Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Accountability andData Sharing:
Improving Mental Health Services in Oklahoma
National Conference of State Legislatures Fall Forum 2007
Mental Health Treatment:Promoting Entry and Retention
November 28, 2007Phoenix, Arizona
Accountability and Data Sharing:Improving Mental Health Services in Oklahoma
ContextAssuring AccountabilitySharing Data
Context
National SceneState Agency OrganizationState Agency Infrastructure
National Scene
DHHS—ACF, CMS, SACWISSAMHSA—CMHS, CSAT, CSAP, OAS, BH EHRAHRQ—HCUP, NMESONCHIT—NHIN, RHIOs, HIE, CCHITAHIC—Consumer Empowerment, Chronic Care, Biosurveillance, EHR, Personal Health, Quality and CPS WorkgroupsNCVHSCDC—NCHS, BRFSS, MMWR
Guiding Documents
Government Performance and Results Act--GPRA (1993)
Mental Health: A Report of the Surgeon General (1999)
IOM Crossing the Quality Chasm (2001)
The President’s New Freedom Commission on Mental Health (2003)
CSAT Technical Assistance Publication (TAP) Series TAP 29 (2007)
SAMHSA Ten Fundamental Components of Recovery
Individualized and Person-CenteredEmpowermentHolisticNon-LinearStrengths-BasedPeer SupportRespectResponsibilityHope
Context
National SceneState Agency OrganizationState Agency Infrastructure
State Agency Organization
GovernorBoardCommissionerDeputies—COO, MH, SA, C&PDivisions—MH, SA, Finance, HRM/HRD, Legal, IDSSOther agencies: OSDH, OKDHS, OKHCA, DRS, OJA, SDE, DOC
Oklahoma Department of Mental Health and Substance Abuse Services
Mental Health and Substance Abuse Services (SMHA and SSA)Prevention and Treatment ServicesAdults and YouthState-operated and Contracted Facilities
Context
National SceneState Agency OrganizationState Agency Infrastructure
State Agency Infrastructure
3.5M state population77 counties19 CMHCs, 60 SATs, 3 specialty, 2 hospitals, 19 APRCs, 20 RCHs2100 staff65,000 MH and SA treatment clients
Information and Decision Support Services (IDSS)
Information ServicesNetwork and TelecommunicationsEvaluation and Data AnalysisGrants Management
Integrated Client Information System (ICIS)
Web-basedCDC and Service FormsOn-line and batch entryUnique statewide agency, staff and recipient identifiersDesign based on MHSIP and DASIS standardsHIPAA, 42CFR Part 2, and OK43A compliantDemographics, diagnoses, assessments, referrals, drug use
Examples of Grants, Contracts and Other Projects
Building Data Infrastructure MH Transformation Demonstrating Program Effectiveness--PACT, SOC, Meth Prev, Suicide Prev, TANF, Drug Court, MH CourtIntegrated Services InitiativeAccess To RecoveryAdult Recovery Collaborative and Partnership for Children’s Behavioral Health
Accountability and Data Sharing:Improving Mental Health Services in Oklahoma
ContextAssuring AccountabilitySharing Data
Assuring Accountability
Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information
Continuous Quality Improvement
Systems Process CoordinatorPI CoordinatorsBoard PI CommitteeNIATxAccreditation OrganizationsPerformance Management ReportsDIRT
Residential Treatment Followed by a Lower Level of Care Within 14 Days
Question: What percent of residential clients received a lower level of care within 14 days? (Lower level care includes community living and outpatient treatment.)
8
11
26
36
38
41
43
45
46
50
56
71
88
96
58
23
38
42
40
14
49
47
36
42
85
86
71
100
0 10 20 30 40 50 60 70 80 90 100
Bill Willis
MHSSO
DRI
Norman Alc & Drug
NE OK Cncl On Alc
Vinita Alc & Drug
The Oaks
Western State Psych Ctr
12 & 12
Alpha II
Opportunities
New Hope
MONARCH
Second Chance CDU
Percent of Residential Services Followed by a Lower Level of Care
FY02 FY01 Standard Standard=35%
DIR visit
Assuring Accountability
Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information
Program Management
Service UtilizationResource AllocationFidelity/Goal Attainment Guidance for TA, Training and Support
3 staff 52% of services
52% of time3 staff
Peer Support Spec.
Doc
Agency A
Agency B
-
4 clients admitted in the month
Assuring Accountability
Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information
Program Evaluation
Fidelity to Implementation PlanProcess/PerformanceOutcomes
Fidelity to Implementation Plan
PACT ExampleAverage 3 direct services per weekServices are available to clients 24 hours a day, 7 days a weekServe people with severe mental illness
Bill Carl Central Jim North OU Red Rock Red RockWillis Albert OK Taliaferro Care Tulsa OKC Tulsa
Current Residence Private Residence 28 37 39 34 93 5 12 115 363 77.9On The Street 1 1 21 1 15 39 8.4Residential Care Home 5 3 3 11 2.4Institutional Setting 1 1 9 2 2 15 3.2Nursing Home 1 1 0.2Community Shelter 1 1 8 1 6 17 3.6Supported Living 1 1 3 4 11 20 4.3
Living Situation Alone 14 19 23 24 61 7 13 99 260 55.8With Family/Relatives 17 18 18 7 45 3 39 147 31.5With Non-Related Persons 1 1 9 32 2 14 59 12.7
Current Employment Full-Time 1 1 1 3 0.6Part-Time 3 3 1 1 3 11 2.4Unemployed 7 5 23 5 107 2 4 12 165 35.4Not in the Labor Force 21 32 15 33 31 4 14 137 287 61.6
Education: Highest Level Completed No Education 1 1 2 0.41-6 1 1 2 5 9 1.97-9 4 4 3 5 17 1 9 43 9.210-12 19 26 29 26 76 5 14 85 280 60.113-16 7 8 10 8 44 2 1 52 132 28.3
Level of Functioning 00-10 1 1 0.211-20 1 6 7 1.521-30 2 2 1 48 61 114 24.531-40 9 4 21 4 68 2 7 55 170 36.541-50 16 28 19 22 20 4 9 24 142 30.551-60 6 4 13 1 2 5 31 6.761 - 70 1 1 0.2
Diagnosis - Axis I Primary Mood Disorders 8 9 3 3 39 1 1 28 92 19.8Other 1 1 1 3 3 9 1.9Other Non-Psychotic 1 1 1 3 0.6Other Psychotic 16 11 27 16 44 4 9 53 180 38.7Schizophrenia 7 16 11 19 54 1 5 68 181 38.9
Diagnosis - Axis II Primary Developmental Disorders 1 1 1 1 1 5 1.1Personality Disorders 6 2 4 2 1 17 32 6.9Unknown/Other/No Diagnosis 31 32 39 35 135 7 16 134 429 92.1
In Need of Alc/Drug Abuse Treatment1 No 10 8 12 54 140 14 18 190 446 60.3Yes 14 4 26 136 12 102 294 39.7
1ASI Alcohol/Drug Use >=5
Demographics, Continued
Process/Performance
Access to CareContinuity of CareWashington Circle Indicators
IdentificationInitiationEngagement
Regional Performance Management Report
Figure 1: Percent of Adults Discharged from Inpatient Care in the Quarterwith Follow-up Outpatient Care within 7 Days (referred/transferred)
0
10
20
30
40
50
60
70
80
90
100
CN EC NE NW OK SE SW TU State
Region
Perc
ent
FY03-4thQtrFY04-1stQtrFY04-2ndQtrFY04-3rdQtrFY04-4thQtrFY05-1stQtrFY05-2ndQtrFY05-3rdQtr
Regional Performance Management Report
Figure 4: Initiation of Substance Abuse TreatmentFollowing a First Detoxification Service
0
10
20
30
40
50
60
70
CN EC NE NW OK SE SW TU State
Region
Perc
ent
FY03-4thQtrFY04-1stQtrFY04-2ndQtrFY04-3rdQtrFY04-4thQtrFY05-1stQtrFY05-2ndQtrFY05-3rdQtrGoal (1/2 SD)
NIATx MeasuresReduced Wait Times
First Contact to AssessmentAssessment to AdmissionFirst Contract to AdmissionAssessment to First Treatment Service
Reduced No ShowsPercent of Contacts which become Assessments
Increased AdmissionsPercent of Assessments which become Admissions
Increased ContinuationPercent w/ 1st Treatment which continue to 4th Treatment
Outcomes
Was it worth the investment?
Increased Quality of LifeReduction in hospital daysReduction in jails daysIncreased employment
PREYear 1Count Count %Change Count %Change Count %Change Count %Change
Days 4220 832 -80.3 939 -77.7 1218 -71.1 558 -86.8Distinct Clients 66 27 -59.1 25 -62.1 26 -60.6 20 -69.7
Episodes 93 37 -60.2 63 -32.3 68 -26.9 50 -46.2Average Days per Episode 45.4 22.5 14.9 17.9 11.2
POST Year 1 Year 2 Year 3 Year 4
Long-term inpatient hospitalization outcomes among 66clients who admitted to PACT prior to 7/1/02 and did not
discharge for at least four years
73 clients met the criteria for inclusion in the study but 7 had no reported pre PACT inpatient hospitalization so were not included in the cohort.
46 clients had at least one post-admission inpatient episode. Of these, eight clients had an inpatient episode in each of the four post-admission years. These eight clients accounted for 42% of all post-admission days.
Notes:
Assuring Accountability
Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information
Drug Court
Drug Court
Criminal Justice Collaboratives
Drug CourtsMental Health CourtsRe-entry Intensive Care Coordination Teams(Re) Establishing Medicaid after Release
Demonstrating the Physical Health-Behavioral Health Link
Oklahoma State Department of Mental Health and Substance Abuse Services (ODMHSAS)Integrated Client Information System (ICIS)
Clients Admitted and Served in 2000-2004Age 10 or olderRemoved dependent children or family members of substance abuse clients to include clients with mental or addictive disorders only212,767 admissions for 124,796 people
Physical Health Data
Oklahoma State Department of Health (OSDH) Center for Health StatisticsHospital Inpatient Discharge Data Set (HIDDS)
Discharges in 2002 & 2003Age 10 and olderNo principle diagnoses of mental disorders
ICD-9 290-319
956,492 discharges for 570,590 people
Data Matching - ConfidentialityThinking outside the box
How to match the data without violating regulations
Matching data in the darkCould not view the data during the matching process
Unique person identifiersRandomly assigned number
Data Matching - ResultsNo personal identifiers49,260 hospital discharges for 18,820 people found in both datasets
ODMHSAS-clients924,624 hospital discharges for 551,770 people not found in ODMHSAS
Non-clients
Results - Length of StayAverage Length of Stay in Hosptial
Days during Two Years
4.05.0
02468
10
ODMHSAS Clients Non-clients
Ave
rage
Num
ber o
f D
ays
Average Length of Stay in Hospital Days during Two Years by Cohort
4.2 3.8 3.75.0
02468
10
MH Only SA Only MH & SA Non-BH
Ave
rage
Num
ber o
f D
ays
Average Number of Discharges in Two Years
Average Number of Discharges During Two Years by Cohort
3.7 2.7
8.2
2
02468
10
MH Only SA Only MH & SA Non-clients
Ave
rage
Num
ber o
f D
isch
arge
s
Average Number of Discharges During Two Years
4.8
2.0
02468
10
ODMHSAS Clients Non-clients
Ave
rage
Num
ber o
f D
isch
arge
s
DemographicsRate of Hospitalization by Age
Rate of Hospitalizations in 2002-2003 by Age Group
5.9
24.5 27.6
13.3
4.8
1.64.2
10.8
8.6 10.3 12.7 15.2
19.2 19.0
0.9
21.4
05
101520253035
10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Perc
ent
ODMHSAS Clients Non-clients Rate of Hospitalizations in 2002-2003 by Age Group and Cohort
6.2
20.7
27.1
17.5
7.2
3.0
9.6
31.6
24.8
23.2
7.8
2.7
0.4
0.13.
2
23.6
31.3
31.3
9.0
1.7
0.0
0.04.
2
10.8
8.6 10
.3 12.7 15
.2 19.2
19.0
1.6
16.7
05
101520253035
10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
Perc
ent
MH Only SA Only MH & SA Non-clients
Assuring Accountability
Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information
Public Information
Consumer choiceAdvocacy promotionProvider incentiveData quality
Accountability and Data Sharing:Improving Mental Health Services in Oklahoma
ContextAssuring AccountabilitySharing Data
Reasons for Data Sharing
Promote Cross-System Collaboration by Identifying Common ClientsAssess Long-Term OutcomesAssess Costs More CompletelyEvaluate Process MeasuresReduce Data Burden for Providers and RecipientsImprove Continuity of Care
Following Service Recipients Long-term through Administrative Databases
Incarceration, probation and parole (DOC)Arrests (OSBI)Employment, unemployment benefits (OESC)DUIs (DPS)Mortality (OSDH)Hospital discharges (OSDH)Medicaid—including SDE, DRS and OJA (OKHCA/OKDHS)
Examples of Data Sharing
Joint Oklahoma Information NetworkTreatment Outcomes and Performance Pilot StudiesOther State Agency projectBrandeis Washington Circle studyAdult Recovery CollaborativeElectronic Health Information Exchange
What has Data Done for Us Lately?
Pinpointed areas for improvement Helped explain why outcomes were achieved Provided evidence of program success Helped establish a more complete picture of program costsProvided feedback to programs about the results of their hard workDemonstrated effectiveness to the legislature to justify their funding and support for
More programsMore staff
Contact Information
Steven Davis, PhDChief Information OfficerOklahoma Department of Mental Health and Substance Abuse ServicesPO Box 53277Oklahoma City, OK [email protected]/eda/statisticsother.htm