ABSTRACT
OBJECTIVE: Practice variations in the diagnosis, treatment, and outcomes of patients with major depression were examined within six psychiatric practices participating in a national outcomes-management project. METHODS: Six of 20 psychiatric clinics met selection criteria for this study and provided a database of 5, 106 patients. Patients completed the BASIS-32, the Short-Form-36 Health Survey, and a Beginning Services Survey. Treatment information was also obtained directly from the clinician or through a medical record review. RESULTS: Although 73.1 to 77 percent of patients screened positive for a depressive disorder, only 18.5 to 36.8 percent were diagnosed with major depression (p<.001). Between 39 and 72 percent of patients received psychotropic medications, a significant difference across sites (p<.001). In addition, the number of psychotherapy sessions was significantly different across sites (p<.001). CONCLUSIONS: Patient care varies considerably across psychiatric practices, a finding that is particularly relevant for developers of performance indicators and risk-adjustment strategies for mental health.
Subject(s)
Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/therapy , Practice Patterns, Physicians' , Psychiatry/trends , Psychotropic Drugs/therapeutic use , Adult , Catchment Area, Health , Depressive Disorder, Major/epidemiology , Female , Humans , Male , Mental Health Services/organization & administration , Middle Aged , Outcome Assessment, Health Care , Patient Compliance , Psychotherapy/methods , Surveys and Questionnaires , Treatment Outcome , United StatesABSTRACT
Group practices have enhanced the accessibility and quality of care through continuous innovation and performance improvement initiatives. However, sustaining a quality infrastructure can be costly. Will purchasers and consumers demand a group-model delivery system that provides accessible, effective, accountable, efficient, and coordinated care when network-models with little overhead can provide basic services for less? Here's how groups in the Institute for Behavioral Healthcare's (IBH) Council of Behavioral Group Practices are innovating to sustain excellence and superior performance.
Subject(s)
Group Practice/organization & administration , Mental Health Services/organization & administration , Organizational Innovation , Total Quality Management/economics , Community Networks/organization & administration , Education, Continuing , Group Practice/economics , Group Practice/standards , Health Services Accessibility , Mental Health Services/economics , Mental Health Services/standards , United StatesABSTRACT
Provider organizations are under increased pressure from payors to produce outcomes data that demonstrate the effectiveness of their treatment services. More and more, providers are collaborating on joint outcomes projects that allow them to benchmark their results with similar organizations. Here are five brief descriptions of such projects. They span a wide spectrum of organizations and include hospitals and comprehensive healthcare systems, behavioral group practices, child welfare agencies, and psychosocial rehabilitation programs. Part one begins below, part two, on page 45.
Subject(s)
Databases, Factual , Mental Health Services/standards , Outcome Assessment, Health Care , Accreditation , Centers for Medicare and Medicaid Services, U.S. , Child , Child Welfare , Cost-Benefit Analysis , Efficiency, Organizational , Group Practice/organization & administration , Group Practice/standards , Health Maintenance Organizations/organization & administration , Health Services Research , Humans , Joint Commission on Accreditation of Healthcare Organizations , Mental Disorders/rehabilitation , Mental Disorders/therapy , Mental Health Services/organization & administration , Social Responsibility , United StatesABSTRACT
Report cards for healthcare services are increasingly in the news, offering the hope that objective information on the quality of health plan and providers services will eventually enable purchasers and consumers to make selections based on true value. Following is a series of five brief articles that review ongoing report card initiatives in private and public sectors of the behavioral healthcare system. The first four articles review actual report cards designed to hold organizations--particularly managed care--accountable for the quality of their services. The last article reviews research on performance measurement across all segments of the behavioral healthcare industry.
Subject(s)
Information Services , Managed Care Programs/standards , Mental Health Services/standards , Quality Assurance, Health Care/standards , Data Collection , Humans , Mental Disorders/therapy , Patient Satisfaction , United StatesABSTRACT
Capitation is more than just a challenge for the behavioral healthcare industry. It also presents an opportunity to develop comprehensive systems of care--driven by the appropriate use of technology and of quality methods--that will meet the needs of designated populations.
Subject(s)
Capitation Fee , Insurance, Psychiatric/trends , Managed Care Programs/trends , Comprehensive Health Care/economics , Comprehensive Health Care/organization & administration , Comprehensive Health Care/standards , Forecasting , Managed Care Programs/economics , Managed Care Programs/standards , Management Information Systems/trends , Patient Satisfaction , Quality of Health Care/standards , United StatesABSTRACT
Clinical and administrative roles and skills have similarities and differences. The clinician who moves from principle clinical responsibility to principle administrative responsibility must learn which behaviors are facilitating and productive and which are impeding. This communication describes the similarities and differences between therapeutic and administrative behaviors and some of the potential difficulties at times of transition. It also advises about preparatory educational experiences in the course of training. The authors call attention to the applications of the field of Social Psychiatry to the questions raised.
