Quality indicators for primary mental health within managed care: a public health focus

Patient satisfaction and treatment outcomes as quality indicators for mental health services

In the United States, the patient has emerged as the central focus in evaluations of mental health services (Buckley, 1993). Whereas evaluation research in the 1980s emphasised the structure and process of mental health care, current evaluation research incorporates client-based measurements of treatment outcomes, such as symptom reduction, functional status and quality of life (Chisholm et al, 1997; Campbell, 1998). In addition, patient satisfaction with mental health services is increasingly used as an outcome dimension and an indicator of service quality (Center for Mental Health Services, 1996; Teague et al, 1997; Howard et al, 2003).

Using Information Technology in Community-Based Psychiatric Nursing Education: The SJSU/NT Project

Information management is growing in importance in health care delivery. Practitioners, case managers, third-party payers, and health care policy makers are increasingly basing their health care decisions on timely and relevant clinicaldata. Since 1997, San Jose State University nursing students have been using the Nightingale Tracker, a computerized clinical communication system, to document client care, electronically transfer clinical information to their instructors, and maintain a systematic method for storing clinical data for further use in program planning, prediction of health care trends, and other research endeavors. Clearly, the potential increase in quality care makes the investment in this information technology (IT) experience worthwhile. Faculty are changing the education paradigm to a learning paradigm, preparing practitioners who can use IT in the current managed care environment to monitor costs while improving care— valuable skills to possess in this ever-evolving health care delivery system.

Performance measurement in mental health care: present situation and future possibilities

SUMMARY

This paper describes performance measurement and its indicators for mental health care services. Performance measurement can serve several goals such as accountability, quality improvement and performance management. For all three purposes structure, process and outcome indicators should be measured. Literature was retrieved from Medline and PsychInfo in order to see which performance indicators were used for the three purposes of performance measurement in mental health care. The indicators were classified in structure, process and outcome indicators. The results show no big differences in the indicators used among studies. Performance management is the performance measurement purpose most referred to, followed by accountability, and quality improvement. Outcome and process indicators are used most, structure indicators are in the minority. Several levels of measurement, that is national or service level, came forward in the literature review. To overcome misinterpretation of data and to be able to improve quality and manage performances, performance indicator sets should refer to structure, process and outcome. Indicators should be chosen carefully with the aim of the measurement taken into mind. Based on this review, a conceptual framework is presented to support managers in their decisions about which indictors can best be used for performance measurement. Additionally, a model that provides an understanding of the use of information gained by performance measurement is given.

An evaluation of a benchmarking initiative in extended treatment mental health services

AIM

To evaluate the effectiveness of a benchmarking initiative in facilitating quality improvement and reform in extended care mental health services.

METHOD

Individual interviews and focus group discussions were conducted with 84 staff in 22 extended care mental health services that had previously participated in a State-wide benchmarking exercise in Queensland, Australia.

RESULTS

Staff reported positive outcomes from participation in the benchmarking exercise. Information derived from benchmarking provided a different perspective on the strengths and weaknesses of individual services and an opportunity to learn from peer services. Staff in 86% of the services identified issues that needed to be addressed and 64% of services had implemented one or more service improvement projects in response to shortcomings identified through the benchmarking exercise.

CONCLUSIONS

The collection and reporting of performance data through a process of benchmarking was successful in facilitating service improvement in most of the participating facilities. Engaging services in all stages of the process was considered useful in converting benchmarking data into knowledge that was able to be applied at the local service level.

Effectiveness of cognitive-behavioral therapy on depressive symptomatology, stress and coping strategies among Jordanian university students

The study examined the effectiveness of cognitive behavioral therapy (CBT) with university students suffering from moderate to severe depressive symptoms in Jordan. Eighty-four university students were recruited and assigned randomly to control and intervention groups. Intervention impact was assessed on measures of depressive symptoms, perceived stress, and coping strategies at three time points; baseline, postintervention, and 3-months postintervention. The interventional model used was the Modified Teaching Kids to Cope (MTKC), and the control group received no treatment. Overall, using CBT showed a significant improvement in the outcome measures. At postintervention, students had lower scores on perceived stress, lower depressive symptoms, less use of avoidance coping strategies, and more use of approach coping strategies. The findings are discussed in terms of treatment implications and recommendations for use at academic and health care settings.

Consumer perspectives on quality of inpatient mental health services

This study, conducted at two public-sector psychiatric hospitals in a south-eastern state, investigated satisfaction with inpatient services and treatment outcomes among 204 hospitalized mental health consumers. A simple survey design with nonrandom sampling technique was used; instruments included the KY-CSI, the 21-item MHSIP Consumer Survey, and the CSQ-8. Respondents reported satisfaction with time available to be with other patients, staff availability, and their degree of comfort talking to staff. Areas of dissatisfaction included lack of client input into treatment planning, lack of family involvement, and lack of medication education. Providers are encouraged to include clients in all phases of treatment planning and to continue to evaluate consumer perspectives of quality services.

Training Consumers to Collect Data in Mental Health Service System Evaluation Research

Consumer satisfaction with services is an outcome measure. This report describes The Consumer Satisfaction Research Associate Training Program, which was designed for the education and supervision of recovered consumers who collected data during four studies at three psychiatric hospitals. The educational program had didactic and laboratory components. Consumer research associates collected quantitative and qualitative data using a survey tool for face-to-face interviews. Participant recruitment and management of confidential records were included in the role. Data collected by research associates from consumers who are in treatment can enhance the validity and trustworthiness of satisfaction surveys. Nurses can play an important role in the research process by serving as staff resources for consumers who collect data in various service system settings.

Best practice in psychogeriatric care

This paper presents a best practice model for psychogeriatric care. Best practice is becoming one of the most common expressions used in the area of health care, and is often referred to in government reports and documents. The definition of 'best practice', however, is still evolving. What then, is best practice? And how can the principles of best practice be applied and integrated into the clinical speciality of psychogeriatrics? The article emphasizes the importance of evidence-based interventions and the need to focus on the pragmatic aspects of providing best practice in the clinical area of psychogeriatrics; that is, what works best in practice? The position taken by the authors of this paper is that the conceptualization of a best practice model in psychogeriatrics is necessary in order to describe and explain the different components involved in the service provided. This conceptualization also communicates and articulates the role of the major stakeholders, and the key players in the achievement of best practice. A psychogeriatric service may become more coherent, more goal-orientated and more efficient if a model is utilized. This paper outlines a proposed model of best practice in psychogeriatrics, and discusses the potential implications for achieving desirable clinical outcomes.

Quality measures for mental health care: results from a national inventory

The National Inventory of Mental Health Quality Measures was funded by the Agency for Healthcare Research and Quality to (1) inventory process measures for assessing the quality of mental health care; (2) identify clinical, administrative, and quality domains where measures have been developed; and (3) identify areas where further research and development is needed. Among the 86 measures identified, most evaluated treatment of major mental disorders, for example, schizophrenia (24 percent) and major depression (21 percent). A small proportion focused on children (8 percent) or the elderly (9 percent). Domains of quality included treatment appropriateness (65 percent), continuity (26 percent), access (26 percent), coordination (13 percent), detection (12 percent), and prevention (6 percent). Few measures were evaluated for reliability (12 percent) or validity (3 percent). Measures imposing a lower burden were more likely to be in use (chi 2 = 4.41, p = .036). Further measures are needed to assess care for several priority clinical and demographic groups. Research should focus on measure validity, reliability, and implementation costs. In order to foster quality improvement activities and use of common measures and specifications for mental health care, the inventory of quality measures will be made available at www.challiance.org/cqaimh.

Bringing psychiatric nursing into the twenty-first century

Psychiatric nursing stands at a crossroads, in danger of losing both its identity and standing within the larger body of nursing. Enrollment in graduate programs is at an all time low and many traditional employment opportunities for psychiatric nurses are disappearing. Many explanations have been proposed to account for the crisis in psychiatric nursing practice. Although many of the identified external forces have had real impact on psychiatric nursing, these factors have impacted all of nursing. Yet our Nurse Practitioner (NP) peers are thriving, with proliferation of NP programs with unprecedented enrollment for this nationally accepted and understood role. The psychiatric nursing crisis may be most directly related to the reality that we as a professional group have thus far failed to adequately respond to external realities that have dramatically altered the environment in which psychiatric nursing occurs. This article argues for reframing the discipline of psychiatric nursing, accomplished as a national consensus building process, and including 4 critical components: (1) reconceptualization of what constitutes the core of psychiatric nursing content and represents the epistemological heart of the profession; (2) identification of the critical clinical competencies that reflect the core content, represent the role and scope of psychiatric nursing, and that match current and anticipated practice realities; (3) identification and standardization of measurable clinical outcomes, predicated on both content and competencies, which will allow psychiatric nurses to measure, in meaningful ways, the impact of their practice on patients' health; and (4) establishment of a research agenda that will allow psychiatric nursing to expand its unique knowledge base.

Developing a CNS role to meet the mental health needs of the underserved

The purpose of this article is to describe a clinical nurse specialist program that prepares psychiatric-mental health nurses for positions in today's mental health care system. Recently, there has been a national increase in psychiatric-mental health nurse practitioner programs and a decrease in psychiatric-mental health-clinical nurse specialist programs. We faced the dilemma that many psychiatric-mental health nurse faculties face in this climate of mental health care delivery changes: how to best prepare psychiatric-mental health nurses for advanced practice. Because of our long history of preparing clinical nurse specialists, we believed the role was a viable one. The clinical nurse specialist role also fit with our university's mission and our beliefs regarding the importance of providing care for underserved populations. The role of the community mental health-clinical nurse specialist is described, and the economic, demographic, and mental health system changes that influenced the development of the community mental health-clinical nurse specialist role are explored. The curriculum and the impact of the program are described and evaluated. Finally, implications regarding the need and the viability of this new role in both psychiatric-mental health nursing and in other specialties as we care for clients in the community are presented.

Public health nursing directors' perceptions regarding interagency collaboration with community mental health agencies

Involvement in collaborative interagency relationships is crucial to the future of public health nursing and public health agencies. The purpose of this study was to describe public health nursing directors' perceptions regarding relationships between public health agencies and mental health agencies in their communities. A secondary analysis was conducted of textual responses to open-ended questions and unsolicited comments from 71 (55%) the of respondents to a larger survey of nursing directors of all public health agencies in Ohio. Data were analyzed inductively using content analysis for emergent themes and patterns, which were organized and classified deductively according to a community interagency collaboration framework. Public health nursing directors described environmental, situational, task, and interagency factors that impact collaboration between their agencies and local community mental health agencies. These descriptions provide a context for understanding impediments to collaboration between these two types of agencies, and have implications for designing interventions to enhance public health nursing directors' skills at marketing both their profession and their agencies. Collaborative relationships between public health and mental health agencies could improve care for community-dwelling persons with severe mental disabilities and enhance the future of public health nursing in a changing, competitive health care system.

Social, community, and preventive interventions

Psychology can and should be at the forefront of participation in social, community, and preventive interventions. This chapter focuses on selective topics under two general areas: violence as a public health problem and health promotion/competence promotion across the life span. Under violence prevention, discussion of violence against women, youth violence, and child maltreatment are the focal points. Under health and competence promotion, attention is paid to the prevention of substance abuse and HIV/AIDS. We highlight a few significant theoretical and empirical contributions, especially from the field of community/prevention psychology. The chapter includes a brief overview of diversity issues, which are integral to a comprehensive discussion of these prevention efforts. We argue that the field should extend its role in social action while emphasizing the critical importance of rigorous research as a component of future interventions.