Use of a Model Maturity Matrix to Build a Quality Improvement Infrastructure for Psychiatric Care.

Despite a call to action by accreditation bodies and payers alike, the infrastructure needed to continuously improve the quality and safety of behavioral health care has been slow to develop. The causes of this are complex and multifactorial yet likely include underdeveloped leadership and capacity to sustainably improve the quality of psychiatric care. This article proposes the use of a quality improvement maturity matrix to serve as both an implementation strategy and a self-assessment measure to strategically guide this infrastructure development. The matrix describes six phases of development across three domains that are generalizable to various behavioral health care settings.

Leveraging Health Information Technology to Meet The Joint Commission's Standard for Measurement-Based Care: A Case Study.

INTRODUCTION: Three decades of research have shown that routinely collecting patient-reported outcomes throughout treatment to inform clinical decision making or measurement-based care (MBC) can improve clinical outcomes, yet widespread adoption continues to be elusive. APPROACH: This article describes how a community behavioral health center addressed Element of Performance (EP) 1 of The Joint Commission's revised MBC standard using health information technology (HIT)-facilitated MBC and a comprehensive implementation plan grounded in the Consolidated Framework for Implementation Research. RESULTS: Across the initial 15-month implementation period, 96.8% of patients who had an intake evaluation also completed baseline measurements via an HIT known as a measurement feedback system (MFS), and 91.5% (78.6%-100%) completed at least one repeated measure. CONCLUSION: MFS reduces many of the logistical barriers of MBC, but implementation of MFS-facilitated MBC requires a comprehensive implementation plan that includes strategies to address barriers across all relevant domains for successful uptake.

Weakness after gastric bypass.

Two patients underwent gastric bypasses and had uneventful hospital courses. In the early postoperative periods, both developed severe, protracted vomiting, weakness, and hyporeflexia. After thorough laboratory and clinical evaluations by neurologists, the patients were diagnosed with Guillain-Barré syndrome, although there were many atypical features. The clinical presentations of these patients are very similar to case reports of nutritional polyneuropathy associated with gastric partitioning. This paper addresses the difficulties of differentiating these two diagnoses.