Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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15 Quality Management
15 Quality Management
Pages 311-320
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From page 311... ...
QUALITY MEASUREMENT Background In health systems, systematic quality measurement is necessary for quality improvement, accountability and transparency, and informed decision making by patients. A well-defined and coordinated set of quality measures using administrative, clinical, and patient-reported data is necessary to track and improve clinical care quality and value.
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. ACA activities intended to broaden the breadth of mental health care measures include the National Behavioral Health Quality Framework (SAMHSA, 2016)
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Mental Health Information System The Mental Health Information System (MHIS) is a system of more than 200 clinical quality and process-of-care measures that was designed to monitor the implementation of the requirements contained in the Uniform Mental Health Services Handbook, a guiding policy document that details the requirements for mental health clinical care delivery within the VA (VA, 2015)
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The shortcomings identified include a lack of measure focus, questionable measure quality, limited alignment between MHIS performance and broader system goals, the presence of substantial variability in facility performance, and a need to examine the allocation of resources necessary for quality improvement (Kizer and Jha, 2014; Lemke et al., 2017; Schmidt et al., 2017)
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For example, specific MHMS calculates the ratio of the number of tele-mental health patients to the number of total mental health outpatients in a facility, the ratio of PC-MHI patients to the total number of primary care patients, and whether the level of patient and provider involvement in BHIP is within the intended range. Potential Drivers of Key Key Access and Access and Quality Measures Quality Measures Wait Times Mental Health Domain Composite Growth Missed Experience of Care Opportunities Staffing Care Continuity Productivity Population Access Space Innovative Programming Tele-Mental PC-MHI BHIP Health FIGURE 15-1 VHA Mental Health Management System framework.
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The reported limitations of the MHMS included the lack of available patient outcome measures and cost data, and low veteran and provider survey response rates; however, it is noted that these are not unique to the VHA (Schmidt et al., 2017)
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The QUERI program consists of 15 interdisciplinary programs involving cross-cutting partnerships to achieve VA national health care priority goals and specific implementation strategies. In the area of mental health, for example, the QUERI for Team-Based Behavioral Health (located in Little Rock, Arkansas)
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collects and uses patient outcome data, which is a significant barrier to quality improvement. The VA has reported it is in the process of developing a comprehensive system to monitor health outcomes with standardized patient-reported outcome measures.
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2016. Adult health care quality measures.
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2013. VHA mental health information system: Applying health information technology to monitor and facilitate implementation of VHA Uniform Mental Health Services Handbook requirements.
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