1
|
Haight RJ, Di Polito CN, Payne GH, Bostwick JR, Fulbright A, Lister JF, Williams AM. Psychotropic stewardship: Advancing patient care. Ment Health Clin 2023; 13:36-48. [PMID: 37063939 PMCID: PMC10094994 DOI: 10.9740/mhc.2023.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/15/2023] [Indexed: 04/18/2023] Open
Abstract
Board Certified Psychiatric Pharmacists (BCPPs) practice in a variety of inpatient and outpatient health care settings as part of collaborative, multidisciplinary teams. The American Association of Psychiatric Pharmacists (AAPP) has promoted the expansion of psychiatric pharmacy through the development of psychotropic stewardship programs (PSPs). Based on the standards developed during the creation and expansion of antimicrobial stewardship programs, psychotropic stewardship promotes the safe and appropriate use of psychotropic medications. AAPP envisions every patient with a psychiatric diagnosis will have their medication treatment plan reviewed, optimized, and managed by a psychotropic stewardship team with a psychiatric pharmacist as a co-leader. Because of variations in practice site resources, patient populations, and provider collaboration, the creation and implementation of PSPs should be based on site-specific needs and opportunities. Initial patient identification could prioritize those prescribed multiple medications, high-risk psychotropics, or comorbid medical diagnoses. However, every patient prescribed a psychotropic medication should have the opportunity to work with a PSP. Incremental implementation may be required during the planning stages of stewardship teams. Use of clinical practice-related core outcomes will allow for the optimization of program resources, increased recognition, and improved patient outcomes. PSPs should be patient-focused and integrate patients' preferences and access to recommended treatment options. The eventual goal of PSP implementation is official recognition by key regulatory agencies as a standard of care for patients who receive a diagnosis of a psychiatric or substance use disorder.
Collapse
Affiliation(s)
- Robert J Haight
- Clinical Pharmacist - Southern Cities Clinic & Forensic Services, Saint Peter Regional Treatment Center (SPRTC), Minnesota Department of Human Services, Saint Peter, Minnesota,
| | - Chelsea N Di Polito
- Assistant Director, Pharmacy Administration - Clinical Services, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Gregory H Payne
- Director of Strategic Initiatives, American Association of Psychiatric Pharmacists, Lincoln, Nebraska
| | - Jolene R Bostwick
- Assistant Dean for Co-Curriculum and Professional Development & Clinical Professor, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - April Fulbright
- Clinical Pharmacist, Caromont Regional Medical Center, Gastonia, North Carolina
| | - Jonathan F Lister
- Clinical Pharmacy Practitioner, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Andrew M Williams
- Supervising Clinical Pharmacist Behavioral Health Pharmacies, Riverside University Health System, Riverside, California
| |
Collapse
|
2
|
Hospital Partnerships for Population Health: A Systematic Review of the Literature. J Healthc Manag 2021; 66:170-198. [PMID: 33960964 DOI: 10.1097/jhm-d-20-00172] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
EXECUTIVE SUMMARY The U.S. healthcare system continues to experience high costs and suboptimal health outcomes that are largely influenced by social determinants of health. National policies such as the Affordable Care Act and value-based payment reforms incentivize healthcare systems to engage in strategies to improve population health. Healthcare systems are increasingly expanding or developing new partnerships with community-based organizations to support these efforts. We conducted a systematic review of peer-reviewed literature in the United States to identify examples of hospital-community partnerships; the main purposes or goals of partnerships; study designs used to assess partnerships; and potential outcomes (e.g., process- or health-related) associated with partnerships. Using robust keyword searches and a thorough reference review, we identified 37 articles published between January 2008 and December 2019 for inclusion. Most studies employed descriptive study designs (n = 21); health needs assessments were the most common partnership focus (n = 15); and community/social service (n = 21) and public health organizations (n = 15) were the most common partner types. Qualitative findings suggest hospital-community partnerships hold promise for breaking down silos, improving communication across sectors, and ensuring appropriate interventions for specific populations. Few studies in this review reported quantitative findings. In those that did, results were mixed, with the strongest support for improvements in measures of hospitalizations. This review provides an initial synthesis of hospital partnerships to address population health and presents valuable insights to hospital administrators, particularly those leading population health efforts.
Collapse
|
3
|
Berkowitz SA, Parashuram S, Rowan K, Andon L, Bass EB, Bellantoni M, Brotman DJ, Deutschendorf A, Dunbar L, Durso SC, Everett A, Giuriceo KD, Hebert L, Hickman D, Hough DE, Howell EE, Huang X, Lepley D, Leung C, Lu Y, Lyketsos CG, Murphy SME, Novak T, Purnell L, Sylvester C, Wu AW, Zollinger R, Koenig K, Ahn R, Rothman PB, Brown PMC. Association of a Care Coordination Model With Health Care Costs and Utilization: The Johns Hopkins Community Health Partnership (J-CHiP). JAMA Netw Open 2018; 1:e184273. [PMID: 30646347 PMCID: PMC6324376 DOI: 10.1001/jamanetworkopen.2018.4273] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland. OBJECTIVE To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending. DESIGN, SETTING, AND PARTICIPANTS Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents. INTERVENTIONS The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations. MAIN OUTCOMES AND MEASURES Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants. RESULTS The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings. CONCLUSIONS AND RELEVANCE A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.
Collapse
Affiliation(s)
- Scott A. Berkowitz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kathy Rowan
- NORC at the University of Chicago, Bethesda, Maryland
| | | | - Eric B. Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michele Bellantoni
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel J. Brotman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Samuel C. Durso
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anita Everett
- Substance Abuse Mental Health Services Administration, Department of Health and Human Services, Washington, DC
| | | | | | | | - Douglas E. Hough
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric E. Howell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuan Huang
- Johns Hopkins HealthCare, Glen Burnie, Maryland
| | - Diane Lepley
- Johns Hopkins Health System, Baltimore, Maryland
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, Maryland
| | - Yanyan Lu
- Johns Hopkins HealthCare, Glen Burnie, Maryland
| | | | | | - Tracy Novak
- Johns Hopkins Health System, Baltimore, Maryland
| | | | | | - Albert W. Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ray Zollinger
- Johns Hopkins Community Physicians, Baltimore, Maryland
| | - Kevin Koenig
- NORC at the University of Chicago, Bethesda, Maryland
| | - Roy Ahn
- NORC at the University of Chicago, Bethesda, Maryland
| | - Paul B. Rothman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
4
|
Conway SJ, Himmelrich S, Feeser SA, Flynn JA, Kravet SJ, Bailey J, Hebert LC, Donovan SH, Kachur SG, Brown PM, Baumgartner WA, Berkowitz SA. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices. Popul Health Manag 2018; 21:357-365. [DOI: 10.1089/pop.2017.0149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - John A. Flynn
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | | - Susan H. Donovan
- Primary Care Coalition of Montgomery County Maryland, Silver Spring, Maryland
| | | | | | | | | |
Collapse
|
5
|
Hsiao YL, Bass EB, Wu AW, Richardson MB, Deutschendorf A, Brotman DJ, Bellantoni M, Howell EE, Everett A, Hickman D, Purnell L, Zollinger R, Sylvester C, Lyketsos CG, Dunbar L, Berkowitz SA. Implementation of a comprehensive program to improve coordination of care in an urban academic health care system. J Health Organ Manag 2018; 32:638-657. [PMID: 30175678 DOI: 10.1108/jhom-09-2017-0228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose Academic healthcare systems face great challenges in coordinating services across a continuum of care that spans hospital, community providers, home and chronic care facilities. The Johns Hopkins Community Health Partnership (J-CHiP) was created to improve coordination of acute, sub-acute and ambulatory care for patients, and improve the health of high-risk patients in surrounding neighborhoods. The paper aims to discuss this issue. Design/methodology/approach J-CHiP targeted adults admitted to the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, patients discharged to participating skilled nursing facilities (SNFs), and high-risk Medicare and Medicaid patients receiving primary care in eight nearby outpatient sites. The primary drivers of the program were redesigned acute care delivery, seamless transitions of care and deployment of community care teams. Findings Acute care interventions included risk screening, multidisciplinary care planning, pharmacist-driven medication management, patient/family education, communication with next provider and care coordination protocols for common conditions. Transition interventions included post-discharge health plans, hand-offs and follow-up with primary care providers, Transition Guides, a patient access line and collaboration with SNFs. Community interventions involved forming multidisciplinary care coordination teams, integrated behavioral care and new partnerships with community-based organizations. Originality/value This paper offers a detailed description of the design and implementation of a complex program to improve care coordination for high-risk patients in an urban setting. The case studies feature findings from each intervention that promoted patient engagement, strengthened collaboration with community-based organizations and improved coordination of care.
Collapse
Affiliation(s)
- Ya Luan Hsiao
- Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Albert W Wu
- Johns Hopkins University Bloomberg School of Public Health and Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | | | | | - Daniel J Brotman
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | | | - Eric E Howell
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Anita Everett
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Debra Hickman
- Sisters Together and Reaching, Baltimore, Maryland, USA
| | - Leon Purnell
- Men and Families Center, Baltimore, Maryland, USA
| | | | | | | | - Linda Dunbar
- Johns Hopkins HealthCare LLC, Baltimore, Maryland, USA
| | - Scott A Berkowitz
- Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| |
Collapse
|
6
|
|
7
|
Schmit MK, Watson JC, Fernandez MA. Examining the Effectiveness of Integrated Behavioral and Primary Health Care Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12173] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael K. Schmit
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
- Now at Department of Counseling and Higher Education, University of North Texas
| | - Joshua C. Watson
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
| | - Mary A. Fernandez
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
| |
Collapse
|
8
|
Case Study: Johns Hopkins Community Health Partnership: A model for transformation. Healthcare (Basel) 2016; 4:264-270. [DOI: 10.1016/j.hjdsi.2016.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/23/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022] Open
|