continuous healing relationships, 58

Health Care for Homeless Veterans (HCHV) program, 475–476

outcome measures, 476

patient characteristics, 475

process measures, 475–476

program participation, 476

program structure, 475

Health care for mental/substance-use conditions, 59–70

consumer role, 61

diagnostic methods, 64–65

differences between general health care and health care for mental and substance-use conditions, 62–64

differences in the marketplace, 69–70

greater diversity of types of providers, 68–69

greater separation from other components of the health care system, 59–61

information sharing and technology, 68

integrating into the NHII, 279–283

mode of clinician practice, 65–66

need to navigate a greater number of care delivery arrangements, 66–67

quality measurement infrastructure, 67–68

solving the problems of, xi

Health care organizations, 13–14, 177–180, 377–378

Health care provider and organization strategies, 234–243

anticipation of comorbidity and formal determination to treat or refer, 235–236

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

linking mechanisms fostering collaborative planning and treatment, 236–240

organizational support for collaboration, 240–243

screening, 234–235

Health care providers, diverse types of, 278

Health care quality, 8, 57

Health Insurance Portability and Accountability Act (HIPAA), 13–14, 68, 158, 177–180, 232–233, 377–378, 405

privacy regulations, 68, 406–407

Health maintenance organizations (HMOs), 277–278, 310

Health of the Nation Outcome Scales (HoNOS), 160

Health plans and purchasers of M/SU health care, recommendations for, 369–372

Health Privacy Project, 405

Health professional education in substance abuse, interdisciplinary project to improve, 299–300

Health Resources and Services Administration (HRSA), 268, 299

Healthplan Employer Data and Information Set (HEDIS), 155, 183–184, 186–187, 221, 271

High quality health care, six aims of, 57

Higher Education Act, 90

High-prevalence childhood conditions, gaps in knowledge about therapies for, 352–353

High-risk populations, 17

I

ICD-9 procedure codes, 155, 157–158

Illness self-management practices and programs

gaps in knowledge about, 355

impaired, 82–83

supporting, 12, 120–122

Improving care, ix

using information technology, 261–262

Improving diagnosis and assessment, 167–169

Improving the production of evidence, 151–167

filling the gaps in the evidence base, 153–160

gaps in the evidence base, 151–153

strengthening and coordinating mechanisms for analyzing the evidence, 161–167

Information infrastructure

initiatives for health care for M/SU conditions, 270–275

relationship to quality, 260–262

Information sharing

difficulties in, 232–233

technology, in health care for mental/substance-use conditions, 68

for treatment purposes under state law and HIPAA, 412–417

Information technology (IT), 2, 307

improving care using, 261–262

less use among M/SU providers, 10, 276

Information technology (IT) initiatives

balancing privacy concerns with data access, 274–275

care delivered by or through non-health care sectors, 275

for health care for mental/substance-use conditions, 270–275

information infrastructure initiatives for health care for M/SU conditions, 270–275

private-sector initiatives, 274

SAMHSA initiatives, 270–274

unique characteristics of M/SU services with implications for the NHII, 274

Innovations

key factors associated with successful adoption of, 170

NIATx, 195

within psychiatry, 167

Inpatients

care measures for, 480–481

improvement after discharge, 482

satisfaction measures, 481

specialized (residential) PTSD programs for, 478

Institute of Medicine (IOM), ix–xi, 8–10, 30, 32, 44, 211n, 220, 243, 245, 260, 267, 279, 425

Instructional directives, psychiatric, 119

Insurance coverage, more limited for M/SU conditions, 7, 328–329

Integrated Delivery Systems Research Network (IDSRN), 359–360

data availability, 359

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

management authority to implement a health care intervention, 359

research expertise, 359

Integrated treatment, 213–214

defined, 213–214

integrated programs, 214

integrated systems, 214

Interactions between the mind/brain and the rest of the body, 11, 71–72, 361, 365, 369, 373, 377, 384, 386

Interactive psychotherapy, 156

Interdisciplinary Project to Improve Health Professional Education in Substance Abuse, 301, 303–304

Interventions to improve decision-making capability, 98

Involuntary treatment, minimizing risks in, 125

J

Jamison, Kay Redfield, 112–113

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 157, 244

Jost, Timothy Stoltzfus, 405–422

Justice systems, 227–230

Juvenile justice system, 42, 229–230

K

Keeping Patients Safe: Transforming the Work Environment of Nurses, 307

Knowledge about effective care delivery

coercion into treatment, 354

demonstrations of illness self-management programs, 355

gaps in, 353–355

potential modification of certain public policies, 354

preventing unintentional discrimination by health care providers, 354

providing patient-centered care, 353–354

understanding decisional capacity among people with substance-use illnesses, 354

Knowledge about effective treatments

gaps in, 351–353

medication treatments for certain substance dependencies, 352

optimal pharmacotherapy for psychosis, 352

prevention and treatment of PTSD, 352

prevention studies, 353

relative effectiveness of different treatments (alone and in combination), 353

therapies for high-prevalence childhood conditions, 352–353

therapies for other population subgroups, 353

treatment of multiple conditions, 351

Knowledge about quality improvement practices for M/SU health care, recommendations about disseminating, 15, 196, 379, 387

Knowledge gaps in treatment for M/SU conditions, 152–153, 351–355

acute stress disorder, 152

amphetamine dependence, 153

cocaine dependence, 153

gaps in treatment knowledge, 351–355

marijuana dependence, 153

posttraumatic stress disorder, 152

psychotic illnesses, 153

relative effectiveness of different treatments, 153

shortcomings in public policy, 355

therapies for children and older adults, 152

therapies for other population subgroups, 153

treatment of multiple conditions, 152

Knowledge representation, 266

L

Leadership, 242–243

and policy practices, 110–111

Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, 245, 250

Linkage of the VA with the Department of Defense (DoD) and other mental health, medical, and social service systems, 424, 437–440

collaborative relationships with other agencies, 439–440

criminal justice involvement, 439

cross MH/SA system use, 437–438

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

primary care and specialty medical services, 438–439

transition from DoD to VA, 437

Linkages with community and other human services resources, 231

Linking mechanisms fostering collaborative planning and treatment, 236–240

case (care) management, 238–239

collocation and clinical integration of services, 237–238

the continuum of linkage mechanisms, 236

formal agreements with external providers, 239–240

recommendations concerning, 16, 248, 282, 363, 367

shared patient records, 238

M

MacArthur Research Network on Mental Health and the Law, 113

MacArthur Violence Risk Assessment Study, 102

Making Health Care Safer: A Critical Analysis of Patient Safety Practices, 307

Managed behavioral health organizations (MBHOs), 67, 220, 222, 243–244, 327–328, 332–335

Management authority, to implement a health care intervention, 359

Marijuana dependence, knowledge gaps in treatment for, 153

Market and policy structures

budgeted systems of care, 343

direct public purchase of behavioral carve-out services in Medicaid, 341–342

effects on quality, 339–343

private payer direct procurement of carve-out services, 342

quality distortions in the purchase of health plan services through competition for enrollees, 339–341

traditional Medicaid programs, 342

Marketplace for mental and substance-use health care, 1, 326–329

dominance of government purchasing, 326–327

financing methods for mental health/substance-use care, 326

frequent direct provision and purchase of care by state and local governments, 329

more limited insurance coverage, 328–329

purchase of M/SU health insurance separately from general health insurance, 327–328

Marketplace incentives to leverage needed change, 325–349

characteristics of different purchasing strategies, 330–337

conclusions and recommendations, 343–346

effects of market and policy structures on quality, 339–343

procurement and the consumer role, 337–339

summary, 325

Marriage and family therapy, 296

Measurement and reporting infrastructure

analyzing and displaying the performance measures in suitable formats, 187–188

auditing to ensure that performance measures have been calculated accurately and according with specifications, 187

conceptualizing the aspects of care to be measured, 182–185

ensuring calculation and submission of the performance measures, 186–187

maintaining the effectiveness of performance measures and measure sets and policies, 188–189

necessary components of a quality, 181–189

pilot testing the performance measure specifications, 186

translating quality-of-care measurement concepts into performance measure specifications, 185–186

Medicaid, 69, 330, 332

traditional programs, 342

Medical Expenditure Panel Survey, 330

Medicare, 88n, 90, 159

Medication, xii

errors, 36n, 148–149

treatments for certain substance dependencies, gaps in knowledge about, 352

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Mental and substance-use health problems and illnesses, ix–x

Americans annually receiving care for, 2–4, 30–32

among veterans and nonveterans in the general population, 428–429

and general health care, 70–72

a leading cause of disability and death, 37–38

mitigating adverse consequences of, 44

Mental and substance-use health services, clinicians in solo or small practices, 277–278

Mental and substance-use health services for veterans

America’s veterans, 427–432

development of MH/SA quality measurement and quality management in the VA, 424–425, 440–446

experience with performance evaluation in the Department of Veterans Affairs, 423–482

front-line experience, 425, 454–456

introduction to the Department of Veterans Affairs in American mental health care, 426–427

linkage of the VA with the Department of Defense and other mental health, medical, and social service systems, 424, 437–440

performance measures used by the Northeast Program Evaluation Center in the evaluation and monitoring of VA mental health programs, 475–482

population characteristics of veterans who used VA services, 464–467

quality of VA MH/SA care, 425, 446–454

status among veteran and nonveteran users of mental health services, 429–430

summary, 423–425

tables, 464–474

treatment of MH/SA in the VA, 424, 432–437

U.S. veterans, 424

VA health service use, 468–470

VA MH/SA services among veterans who used any MH/SA care, 471–472

veterans treated for mental health diagnosis in the VHA, by specialty, 473

workload of specialized VA mental health programs, 474

Mental Health: Culture, Race, and Ethnicity, 290

Mental health and substance-use treatment information

constraints on sharing imposed by federal and state medical records privacy laws, 405–422

HIPAA privacy regulations, 406–407

information sharing for treatment purposes under state law and HIPAA, 412–417

introduction, 405

North Carolina General Stat. Ann. § 122C-55, 418–422

relationship between federal and state privacy law, 407–409

state laws governing mental health records, 409–411

state laws governing the confidentiality of substance abuse records, 411

state medical records confidentiality laws, 409

Mental health care

discrimination in health insurance coverage of, 88–89

introduction to the Department of Veterans Affairs in, 426–427

Mental Health Corporations of America, 274

Mental health intensive case management (MHICM), 479–480

appropriateness of admissions, 479

outcomes, 480

program structure, 479

treatment process, 480

Mental Health Parity Act, 88n

Mental Health Statistical Improvement Project (MHSIP), 269–271, 283

survey, 160

Mental illnesses, 96–98

ability of interventions to improve decision-making capability, 98

difference in decision-making ability, 96–97

poor decision-making abilities better predicted by cognitive than by psychotic symptoms, 97–98

summary, 98

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Multi-Agency INitiative on Substance abuse TRaining and Education for AMerica (Project MAINSTREAM), 300

Multiple conditions, gaps in knowledge about treating, 351

N

National Advisory Council on Nurse Education and Practice (NACNEP), 287, 316–317

National Alliance for the Mentally Ill (NAMI), 109

National Association of Alcohol and Drug Abuse Counselors (NAADAC), 302–304

National Association of State Alcohol and Drug Abuse Directors (NASADAD), 158, 232

National Association of State Mental Health Program Directors (NASMHPD), 158, 187, 232

National Committee for Quality Assurance (NCQA), 186, 244

Healthplan Employer Data and Information Set, 155, 183–184, 186–187, 221, 232–233, 271

National Committee on Vital and Health Statistics, 267

National Compensation Survey, 88

National Coordinator. See Office of the National Coordinator of Health Information Technology

National Epidemiologic Survey on Alcohol and Related Conditions, 214

National Health Information Infrastructure (NHII), 18–19, 260, 280, 380–381

activities under way to build, 262–268

data standards, 265–267

electronic health records, 264–265

a secure interoperable platform for exchange of patient information across health care settings, 267–268

National Health Information Infrastructure (NHII) benefiting persons with mental and substance-use conditions, 259–285

activities under way to build a national health information infrastructure, 262–268

building the capacity of clinicians treating mental and substance-use conditions to participate in the NHII, 276–279

information technology initiatives for health care for mental/substance-use conditions, 270–275

integrating health care for mental and substance-use conditions into the NHII, 279–283

need for attention to mental and substance-use conditions in the NHII, 268–270

National Health Interview survey, 3

National Healthcare Quality Report, 180

National Institute of Child Health and Human Development, 13–14, 177–180, 377–378

National Institute of Mental Health (NIMH), 13–14, 22–23, 172, 177–180, 222, 358, 377–378, 383

Outreach Partnership Program, 109

National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13–14, 22–23, 172, 177–180, 214, 222, 303, 358, 377–378, 383

National Institute on Drug Abuse (NIDA), 13–14, 22–23, 172, 177–180, 222, 358, 377–378, 383

National Institutes of Health (NIH), 32, 172, 222

National Inventory of Mental Health Quality Measures, 180

National Library of Medicine, 267

National Mental Health Program Performance Monitoring System, 160

National Quality Forum, 14–15, 182, 195–196, 370, 378–379

National Quality Measurement and Reporting System (NQMRS), 182

National Registry of Evidence-based Programs and Practices (NREPP), 163–164, 310

National Research Council, 154, 357

National Survey of Child and Adolescent Well-Being (NSCAW), 226

National Survey on Drug Use and Health, 145

National Treatment Plan Initiative, 87

Nationwide summit on behavioral health information management, and the NHII, 273–274

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Network for the Improvement of Addiction Treatment (NIATx), 194–195, 360

the innovation initiative, 195

the single state agency initiative, 195

the treatment provider initiative, 194–195

New Freedom Commission on Mental Health, 218, 220, 246, 282, 289, 391

New Mexico’s Behavioral Health Collaborative, case study in policy coordination, 247

Non-health care sectors

child welfare services, 226–227

employee assistance programs, 230–231

involvement in M/SU health care, 224–232

justice systems, 227–230

linkages with community and other human services resources, 231

schools, 225–226

North Carolina General Stat. Ann. § 122C-55, 418–422

Number of Americans annually receiving care, 30–32

Nursing education, paucity of content on substance-use care in, 302

O

Office of Minority Health, 13–14, 177–180, 377–378

Office of the National Coordinator of Health Information Technology (ONCHIT), 17–18, 263, 268, 282, 374–375

Organizational support

for collaboration, 240–243

for continuing education, 308

facilitating structures and processes at treatment sites, 240–242

flexibility in professional roles, 242

leadership, 242–243

Organizations

conducting systematic evidence reviews in M/SU health care, 163–166

providing M/SU health care, recommendations for, 365–368

Outcome measures, 476–477, 479–480

the Global Assessment of Functioning scale, 482

Outpatient care measures, 481

all VA PTSD treatment, specialized and non-specialized, 478

continuity of care among outpatients with psychotic diagnoses, 481

continuity of care among outpatients with PTSD diagnosis, 478

improvement during treatment, 482

service utilization and continuity of care, 478, 481

Outpatient programs (specialized for PTSD), 477–478

costs, 478

patient characteristics, 477–478

workload, 478

Outreach Partnership Program, 109

P

Partnerships

public-private, 189–193

researchers and stakeholders, 23, 358, 388

Pastoral counseling, 296

Patient activation, 83–84

Patient as the source of control, 78

Patient characteristics, 475, 477–478

Patient decision making, 12

preserving in coerced treatment, 124

Patient Health Questionnaire, 235

Patient information, exchanging across health care settings, a secure interoperable platform for, 267–268

Patient needs and values, customization based on, 9

Patient Outcomes Research Team (PORT) Pharmacotherapy Guidelines, for patients with schizophrenia, adherence to, 33, 482

Patient-centered care, xii, 8, 57, 77, 451–452

actions supporting, 108–128

anticipation of needs, 78

combating stigma and supporting decision making at the locus of care delivery, 110–115

customization based on patient needs and values, 78

eliminating discriminatory legal and administrative policies, 122–126

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

gaps in knowledge about providing, 353–354

the need for transparency, 78

obstacles to, 11

the patient as the source of control, 78

preserving in coerced treatment, 124

providing decision-making support to all M/SU health care consumers, 116–122

recommendations concerning, 11–12, 126–128, 361–362, 365–366, 369, 384

rules helping to achieve, 78–79

shared knowledge and the free flow of information, 78

Patients’ ability to manage their care and achieve desired health outcomes

adverse effects on, 81–84

decreased self-efficacy, 82

diminished self-esteem, 81

impaired illness self-management, 82–83

weakened patient activation and self-determination, 83–84

Patients’ decision-making abilities and preferences supported, 77–139

actions supporting patient-centered care, 108–128

coerced treatment, 103–108

evidence countering stereotypes of impaired decision making and dangerousness, 92

rules helping to achieve patient-centered care, 78–79

stigma and discrimination impeding patient-centered care, 79–92

summary, 77–78

Peer support programs, xii, 118–119

Performance measures

analyzing and displaying in suitable formats, 187–188

ensuring calculation and submission, 186–187

pilot testing specifications for, 186

public-sector efforts to develop, test, and implement, 192–193

recommendations for, 17–18, 374–375, 380

Performance Measures Advisory Group (PMAG), 157

Performance measures used by the National Mental Health Program Performance Monitoring System, 480–481

inpatient care measures, 480–481

inpatient satisfaction measures, 481

outpatient care measures, 481

population coverage, 480

Performance measures used by the Northeast Program Evaluation Center in the evaluation and monitoring of VA mental health programs, 475–482

adherence to PORT Pharmacotherapy Guidelines for patients with schizophrenia, 482

Compensated Work Therapy and Compensated Work Therapy/Transitional residence programs, 476–477

Health Care for Homeless Veterans and Domiciliary Care for Homeless Veterans programs, 475–476

mental health intensive case management, 479–480

outcomes on the Global Assessment of Functioning scale, 482

PTSD performance monitors and outcome measures, 477–479

Personal health records (PHRs), 264n, 272

Personal Responsibility and Work Opportunity Reconciliation Act, 91

Pharmacotherapy for psychosis, 5

gaps in knowledge about optimal, 352

Physicians

integrating, 213

paucity of content on substance-use care in education of, 300–301

Poor care, hindering improvement and recovery for many with mental and substance-use conditions, 5–6, 35–36

Poor decision-making abilities, better predicted by cognitive than by psychotic symptoms, 97–98

Populations

coverage issues, 480

gaps in knowledge about therapies for other subgroups, 353

high-risk, 17

Posttraumatic stress disorder (PTSD)

inpatient care (generalized and specialized programs), 479

knowledge gaps in treatment for, 152

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Posttraumatic stress disorder (PTSD) performance monitors and outcome measures, 477–479

all PTSD inpatient care (generalized and specialized programs), 479

inpatient/residential programs (specialized PTSD programs), 478

outcomes, 479

outpatient care measures (all VA PTSD treatment, specialized and non-specialized), 478

outpatient programs (specialized PTSD outpatient programs), 477–478

Practices of purchasers, quality oversight organizations, and public policy leaders, 243–247

collaboration and coordination in policy making and programming, 245–247

purchaser practices, 243–244

quality oversight practices, 244–245

President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 180

President’s New Freedom Commission on Mental Health, 218, 220, 246, 282, 289, 391

Prevention studies

failure of, 146–147

gaps in knowledge about, 352–353

Primary care, and specialty medical services, 438–439

Privacy concerns, 17–18, 374–375

need to balance with data access, 274–275

Private payer direct procurement, of carve-out services, 342

Private-sector initiatives, 274

The Davies Award, 274

Mental Health Corporations of America, 274

Procedure codes, 13–14, 174–180, 377–378

ICD-9, 157–158

Process measures, 475–477

Procurement, and the consumer role, 337–339

Professional associations, 13–14, 166, 173, 177–180, 377–378

Professional education and training, 294–304

deficiencies in, 297–304

inadequate faculty development, 303

little assurance of competencies in discipline-specific and core knowledge, 298–300

paucity of content on substance-use care, 300–303

summary, 303–304

variation in amounts and types of, 294–297

Program participation issues, 476–477

Program structure, 475, 479

integrated, 214

Project MAINSTREAM. See Multi-Agency INitiative on Substance abuse TRaining and Education for AMerica

Project MATCH Form 90, 160

Proxy directives, psychiatric, 119–120

Psychiatric instructional directives, 119

Psychiatric nursing, 295

Psychiatric proxy directives, 119–120

Psychiatry, 112–113, 294

innovation within, 167

Psychologist education, paucity of content on substance-use care in, 301

Psychology, 294–295

Psychosocial rehabilitation, xii, 5, 296

Psychotherapy

insight oriented, behavior modifying and/or supportive, 156

interactive, 156

Psychotic illnesses, knowledge gaps in treatment for, 153

Public and publicly funded programs

recommendations for, 22, 346, 372, 376

requiring submission of jointly agreed-upon public- and private-sector measures in, 191–192

Public policy

gaps in knowledge about potential modification of, 354

shortcomings in, 355

Public policy leaders, practices of, 243–247

Publicly budgeted systems of care, 336–337

Public-private leadership and partnership to create a quality measurement and reporting infrastructure, 189–193

continuing public-sector efforts to develop, test, and implement new performance measures, 192–193

establishing collaborative public- and private-sector efforts, 190–191

recommendations regarding, 19, 280–281, 364, 368, 371, 375

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

requiring submission of jointly agreed-upon public- and private-sector measures in public and publicly funded programs, 191–192

strategy for quality measurement and improvement, 195–196

Purchasers of M/SU services

practices of, 243–244

recommendations for, 22, 345, 372, 376

Purchase of M/SU services

direct, of carve-out services by group payers, 332–333

of M/SU health insurance separately from general health insurance, 327–328

of services by carve-out organizations, 334–335

of services in traditional Medicaid programs, 335–336

through competitive insurance markets, with competition for enrollees, 330–332

Purchasing strategies, 330–337

publicly budgeted systems of care, 336–337

Q

Quality Chasm in health care for mental and substance-use conditions, 29–55

continuing advances in care and treatment enabling recovery, 32–34

gaps in knowledge about how to improve, 355

numbers of Americans annually receiving care, 30–32

poor care hindering improvement and recovery for many, 35–36

scope of the study, 47

serious personal and societal consequences of failing to provide effective care, 37–44

a strategy to improve overall health care, crossing the Quality Chasm, 44–46

summary, 29–30

ten rules to guide the redesign of health care, 9, 58

Quality distortions in the purchase of health plan services through competition for enrollees, 339–341

Quality Enhancement Research Initiative, 173

Quality improvement

at all levels of the health care system, review of actions needed for, 360–388

at the locus of care, 193–194

Network for the Improvement of Addiction Treatment, 194–195

recommendations for, 22, 344–345, 372

workforce capacity for, 286–324

Quality management, in the “new VA,” expansion of, 443–446

Quality measurement and quality management in the VA, 424–425, 440–446

evaluation and monitoring of specialized VA MH/SA programs, 441–443

expansion of quality management in the “new VA,” 443–446

Quality measurement and reporting infrastructure, 1, 180–193

in health care for mental/substance-use conditions, 67–68

necessary components of, 181–189

need for public-private leadership and partnership to create, 189–193

Quality of care problems, 141–151

failure to treat and prevent, 144–147

unsafe care, 147–151

variations in care due to a lack of evidence, 143–144

Quality of VA MH/SA care, 425, 446–454

effectiveness, 448–451

efficiency, 453

equity minorities, 453–454

female veterans, 454

patient-centered care, 451–452

safety, 447–448

timeliness, 452–453

Quality oversight organizations, practices of, 244–245

R

Recommendations, 126–128, 177–180, 317–319

for accreditors of M/SU health care organizations, 12, 21, 318, 384–385

for clinicians, 361–364

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

for clinicians providing M/SU services, 14, 362, 366

concerning coerced treatment, 12–13, 362, 366, 373–374

concerning collaboration, 16–17, 363, 367, 370–371, 374, 379–380, 385

concerning coordinating care for better mental, substance-use, and general health, 17, 248–250, 364, 368

concerning cross-agency research efforts, 22–23, 358, 383

concerning dissemination of the evidence, 13–14, 377–378

concerning faculty development, 21, 318, 383

concerning linking mechanisms to foster collaborative planning and treatment, 16, 363, 367

concerning patient-centered care, 11–12, 361–362, 365–366, 369, 384

concerning research designs, 15–16, 387

on coordinating care for better mental, substance-use, and general health, 248–250

for data standards, 19, 371

for the DHHS, 14–15, 370, 378–379

about disseminating knowledge about quality improvement practices for M/SU health care, 15, 379, 387

for educational institutions, 21, 318, 386

for electronic health records, 19–20, 371–372, 375, 381–382

for federal policy makers, 377–383

for funders of M/SU health care research, 387–388

for health care financing, 22, 344, 372, 375

for health plans and purchasers of M/SU health care, 369–372

for institutions of higher education, 386

for organizations providing M/SU health care, 365–368

for performance measures, 17–18, 374–375, 380

for public and publicly funded programs, 22, 346, 372, 376

for purchasers, 22, 345, 372, 376

for quality improvement, 22, 344–345, 372

regarding public-private leadership and partnership to create a quality measurement and reporting infrastructure, 19, 364, 368, 371, 375

for state policy makers, 373–376

for workforce capacity for quality improvement, 20–21, 382–383, 386

Redesigning health care, 57–59

anticipation of needs, 9, 58

care based on continuous healing relationships, 9, 58

continuous decrease in waste, 9, 58

cooperation among clinicians, 9, 58

customization based on patient needs and values, 9, 58

deference to the patient as the source of control, 9, 58

evidence-based decision-making, 9, 58

need for transparency, 9, 58

recommendations for, 11, 72, 365, 369

safety as a system property, 9, 58

shared knowledge and the free flow of information, 9, 58

six aims of high quality health care, 57

ten rules to guide, 9, 58

Regional health information organizations (RHIOs), 275

Reporting. See Measurement and reporting infrastructure

Research designs, 357–359

recommendations concerning, 15–16, 196, 387

Research expertise, 359

Restrictions on access to student loans for some drug offenses, 90–91

Risks. See also Benefits and risks of different treatment

of dangerousness, 100–103

in involuntary treatment, minimizing, 125

Rules to guide the redesign of health care, 9, 58

S

Safety in health care, 8, 57, 447–448

heightened concerns, and need for multiple actions, 150–151

as a system property, 9, 58

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

School achievement by children, 39–41

Screening, 234–235

Self-efficacy, 81

Self-esteem, diminished, 81

Separate public-sector delivery system, 1

frequent need for individuals with severe mental illnesses to receive care through, 223–224

Separation of health care system components for mental/substance-use conditions, 60–61

from each other, 59–61, 222–223

from general health care, 219–222

Serious personal and societal consequences of failing to provide effective care for mental and substance-use conditions, 6–7

Service design, administration, and delivery

consumer participation in service design and administration, 114

consumers as service providers, 114–115

involving consumers in, 114–115

Service utilization and continuity of care, 478, 481

Services Accountability Improvement System (SAIS), 272–273

Shared decision making, 212

Shared knowledge in health care, and the free flow of information, 9, 58, 78

Shared patient records, 238.

See also Constraints on sharing imposed by federal and state medical records privacy laws

Shared understanding of goals and roles, 212

Single state agency initiative, of NIATx, 195

Social work, 295

paucity of content on substance-use care in education for, 301–302

Software and Technology Vendors’ Association (SATVA), 271, 273–274

Solo practice, 309–310

clinically trained specialty mental health personnel reporting individual practice as their primary or secondary place of employment, 309

Source of control, 9, 58

Specialized VA MH/SA programs, 434

evaluation and monitoring of, 441–443

Specialty medical services, and primary care, 438–439

Specialty mental health providers, 291–292

clinically active (CA) or clinically trained (CT) mental health personnel, 292

Specialty substance-use treatment providers, 292–293

Stakeholders, 435–436

more diverse, 183

Stanford University, 83

State and local governments, 165–166

frequent direct provision and purchase of care by, 329

State data infrastructure grants, 271

State laws

governing mental health records, 409–411

governing the confidentiality of substance abuse records, 411

State medical records confidentiality laws, 409

State Outcomes Measurement and Management System, 183

State policy makers, recommendations for, 373–376

State privacy law, 407–409

Stereotypes of impaired decision making and dangerousness, 92–93

evidence countering, 92

evidence of decision-making capacity, 93–100

harmful stereotypes of impaired decision making and dangerousness, 92–93

risk of dangerousness, 100–103

Stigma, 79–92

affecting clinician attitudes and behaviors, 84–87

pathway to diminished health outcomes, 81

Strategies for filling knowledge gaps, 355–360

Agency for Healthcare Research and Quality’s Integrated Delivery Systems Research Network, 359–360

Network for the Improvement of Addiction Treatment, 360

research designs, 357–359

Strategies to improve overall health care, 8–10, 44–46

six aims of high quality health care, 8

ten rules to guide the redesign of health care, 9

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Strong information infrastructure

improving care using information technology, 261–262

as vital to quality, 260–262

Structures and processes for collaboration that can promote coordinated care, 233–247

health care provider and organization strategies, 234–243

practices of purchasers, quality oversight organizations, and public policy leaders, 243–247

Student loans, 90–91

Substance Abuse and Mental Health Services Administration (SAMHSA) initiatives, 13–14, 17–19, 22–23, 32, 60, 158, 171–172, 177–180, 189–193, 270–274, 291, 358, 374–375, 377–378, 380–381, 383

Alcohol and Drug Services study, 292

Behavioral Health Data Standards Workgroup, 272

Center for Substance Abuse Treatment, 299

Drug Evaluation Network System, 273

EHRs and personal health records, 272

mental health Decision Support 2000+ and statistics improvement program, 270–271

National Treatment Plan Initiative, 87

nationwide summit on behavioral health information management and the NHII, 273–274

Recovery Community Services Program, 115

state data infrastructure grants, 271

substance abuse information system, 272–273

Uniform Reporting System, 272

Substance Abuse Prevention and Treatment (SAPT) Block Grants, 223, 337

Substance-use health care. See also Mental and substance-use health problems and illnesses

discrimination in health insurance coverage of, 89–90

professional training on, 300–303

treatment counseling, 296–297

Systems, integrated, 214

T

Temporary Assistance for Needy Families (TANF), 91, 354

Terminology issues, 86–87, 266

Therapies for children and older adults, knowledge gaps in, 152

Therapies for high-prevalence childhood conditions, gaps in knowledge about, 352–353

Therapies for other population subgroups, gaps in knowledge about, 153, 353

Timely health care, 8, 57, 452–453

To Err Is Human: Building a Safer Health System, 44, 45n

Tolerance for “bad” decisions, 111–114

Traditional Medicaid programs, 342

Transforming Mental Health Care in America , 246

Transition from DoD to VA, 437

Transparency, 9

needed in health care, 58, 78

in policies and practices for assessing decision-making capacity and dangerousness, 123–124

Treatment, failure of, 144–146

Treatment knowledge, 351–355

about effective care delivery, 353–355

about effective treatments, 351–353

gaps in effective, 351–353

about how to improve quality, 355

Treatment of mental health and substance abuse in the VA, 424

administrative organization, 434–435

changes in MH/SA service delivery, 436–437

patients, administration, relationships with other federal agencies, stakeholders, and changes, 432–437

relationships with other federal departments, 435

specialized MH/SA programs, 434

stakeholders, 435–436

VA patients diagnosed with mental health and substance abuse disorders, 432–433

Treatment of multiple conditions, knowledge gaps in, 152

Treatment process, 480

Treatment provider initiative, of NIATx, 194–195

Treatment sites, facilitating structures and processes at, 240–242

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

U

Unclear accountability, 184–185

for coordination, 231–232

Underused sources of communication and influence, 173–177

Agency for Healthcare Research and Quality, 176–177

Centers for Disease Control and Prevention, 174–176

Uniform Reporting System (URS), 272

Unquiet Mind, An, 112–113

Unsafe care, 147–151

heightened safety concerns and need for multiple actions, 150–151

medication errors, 148–149

seclusion and restraint, 149–150

U.S. Bureau of Justice Statistics, 7

U.S. Food and Drug Administration (FDA), 162, 353

U.S. Government Accountability Office (GAO), 7, 41, 89, 149

U.S. Preventive Services Task Force, 163, 234, 357

U.S. Surgeon General, 32, 290, 391

Use levels

of the Internet and other communication technologies for service delivery, 310–311

of VA mental health services, 431–432

of VA services, 430–431

User Liaison Program (ULP), 176–177

V

VA. See Department of Veterans Affairs

Variations in care, due to a lack of evidence, 143–144

Variations in the workforce treating M/SU conditions, 288–294

in amounts and types of education, 294–297

counseling, 295

general medical/primary care providers, 293–294

insufficient workforce diversity, 290

in licensure and credentialing requirements, 304–305

marriage and family therapy, 296

pastoral counseling, 296

psychiatric nursing, 295

psychiatry, 294

psychology, 294–295

psychosocial rehabilitation, 296

social work, 295

specialty mental health providers, 291–292

specialty substance-use treatment providers, 292–293

substance-use treatment counseling, 296–297

Varied reimbursement and reporting requirements, 278–279

Veterans. See also Mental and substance-use health services for veterans

of America, 424, 427–428

female, 454

mental health and substance abuse disorders among veterans and nonveterans in the general population, 428–429

mental health and substance abuse status and use of VA services, 427–432

MH/SA status among veteran and nonveteran users of mental health services, 429–430

quality measurement and quality management in the VA, 424–425, 440–446

treated for mental health diagnosis in the VHA, by specialty, 473

use of all VA services, 430–431

use of non-VHA M/SU treatment services, 437–438

use of VA mental health services, 431–432

who used VA services, population characteristics of, 464–467

Veterans Health Administration (VHA), 160, 172–173, 181, 427

administrative organization, 434–435

Quality Enhancement Research Initiative, 173

Violent behavior. See Dangerousness

W

Waste in health care, continuous decrease in, 9, 58

Weakened patient activation and self-determination, 83–84

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×

Wellness Recovery Action Plan (WRAP), 121

Workforce

capacity for quality improvement, 2, 286–324

chronology of well-intentioned but short-lived initiatives, 312–315

critical role and limitations to its effectiveness, 288

greater variation in the workforce treating M/SU conditions, 288–294

inadequate continuing education, 305–308

insufficient diversity of, 290

more solo practice, 309–310

need for a sustained commitment to bring about change, 315–317

problems in professional education and training, 294–304

recommendations for, 20–21, 317–319, 382–383, 386

summary, 286–288

use of the Internet and other communication technologies for service delivery, 310–311

variation in licensure and credentialing requirements, 304–305

Workforce shortages and geographic maldistribution, 289

Workload, 478

of specialized VA mental health programs, 474

Workplace productivity, 39

World Bank, 37

World Health Organization, 37

Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 483
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 484
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 485
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 486
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 487
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 488
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 489
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 490
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 491
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 492
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 493
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 494
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 495
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 496
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 497
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 498
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 499
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 500
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 501
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 502
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 503
Suggested Citation:"Index." Institute of Medicine. 2006. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: The National Academies Press. doi: 10.17226/11470.
×
Page 504
Improving the Quality of Health Care for Mental and Substance-Use Conditions Get This Book
×
Buy Hardback | $59.95 Buy Ebook | $47.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are serious—for these individuals and their families; their employers and the workforce; for the nation’s economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substance–use conditions will benefit from this guide to achieving better care.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!