Literature Collection

8021

Quality and efficiency in small practices transitioning to patient centered medical homes: A randomized trial.

Type: Journal Article

Authors: Judith Fifield, Deborah Dauser Forrest, Joseph A. Burleson, Melanie Martin-Peele, William Gillespie

Year: 2013

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8022

Quality and equity of primary care with patient-centered medical homes: results from a national survey

Type: Journal Article

Authors: J. Aysola, A. Bitton, A. M. Zaslavsky, J. Z. Ayanian

Year: 2013

Publication Place: United States

Abstract: BACKGROUND: : The patient-centered medical home (PCMH) model has gained support, but the impact of this model on the quality and equity of care merits further evaluation. OBJECTIVE: : To determine if PCMHs are associated with improved quality and equity in pediatric primary care. RESEARCH DESIGN: : Using the 2007/2008 National Survey of Children's Health, a nationally representative survey of parents/guardians of children (age, 0-17 y), we evaluated the association of PCMHs with 10 quality-of-care measures using multivariable regression models, adjusting for demographic and socioeconomic covariates. For quality indicators that were significantly associated with medical homes, we determined if this association differed by race/ethnicity. RESULTS: : Compared with children without medical homes, those with medical homes had significantly better adjusted rates for 6 of 10 quality measures (all P

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8023

Quality improvement and models of behavioral healthcare integration: Position paper #2 from the International Society of Psychiatric-Mental Health Nurses

Type: Journal Article

Authors: L. P. Shell, M. Newton, V. Soltis-Jarrett, K. M. Ragaisis, J. M. Shea

Year: 2019

Publication Place: United States

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8024

Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians

Type: Journal Article

Authors: L. S. Meredith, M. Jackson-Triche, N. Duan, L. V. Rubenstein, P. Camp, K. B. Wells

Year: 2000

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8025

Quality improvement in healthcare delivery utilizing the patient-centered medical home model

Type: Journal Article

Authors: F. Akinci, P. M. Patel

Year: 2014

Publication Place: United States

Abstract: Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

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8026

Quality improvement in primary care mental health practice. A case for political intervention?

Type: Journal Article

Authors: H. Middleton

Year: 2008

Publication Place: England

Abstract: Improving the quality and consistency of detecting and providing for so-called common mental health problems in primary care settings is a contemporary issue. Such conditions are common and they are now recognised as a significant burden upon the economy. Though energetically pursued for much of the last half century, a medical approach based upon syndromal diagnosis and treatment has not provided a clear, evidence-based approach to their management that can form the basis of an educational intervention. Where that has been attempted and evaluated, it has been found wanting. A more politically driven imperative has stimulated 'top-down' and firmly managed processes of change, encouraged by fresh investment. Improving Access to Psychological Therapies will not be the first programme to influence mental health services in this way. Experience of other programmes of deliberately managed change suggests that this approach can be effective and productive, particularly in a context which mental health exemplifies, where there are relatively few clinical certainties and a multitude of opinions.

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8027

Quality Improvement in Primary Care: External Supports for Practices

Type: Government Report

Authors: E. F. Taylor, D. Peikes, K. Geonnotti, R. McNellis, J. Genevro, D. Meyers

Year: 2014

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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8028

Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care

Type: Journal Article

Authors: J. Unutzer, Y. F. Chan, E. Hafer, J. Knaster, A. Shields, D. Powers, R. C. Veith

Year: 2012

Publication Place: United States

Abstract: Objectives. We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. Methods. We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization. Results. Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval = 1.39, 2.14) after the P4P program implementation compared with pre-program implementation. Conclusions. Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.

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8029

Quality Indicators for Physical and Behavioral Health Care Integration

Type: Journal Article

Authors: M. L. Goldman, B. Spaeth-Rublee, H. A. Pincus

Year: 2015

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8030

Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method

Type: Journal Article

Authors: M. Hartveit, K. Vanhaecht, O. Thorsen, E. Biringer, K. Haug, A. Aslaksen

Year: 2017

Publication Place: England

Abstract: BACKGROUND: Communication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking. The aim of the present study was to develop quality indicators to detect the impact that the quality of referral letters from primary care to specialised mental health care has on the quality of mental health services. METHODS: Using a modified version of the RAND/UCLA appropriateness method, a systematic literature review and focus group interviews were conducted to define quality indicators for mental health care expected to be affected by the quality of referral information. Focus group participants included psychiatrists, psychologists, general practitioners, patient representatives and managers. The existing evidence and suggested indicators were presented to expert panels, who assessed the indicators by their validity, reliability, sensitivity and feasibility. RESULTS: Sixteen preliminary indicators emerged during the focus group interviews and literature review. The expert panels recommended four of the 16 indicators. The recommended indicators measure a) timely access, b) delay in the process of assessing the referral, c) delay in the onset of care and d) the appropriateness of the referral. Adjustment was necessary for five other indicators, and seven indicators were rejected because of expected confounding factors reducing their validity and sensitivity. CONCLUSIONS: The quality of information relayed in the referral process from primary care to specialised mental health care is expected to affect a wide range of dimensions defining high quality care. The expected importance of the referral process for ensuring 'timely access'-one of the six aims of high-quality health care defined by the Institute of Medicine-is highlighted. Exploring the underlying mechanisms for the potential impact of referral information on patient outcomes is recommended to enhance quality of care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01374035 (28 April 2011).

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8031

Quality of care for primary care patients with anxiety disorders

Type: Journal Article

Authors: M. B. Stein, C. D. Sherbourne, M. G. Craske, A. Means-Christensen, A. Bystritsky, W. Katon, G. Sullivan, P. Roy-Byrne

Year: 2004

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8032

Quality of Care Perceived by Older Patients and Caregivers in Integrated Care Pathways With Interviewing Assistance From a Social Robot: Noninferiority Randomized Controlled Trial

Type: Journal Article

Authors: R. Boumans, F. van Meulen, W. van Aalst, J. Albers, M. Janssen, M. Peters-Kop, Huisman- de Waal, A. van de Poll, K. Hindriks, M. Neerincx, Olde Rikkert

Year: 2020

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8033

Quality of communication between primary health care and mental health care: an examination of referral and discharge letters

Type: Journal Article

Authors: J. Durbin, J. Barnsley, B. Finlayson, L. Jaakkimainen, E. Lin, W. Berta, J. McMurray

Year: 2012

Publication Place: United States

Abstract: In managing treatment for persons with mental illness, the primary care physician (PCP) needs to communicate with mental health (MH) professionals in various settings over time to provide appropriate management and continuity of care. However, effective communication between PCPs and MH specialists is often poor. The present study reviewed evidence on the quality of information transfer between PCPs and specialist MH providers for referral requests and after inpatient discharge. Twenty-three audit studies were identified that assessed the quality of content and nine that assessed strategies to improve quality. Results indicated that rates of item reporting were variable. Within the limited evidence on interventions to improve quality, use of structured forms showed positive results. Follow-up work can identify a minimum set of items to include in information transfers, along with item definitions and structures for holding this information. Then, methodologies for measuring data quality, including electronically generated performance metrics, can be developed.

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8034

Quality of life among opiate-dependent individuals: A review of the literature

Type: Journal Article

Authors: J. De Maeyer, W. Vanderplasschen, E. Broekaert

Year: 2010

Publication Place: Netherlands

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8035

Quality of life among patients with bipolar disorder in primary care versus community mental health settings

Type: Journal Article

Authors: C. J. Miller, K. M. Abraham, L. A. Bajor, Z. Lai, H. M. Kim, K. M. Nord, D. E. Goodrich, M. S. Bauer, A. M. Kilbourne

Year: 2013

Publication Place: Netherlands

Abstract: INTRODUCTION: Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder. METHODS: HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) composite scale scores. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse. RESULTS: A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p=0.98 and p=0.49, respectively). Depressive symptoms were associated with lower MCS scores (B=-0.68, p<0.001) while arthritis/chronic pain was strongly related to lower PCS scores (B=-5.23, p<0.001). LIMITATIONS: This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states. DISCUSSION: Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment.

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8036

Quality of life and healthcare service utilization among methadone maintenance patients in a mountainous area of Northern Vietnam

Type: Journal Article

Authors: L. H. Nguyen, L. H. T. Nguyen, V. L. Boggiano, C. D. Hoang, H. Van Nguyen, H. T. Le, H. Q. Le, T. D. Tran, B. X. Tran, C. A. Latkin, N. Zary, M. T. T. Vu

Year: 2017

Publication Place: England

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8037

Quality of life as an outcome of opioid use disorder treatment: A systematic review

Type: Journal Article

Authors: J. W. Bray, B. Aden, A. A. Eggman, L. Hellerstein, E. Wittenberg, B. Nosyk, J. C. Stribling, B. R. Schackman

Year: 2017

Publication Place: United States

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8038

Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations

Type: Journal Article

Authors: K. M. Liberman, Y. S. Meah, A. Chow, J. Tornheim, O. Rolon, D. C. Thomas

Year: 2011

Abstract: Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P = 0.008) and Medicaid (P = 0.09). Similarly, a greater number of EHHOP patients had better acute phase (P = 0.001; P = 0.096) and continuous phase (P = 0.049; P = 0.88) pharmacologic treatment than patients with commercial health plans and Medicaid, respectively. EHHOP meets and, in some areas, exceeds the quality of depression treatment when compared to insured populations. Even though EHHOP already surpasses these indicators, the clinic can improve its diagnostic capabilities, prescription medication adherence, and referral care follow-through by creating an on-site mental health clinic.

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8039

Quality of mental health care for children: a familiar storyline

Type: Journal Article

Authors: K. J. Kelleher, S. M. Horwitz

Year: 2006

Publication Place: United States

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8040

Quality of mental health care for youth with asthma and comorbid anxiety and depression

Type: Journal Article

Authors: W. J. Katon, L. Richardson, J. Russo, P. Lozano, E. McCauley

Year: 2006

Publication Place: United States

Abstract: OBJECTIVES: Youth with asthma have a high rate of anxiety and depressive disorders, and these comorbid disorders are associated with increased asthma symptom burden and functional impairment. This study examined the rates and predictors of recognition of anxiety and depressive disorders among youth (ages 11 to 17) with asthma who are seen in primary care settings as well as the quality of mental health care provided to those with comorbid anxiety and depression over a 12-month period. METHODS: This study used automated utilization and pharmacy data from a health maintenance organization to describe the rate of recognition of Diagnostic and Statistical Manual of Mental Disorders, edition IV, anxiety and depressive disorders and the quality of mental health care provided for the 17% of youth with asthma and comorbid anxiety and/or depression during the 12-month period prior to diagnosis. Psychiatric diagnoses were based on a telephone version of the Computerized Diagnostic Interview Schedule for Children (Version 4.0). RESULTS: Approximately 35% of youth with 1 or more anxiety and depressive disorders and 43% of those with major depression were recognized by the medical system during a 12-month period. Greater functional impairment (odds ratio [OR] 3.32, 95% confidence interval [CI] 1.25-8.79), higher severity on parent-rated anxiety and depressive symptoms (OR 2.49, 95% CI 1.04-6.00), and a greater number of primary care visits (OR 1.26, 95% CI 1.10-1.44) were associated with significantly higher recognition rates while having Medicaid or Washington state medical insurance was associated with lower rates of recognition (OR 0.27, 95% CI 0.08-0.92). Only approximately 1 in 5 youths with comorbid major depression received an adequate dosage and duration of antidepressant medication, and only 1 in 6 received a minimally adequate number of psychotherapy sessions (> or =4 visits). CONCLUSION: Rates of recognition of comorbid anxiety and depressive disorders are low in youth with asthma and few youth with asthma and comorbid anxiety and depression receive guideline-level mental health treatment.

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