Quality development in health

Office of Mental Health Continuous Quality Improvement Initiative for

Health Promotion and Care Coordination: 2013 Project Activities and Expectations

March 2013

Overview  Welcome  2013 CQI Project Options  Implementing a CQI project  Using PSYCKES  Center for Practice Innovations  Project Expectations  Next Steps

Orientation to Training  Three kickoff training webinars

 Quality Concerns: Health Promotion and Coordination/Behavioral Health Care Coordination

 Project Activities and Expectations  Project Planning Form (optional)

 Ongoing project training  Using PSYCKES

 Consent Module  Using PSYCKES for QI  Using PSYCKES for Clinicians

 CPI modules and other supports  Resource library  Webinar series (live and archived)

 Webinars on special topics, based on clinic interest and request

2013 OMH CQI Projects

 New indicators/projects are aligned with new directions in health care  Health Promotion and Coordination  Behavioral Health (BH) Care Coordination

 Center for Practice Innovations support for CQI Initiative  On-line learning modules to support direct care

staff engaged in these projects  Enhanced Medicaid funding for eligible clinics  Moving from PDCA to DMAIC (Six Sigma)

Health Promotion and Coordination PSYCKES Indicators

4+ Inpatient/ER – Med High Utilization of Medical Inpatient / Emergency Room

Prevent Hosp Asthma Preventable Hospitalizations - Adult Asthma

Prevent Hosp Diabetes Preventable Hospitalizations - Adult Diabetes

Prevent Hosp Dehydration

Preventable Hospitalizations - Adult Dehydration

No Diabetes Screening-On Antipsychotic

No Diabetes Screening for Individuals on Antipsychotics

Diabetes Monitoring- No HbA1c > 1 Yr

No Diabetes Monitoring for Individuals with Diabetes

No Outpatient Medical Visit >1 Yr

No Outpatient Medical Visit in Past Year

Behavioral Health Care Coordination PSYCKES Indicators

4+ Inpatient/ER – BH

High Utilization of Behavioral Health Inpatient / ER

3+ Inpatient – BH High Utilization of Behavioral Health Inpatient Services

3+ ER – BH High Utilization of Behavioral Health ER

Readmission - All BH 45 day

Behavioral Health Rehospitalization within 45 Days

Adherence – Antipsychotic (Schz)

Adherence to Antipsychotic Medications for Individuals with Schizophrenia

Adherence Mood Stabilizer (Bipolar)

Adherence to Mood Stabilizer Medications for Individuals with Bipolar Disorder

Antidepressant < 12 weeks (Depression)

Antidepressant Trial of less than 12 weeks for Individuals with Depression

IMPLEMENTING CQI

Implementing a CQI Project Using DMAIC Model

 Six Sigma model highly data-driven: focuses on measuring and improving quality  Healthcare examples: service level, service

cost, customer satisfaction, clinical excellence  DMAIC (Define-Measure-Analyze-Improve-

Control)  Inspired by PDCA  Often organizations will begin with a

“Recognize” step

Recognize  Review training materials with CQI team  Review prevalence of all indicators in the indictor

sets  PSYCKES QI Report; compare agency/region/ state

 Opportunity to improve - select a project based on:  Baseline performance in PSYCKES

 “High risk, high volume, problem prone”

 Input from staff; alignment with clinic priorities

 Experience gained in Phase I/II

Define  Establish team based on project

requirements  Identify overarching goal for project  Evaluate organizational resources and

supports  Review organizational processes  Determine timeline

Measure  Identify key project metrics  Develop detailed process maps  Establish baseline data and develop data

collection plan (What, How, Who)  Who needs lab work, when referrals are

made, when lab results are put in chart  Who is at high risk of admission, clinical

evaluation to determine appropriate intervention(s), intervention(s) delivered

 Plan for communicating data to staff and leadership

Analyze  Review data to identify sources of

variation  Identify value/non-value added steps  Identify critical factors driving performance  Identify gaps between current

performance and desired goal

Improve  Identify/select processes and strategies to achieve goal

 Clinical interventions - focus on specific clinical interventions that you want to increase capacity to deliver in your clinic

 Workflow redesign - define how clinic will change workflow processes to insure that clients are identified, reviewed and receive an intervention

 Develop an action plan with measurable steps to achieve goal  Staff responsible

 Resources required

 Timeframe for completion

 Definition of success/completion

Capacity Building Clinical Interventions (Reviewed in Quality Concerns Webinar)

 Medication related approaches (e.g., increase long-acting injectables)  Psychosocial Interventions, for example:

 Integrated treatment for substance use disorder  Motivational Interviewing  Behavioral tailoring or cue-dose training  Wellness self management

 Developing additional support, for example:  Peer support  Family involvement  Health Home Care Management and support services  Referral/linkage to health educator/primary care physician  Assisted Outpatient Treatment (AOT)

 Integrated mental and physical health  OMH optional clinic services - Health Physicals and Health Monitor

Services

Referrals and Organizational Interventions

 Health Home referral: work through SPOA or directly with Health Home

 Home attendant referral  AOT: work with OMH field office/LGU  Health physicals: obtain operating certificate to

provide optional services  Complete Part 599 Clinic Regulation Survey on Mental Health

Provider Data Exchange to revise operating certificate

 NYS OMH 14 NYCRR Part 599, “Clinic Treatment Programs,” Interpretive/Implementation Guidance, 01-04-2012

Optional Clinic Services

Health Physicals and Health Monitoring

 Health Physical: evaluation of an individual, including an age/gender appropriate history, exam, and the ordering of laboratory/diagnostic procedures  Provided by: MD, NP, PA

 Health Monitoring: Continued measuring of specific health indicators associated with increased risk of medical illness and early death  Adults: blood pressure, body mass index (BMI),

substance use and smoking cessation.  Children: BMI percentile, activity/exercise level, and

smoking status  Provided by: MD, NP, RN, LPN, PA

Control  Review performance to

 Sustain improvement

 Establish corrective plans as needed

 Translate and transfer learning

 Monthly meetings of QI team to review data at client, prescriber, and clinic level; progress towards goals; and barriers to change

 Regular meetings with staff and leadership to review progress and outcomes

USING PSYCKES

Define and Measure: Review Prevalence of Indicators

Analyze: Review Variation

Improve: Define Target Population

Clinical Summary Supports Client Assessment

 Diagnoses  Comorbid medical/substance use/mental health conditions

 Service utilization patterns  Integrated Graph shows gaps in services and/or medication

 Engagement in primary care

 Use of ER/inpatient services

 Monitoring  Medication orders show gaps between pick-ups

 Review laboratory services, test names, dates and providers

Client demographics, quality flag, diagnoses Select time frame, note level of access

Clinical Summary

Clinical Summary: Integrated View as Graph

All services displayed in graphic form to allow ready identification of utilization patterns, including medication adherence and outpatient, inpatient and ER services. Note “Inpatient BH” – scattered dots

Hospital/ER Services: Integrated Behavioral/Medical

Service type, provider, diagnosis, admission/discharge dates, length of stay, procedures

Labs and Other Data Dental, Vision, Labs, X-Ray, Living Support, Transportation

USING THE PSYCKES CONSENT MODULE

Access Type

Includes Data with Special Protections?

(SUD, HIV, Family Planning, Genetic)

Duration

Provided service in past 9 months

No, get client name only Up to 9 months after

last service

Quality Flag No, but get all other

data As long as flag is active;

up to 9 months after last service

Clinical Emergency

Yes, all data 72 hours

Consent Yes, all data 3 years after last service

Client Information in PSYCKES: Comparison

PSYCKES Consent Process Overview

 Only staff with “PSYCKES-Registrar” role can use Consent Module.  Clinic decides which staff should have Registrar role: Security

Manager designates using SMS

 Client is asked to sign PSYCKES Consent Form  Must use form available in PSYCKES (English and Spanish)

 Registrar uses Consent Module to attest  Signed consent, or  Clinical emergency

 Any PSYCKES user (Registrar or not) within the agency can then access client data.

Three Steps for Consent

 Find client (Medicaid ID or SSN)  Attest to rationale for access  Attest to client identity

 Trainings available:

 Consent module webinar  Using PSYCKES for Clinicians

CENTER FOR PRACTICE INNOVATIONS (CPI)

Who CPI is and How We Support the CQI initiative

The Center for Practice Innovations (CPI) supports the New York State Office of Mental Health’s mission to promote the widespread availability of evidence-based practices to improve mental health services, ensure accountability, and promote recovery-oriented outcomes for consumers and families. For phase III of this CQI initiative, CPI will provide free training and implementation supports to help clinics transform their care.

Health Promotion and Coordination - Adult Online Training Modules Required

1. Integrating Medical, Psychiatric, and Addiction Treatment Services

2. Wellness Self-Management 3. Stage-wise Treatment 4. Motivational Interviewing I 5. Motivational Interviewing II 6. Motivational Interviewing III 7. Motivational Interviewing and Harm Reduction 8. Practitioner Tools for Treating Tobacco Dependence 9. Understanding the Use of Medications to Treat Tobacco

Dependence 10. Implementing Tobacco Dependence Treatment

Health Promotion and Coordination - Youth Online Training Modules Required

1. Co-occurring Disorders in Adolescents 2. Integrating Medical, Psychiatric, and Addiction Treatment

Services 3. Stage-wise Treatment 4. Motivational Interviewing I 5. Motivational Interviewing II 6. Motivational Interviewing III 7. Motivational Interviewing and Harm Reduction 8. Practitioner Tools for Treating Tobacco Dependence 9. Understanding the Use of Medications to Treat Tobacco

Dependence 10. Implementing Tobacco Dependence Treatment

Behavioral Health Care Coordination - Adult Online Training Modules Required

1. Engaging Consumers 2. Stage-wise Treatment 3. Early Stages of Change 4. Motivational Interviewing I 5. Motivational Interviewing II 6. Motivational Interviewing III 7. Motivational Interviewing and Harm Reduction 8. Individual Interventions 9. Generating the Collaborative Treatment Plan 10.Persuasion Groups

Behavioral Health Care Coordination - Youth Online Training Modules Required

1. Co-occurring Disorders in Adolescents 2. Engaging Consumers 3. Stage-wise Treatment 4. Early Stages of Change 5. Motivational Interviewing I 6. Motivational Interviewing II 7. Motivational Interviewing III 8. Motivational Interviewing and Harm Reduction 9. Individual Interventions 10.Generating the Collaborative Treatment Plan

CPI’s Online Training Modules  Developed according to the principles of adult

learning theory  Received awards for excellence in online

training  Features

 Interactive learning activities and knowledge checks  Video clips of consumers and practitioners  Video clips of skill demonstrations and panel discussions  Links to resources  Text version for every page  10 item exam to demonstrate knowledge learned

Additional Modules Available CPI has a growing library of online training modules; topics include: Clinical Supervision Individual Placement and Support (IPS) model of supported employment. Screening/assessment for co-occurring mental health and substance use disorders Stage-wise treatment groups Cognitive-behavioral therapy Helping people consider clozapine (in production) Suicide prevention (in production)

Live and Archived Webinars  Regularly scheduled live webinar series and special webinars for supervisors and for practitioners. Archived webinars; examples include:  Differential diagnosis for people with mental health

symptoms and substance use (Dr. Michael First)  Motivational Interviewing – 3 part series for supervisors

and for practitioners (Rusty Foster)  Engaging hard to engage clients – 2 part series (multiple

presenters)  Cognitive-behavioral therapy – 3 part series (Rusty Foster)  Street Drugs 101 (Dr. Petros Levounis)  Clinical Supervision and Field Mentoring (Deborah Myers)  Using the Group Supervision Process (Rusty Foster)

Resource Library

Tracking Tools  Supervisors have the ability to assign and

track training in the online system.  This includes the ability to pull summary

reports and to view progress for any given individual.

 Each supervisor has, on their learning transcript, a short video describing how to assign training and view what people have done.

Example Summary Report

Example Staff Transcript

Strategies From the Field: Helping Staff Find Time to Complete Modules  Watch modules together as a group during a regularly

scheduled staff meeting  Raffle inexpensive (or free) prizes monthly (each module

completed gives you one ticket in the raffle) – examples have included fun seasonal baskets, books, employee of the month parking spot, extra dress down day.

 Allow interested staff to cover some days or shifts that are typically less busy.

 Provide lunch once a month for staff who agree to use their personal lunch (or other) time to complete the training.

PROJECT EXPECTATIONS

Project Activities and Expectations

 Complete OMH Documentation  Participating Clinic Contact Form (was due 12/14/12)  Project Planning Form (due 3/15/2013)  Interim report (future)

 Webinar trainings: 2 staff from each clinic  Quality Concerns  Project Activities and Expectations  Project Planning Form (optional)

 Monthly on-line data reporting  Direct care staff complete CPI modules  Participation in conference calls/site visits to review project  Use DMAIC Model (or other robust CQI methodology) to

support project implementation

Next Steps

Next Steps  Check that 2 staff from each clinic attended training

 Quality Concerns  Project Activities and Expectations  Project Planning Form (optional)

 Develop CQI team  Define project

 Select project and interventions  Develop action plan

 Complete Project Planning Form  Register for CPI modules  Designate PSYCKES registrars; clinic security manager

enrolls registrars in OMH security management system

Project Planning Form (PPF)

 Due March 15

 PPF purpose:

 Updates agency/clinic demographic data  Helps clinics select and document a new project  Asks for information about workflow processes and

clinical interventions

 PPF Webinar  Held 3 live webinars in February  Recorded version posted on website

Monthly Reporting

 Clinics will no longer report on medication projects  Final data submission was December (reporting on

November)  If clinic owes OMH previous reporting data, contact

PSYCKES-Help to submit previous months’ data  Monthly reporting will focus on project

implementation milestones, for example  PSYCKES registrar is enrolled  All staff have completed CPI training

 Reporting to begin in late Spring

CPI Next Steps • Clinic director clicks

http://practiceinnovations.org/LinkClick.aspx?fileti cket=xQqhJk5hqI8%3d&tabid=186 to complete a brief registration form.

• Approximately one week after CPI receives the brief registration form, CPI will send to the clinic director a link for staff to register in CPIs learning community.

• Clinic director informs direct care staff about the project purpose and goals and the relevant CPI training modules.

CPI Next Steps (con’t)  Clinic director forwards link to all direct care staff.

 Direct care staff click on link to create usernames and passwords.

 Once registered, CPI will assign the required modules to staff and send them detailed instructions for accessing the training.

 If the program is already registered in CPI’s learning community, CPI will also assign the required modules to staff members who already have logins and send them detailed instructions for accessing the training.

RESOURCES

PSYCKES Resources

 Ongoing trainings via webinar  See Calendar on website for registration  Using PSYCKES, topics of special interest

 www.psyckes.org  PSYCKES Users’ Guide  Frequently Asked Questions  Recorded Webinars  Project Tools  Technical Specifications

Contact Information

 PSYCKES-Help - PSYCKES-help@omh.ny.gov

 PSYCKES Application

 OMH Help Desk 800-HELP-NYS (800-435-7697)

 Access and token issues  Security Management System support

 CPI helpdesk

 212-543-5127 cpihelp@nyspi.columbia.edu),

 Contact Us Page – PSYCKES Website