Participatory System Dynamics vs Usual Quality Improvement: Staff Use of Simulation as an Effective, Scalable and Affordable Way to Improve Timely Mental Health Care?

2020 ◽

Vol 1 (1) ◽

pp. 31-35 ◽

Cited By ~ 1

Author(s):

Patrick Daigle ◽

Abraham Rudnick

Keyword(s):

Mental Health ◽

Health Care ◽

Quality Improvement ◽

Mental Health Care ◽

Health Care Quality ◽

Care Quality ◽

Health Clinic ◽

Quality Improvement Initiative ◽

Service Users ◽

Specialized Mental Health

This paper presents an organizational (ambulatory) case study of shifting mental health care from in-person to remote service delivery due to the current (COVID-19) pandemic as a rapid quality improvement initiative. Remotely delivered mental health care, particularly using synchronous video and phone, has been shown to be cost-effective, especially for rural service users. Our provincial specialized mental health clinic rapidly shifted to such remote delivery during the current pandemic. We report on processes and outputs of this rapid quality improvement initiative, which serves a purpose beyond pandemic circumstances, such as improving access to such specialized mental health care for rural and other service users at any time. In conclusion, shifting specialized mental health care from in-person to remotely delivered services as much as possible could be beneficial beyond the current pandemic. More research is needed to optimize the implementation of such a shift.

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Systems monitoring and quality improvement

10.1093/med/9780199360574.003.0066 ◽

2015 ◽

Cited By ~ 1

Author(s):

Jeffrey L. Metzner

Keyword(s):

Mental Health ◽

Health Care ◽

Quality Improvement ◽

Mental Health Care ◽

Health Care System ◽

Class Action ◽

Mental Health Care System ◽

Monitoring Process ◽

Consent Decrees ◽

Correctional Mental Health

Class action litigation that includes a focus on constitutionally inadequate correctional mental health care systems has been a major and effective force in jail and prison reform during the past four decades. Benefits to correctional mental health systems resulting from such litigation have included increased resources needed to implement basic policies and procedures that are necessary for a constitutionally adequate system. Following the passage of the Prison Litigation Reform Act of 1995, newly initiated consent decrees related to class action litigation involving correctional mental health services significantly decreased. The reduction in litigation related to this act followed from limiting the discretion of judges in approving such decrees that were previously allowed. Private settlement agreements and/or memoranda of agreement or their equivalents (the “Agreement”) have been substituted for the consent decree process. Although the judicial enforcement specific to implementation of these Agreements is weak, the monitoring process of such Agreements is very similar to those previously used with consent decrees. This chapter will summarize the monitoring process frequently involved in an Agreement resulting from a class action lawsuit specific to a correctional mental health care system using a single prison mental health system as an illustrative example. Emphasis will be placed on the importance of developing a quality improvement process that should ultimately eliminate the need for a monitor external to the mental health care system.

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Addressing distress in head and neck cancer patients: A quality improvement project.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.43 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 43-43

Author(s):

Natalie Riblet ◽

Karen Skalla ◽

Alison Peterson ◽

Auden McClure ◽

Karen Homa ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Head And Neck Cancer ◽

Quality Improvement ◽

Mental Health Care ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Medical Oncology ◽

Senior Leadership

43 Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. Methods: Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. Results: Prior to January 2011, identification of distress was based on provider’s clinical assessment. Of 104 patients seen between November 2010 and January 2011, 25% (26) were diagnosed with psychological problems. Cause-effect diagraming suggested that lack of a formalized process for distress assessment contributed to missed diagnoses. Providers were unfamiliar with mental health resources. As reported in Psycho-Oncology 21(Suppl. 1): 51(2012) after implementing process changes, bi-weekly distress screening rates rose from 0% to 38% between January and July 2011. With additional PDSA cycles, these rates increased to 74% between October 2011 and April 2012. Similar to proposed benchmarks, 84% (47) of newly diagnosed patients (56) were assessed for distress. Furthermore, of 138 unique patients seen, 71% (98) were screened for distress and 47% (46) of these had heightened distress. Providers addressed the needs of all those identified. Improvement was attributed to the empowerment of staff and participation of senior leadership. Barriers included a heavy reliance on the presence of trained staff. Conclusions: Quality improvement methods can be applied to the cancer setting in order to create systems of care, which more reliably identify and address distress. Teams, however, must be invested in the work and receive support from senior leadership.

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PUBLIC POLICY SESSION 1: USING QUALITY IMPROVEMENT AND INTEGRATING MENTAL HEALTH CARE TO IMPROVE SOCIAL DETERMINANTS OF HEALTH

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2019.07.004 ◽

2019 ◽

Vol 27 (3) ◽

pp. S223

Author(s):

Adrienne Mims

Keyword(s):

Mental Health ◽

Health Care ◽

Public Policy ◽

Quality Improvement ◽

Mental Health Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health

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Paving the way for electronic patient-centered measurement in team-based primary care: an integrated knowledge translation approach (Preprint)

10.2196/preprints.33584 ◽

2021 ◽

Author(s):

Selena Davis ◽

Marcy Antonio ◽

Mindy Smith ◽

Paul Burgener ◽

Danielle C. Lavallee ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Quality Improvement ◽

Knowledge Translation ◽

Mental Health Care ◽

Integrated Knowledge Translation ◽

Care Pathways ◽

Patient Portal ◽

Integrated Knowledge

BACKGROUND Patient-centred measurement (PCM) aims to improve overall quality of care through the collection and sharing of patients’ values and perspectives. Yet, the use of PCM in care team decisions remains limited. Integrated knowledge translation (IKT) offers a collaborative, adaptive approach to explore best practices for incorporating PCM into primary care practices by involving knowledge users, including patients and providers, in the exploratory process. OBJECTIVE (i) test the feasibility of using patient-generated data (PGD) in team-based care; (ii) describe use of these data for team-based mental health care; and (iii) summarize patient and provider care experiences with PCM. METHODS We conducted a multi-methods exploratory study in a rural team-based primary care clinic using IKT to co-design, implement and evaluate use of PCM in team-based mental health care. Care pathways, workflows, and quality improvement activities were iteratively adjusted to improve integration efforts. Patient and provider experiences were evaluated using individual interviews relating use of PCM and patient portal in practice. All meeting notes, interview summaries, and emails were analyzed to create a narrative evaluation. RESULTS During co-design, a care workflow was developed for incorporating electronically-collected PGD from the patient portal into the electronic medical record (EMR), and customized educational tools and resources were added. During implementation, care pathways and patient workflows for PCM were developed. Patients found portal use easy, educational, and validating, but data entries were not used during care visits. Providers saw the portal as extra work and lack of portal/EMR integration was a major barrier. The IKT approach was invaluable for addressing workflow changes and understanding ongoing barriers to PCM use and quality improvement. CONCLUSIONS Although the culture towards PCM is changing, use of PCM during care was not successful. Patients felt validated and supported through portal use and could be empowered to bring these data to their visits. Training, modeling, and adaptable PCM methods are needed before PCM can be integrated into routine care.

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