How can professionals maintain or improve the quality of care they provide when pressured by payers to reduce the cost of care?
Clinicians today face the challenge of providing optimal care in an environment where costs drive clinical practice. But high quality, not cost, remains the goal of professionals. By arming themselves with measurable results, clinicians can improve the processes of delivering mental health care and translate those improvements into better outcomes for patients and their families. In this timely guide, the editors have gathered the work of 49 distinguished contributors and crafted a valuable resource for overcoming the extraordinary challenge of delivering high quality mental health care. This groundbreaking book is divided into three sections:
- The challenges today’s clinicians face in providing optimal mental health care—Beginning with a review of the report to then-President Clinton from the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, subsequent chapters discuss professional ethics and managed care, how Wall Street investors are changing the practice of medicine, problems faced by managed care, and changes needed in medical education to ensure that physicians are well prepared to practice medicine in the 21st century.
- Proven techniques for quality measurement—Measuring quality of care presents significant conceptual and methodological problems. These chapters review quality measurement methods and describe support by the federal government to improve these methods. Also addressed are how consumers are joining the quality of care measurement movement and how one large urban county mental health program is advancing quality measurement.
- Fourteen case reports of quality improvement projects—These chapters detail principles and techniques that can be replicated or tailored to fulfill the requirements of a variety of clinical settings, ranging from the national health service in Great Britain to a small geriatric unit in a large hospital. The work showcased here was done by clinicians or administrators who, concerned about the quality of care in their own settings, used data to test for themselves whether their interventions resulted in improved care.
Even if managed care disappeared, we would still need to question, examine, and improve the quality of patient care—with clinicians taking the lead, because only they can appreciate the subtle nuances that maintain or improve quality standards, and only they can make substantive changes in their clinical settings.
As both a broad conceptual framework for considering the quality of mental health care and as a practical field guide to real-life techniques for measuring the quality of care, this volume will prove exceptionally valuable for mental health care professionals, administrators, and policymakers as well as for consumers and consumer advocates, researchers, students, and public health professionals.
Introduction. Part I: Challenges. Introduction. The President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Maintaining professional ethics in a changing health care system. Quality of care in an era of Wall Street medicine. Can managed care deliver quality? Role of academic medical centers in achieving quality. Part II: Quality Measurement. Introduction. Measuring quality: An overview. Risk adjustment of clinical outcome data. Building partnerships in accountability: Consumer satisfaction. Toward a national report card: Measuring consumer experiences. Practical steps toward quality improvement: A public sector example. The American Psychiatric Association’s agenda for evidence-based quality. Status of national efforts to improve accountability for quality. Part III: Case Reports. Intensive psychiatric community care in the Department of Veteran's Affairs. A national strategy to reduce depression and suicide in England. The Texas Medication Algorithm Project. Improving the quality of community-based services for children. Improved emergency access for Medicaid clients: A Colorado case study. Improving employment outcomes for people with severe psychiatric disabilities. Matching substance abuse patients to services. Adverse drug reactions: An interdisciplinary team approach. High-risk Medicaid enrollees and a community-based support program. Increasing consumer involvement in treatment. Improving the detection of mental disorders by primary care clinicians. Reducing the incidence of restraint and seclusion. Using dialectical behavior therapy in the treatment of borderline personality disorder. Reducing the risk of falls for elderly patients. Afterword. Index.
"Improving Mental Health Care
will appeal to a broad audience. It provides both practical guidance and encouragement to anyone interested in systems change and the possibilities for improving care in a difficult practice environment. In a time of brooding pessimism and dangerous passivity, it provides an antidote and a practical model for moving forward into the coming era."—Michael Bennett, M.D., Journal of Clinical Psychiatry
"Improving Mental Health Care provides a good introduction to the multiple roles that clinicians and managers can adopt to improve care."—Alexander S. Young, M.D., M.S.H.S., Psychiatric Services, 4/1/2003
Barbara Dickey, Ph.D.,
is Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School and The Cambridge Hospital. She has been active in hospital quality improvement efforts and has a long academic career in health services research. She has published widely in the fields of outcome research, homelessness, and the effects of managed care on costs and outcomes for people with serious mental illness. She is leading a research study of the quality of care for adults with schizophrenia, comparing the treatments and outcomes of people in managed care with those whose care is not managed. With Dr. Sederer, she coedited Outcomes Assessment in Clinical Practice.
Lloyd I. Sederer, M.D., was Medical Director and Executive Vice President of McLean Hospital at the time this book was being prepared. In this role, he directed the hospital's clinical services, including its special emphasis on clinical quality assessment and quality improvement. He is now Director of the Division of Clinical Services at the American Psychiatric Association in Washington, D.C. Dr. Sederer is Associate Professor of Clinical Psychiatry at Harvard Medical School and has published 10 books and over 125 articles, reviews, chapters, and monographs. He has consulted nationally and internationally on clinical care and service delivery, quality improvement, risk management, and the regulation and reimbursement of medical care.