breakout understanding mental health management tools for ... conference presentations/day 2... ·...

Understanding Mental Health Management Tools for Mental Health

Performance Improvement

Jodie Trafton, PhD – Office of Mental Health OperationsCliff Smith, PhD, ABPP – Iron Mountain VA Medical CenterDan Kivlahan, PhD – Mental Health ServicesLisa Kearney, PhD, ABPP – Office of Mental Health Operations

VETERANS HEALTH ADMINISTRATION

Objectives for the Breakout

Identify common tools for management in mental health: MH Management Dashboard, SAIL, MHOB, MHIS, ACAP tools)

Identify methods for utilizing these tools for performance improvement through creation and monitoring of local strategic action plans.

Identify strategies for discussing MH SAIL and MH Management Planning Tool with Executive Leadership

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MH Management Discussions with the MH Management Tool

• MH Management Tool consolidates data from multiple sources to provide a view of key resource, environment, process and eventually outcome measures to help understand facility challenges and facilitate problem-solving

• The tool complements findings from the MH Domain of the SAIL to improve understanding of the drivers of performance on SAIL.

• Discussed in quarterly meetings between OMHO leadership, VISN MH Leads and other VISN and facility leadership, leading to action planning as needed at the facility, VISN and VACO level.

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MH Management Discussions with the MH Management Tool

• Discussion designed to identify higher level/systems solutions to challenges that are not feasibly solved via actions at the local MH program level

• Opportunity for local MH programs to get help with challenges (e.g. space constraints, high growth rates, lack of availability of providers for recruitment).

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Mental Health Management Tool

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Mental Health Management Tool

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Mental Health Plan Data (1)Clinical Outcomes (TBD), Satisfaction, Continuity of Care,

Missed Opportunities

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Mental Health Plan Data (2)Wait Times, Population Access, Staffing, Space

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Mental Health Plan Data (3)Productivity, PCMHI, Telemental Health, Growth; Gaps

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Onboard MH Clinical FTE and Productivity• Facility and provider level data on MH encounters, outpatient

MH clinical hours/FTE, and outpatient MH clinical productivity (by pay period)

• Revised VSSC dashboard will display additional data– Include inpatient mental health and homeless providers– Allow provider type summaries.– Currently available as custom excel reports from OMHO PERC

• Used to track adequacy of MH staff to patient ratios (e.g. on MH Management Tool)

• Used to monitor MH provider productivity per the MH Productivity Directive

Available here: https://securereports2.vssc.med.va.gov/Reports/Pages/Report.aspx?ItemPath=%2fMentalHealth%2fMHOB%2fMHOB_Summary

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Tracking Consult Management and Response

• Consult is needed to make all mental health referrals that cut across programs of care, including:– From one mental health program to another (e.g., general

outpatient MH to PCT)– From a non-mental health setting to mental health

setting (e.g., endocrinology to MH; Homeless Program to MH)

– From one facility to another facility for MH services (interfacility consults)

MH Consult Dashboard https://spsites.dwh.cdw.portal.va.gov/sites/OMHO_Consult/_layouts/ReportServer/RSViewerPage.aspx?rv:RelativeReportUrl=/sites/OMHO_Consult/AnalyticsReports/TimelinessMatrixReport.rdl&Source=https://spsites.dwh.cdw.portal.va.gov/sites/OMHO_Consult/AnalyticsReports/Forms/AllItems.aspx&DefaultItemOpen=1

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Mental Health Information System• Presents over 200 metrics designed to track adherence to

requirements in the Uniform Mental Health Services Handbook

• Broken into domains. Items that are extreme outliers (e.g. 1.5 to 2 standard deviations from the facility mean) in the non-desired direction are flagged.

• Used to guide identification of challenges and strengths for the site visit and action planning, and strong practices programs.

• Summary metrics for the Psychotropic Drug Safety Initiative have been added.

http://reports2.vssc.med.va.gov/Reports/Pages/Report.aspx?ItemPath=%2fMentalHealth%2fMHInformationSystem%2fMHInformationSystem

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Psychotropic Drug Safety Initiative

• Includes summary and real-time actionable patient tools to encourage review and process improvement in common areas of non-optimal mental health prescribing

• Real-time tools enable proactive panel management-based approaches to improving care quality– Facilitate clinical implementation of panel-management based

care practices, with plans to expand these tools into additional care domains (e.g. evidence-based psychotherapy, risk mitigation, etc.)

• Facility efforts on PDSI last year were associated with improvements in clinical practice patterns

https://spsites.dwh.cdw.portal.va.gov/sites/OMHO_PsychPharm/Pages/Real-Time-PDSI-Dashboard.aspx

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Tools to improve tracking of implementation of new initiatives

• Overdose Education and Naloxone Distribution: new initiative to provide at risk patients overdose education and naloxone kits to reverse opioid overdose

https://spsites.dwh.cdw.portal.va.gov/sites/OMHO_PsychPharm/_layouts/ReportServer/RSViewerPage.aspx?rv:RelativeReportUrl=/sites/OMHO_PsychPharm/AnalyticsReports/HeatMapOEND.rdl&Source=https%3A%2F%2Fspsites%2Edwh%2Ecdw%2Eportal%2Eva%2Egov%2Fsites%2FOMHO%5FPsychPharm%2FAnalyticsReports%2FForms%2FAllItems%2Easpx&DefaultItemOpen=1

• Evidence-based Psychotherapy Templates: improve adherence to and documentation of use of selected evidence-based psychotherapy protocols.

https://spsites.dwh.cdw.portal.va.gov/sites/OMHO_PsychPharm/_layouts/ReportServer/RSViewerPage.aspx?rv:RelativeReportUrl=/sites/OMHO_PsychPharm/AnalyticsReports/EBPTemplates_HeatMap.rdl&Source=https%3A%2F%2Fspsites%2Edwh%2Ecdw%2Eportal%2Eva%2Egov%2Fsites%2FOMHO%5FPsychPharm%2FAnalyticsReports%2FForms%2FAllItems%2Easpx&DefaultItemOpen=1

• Tools identify sites where implementation has been started and tracks uptake of new practices

• Provides maps and tables of counts of kits distributed and templates used at each facility

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How Can I Possibly Utilize All These Dashboards?

Identify what is important for you to measure from a quality improvement perspective and utilized the associated measures to track progress over time

Delegate responsibility to appropriate team members so that each team owns their own data

Identify what is important to leadership and to Veterans related to administrative and clinical outcomes and find ways to measure and report back on progress

Create a regular timeline for data extraction and reporting to be used in regular meetings with all stakeholders

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Additional Available Tools

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Know Your Grid

• Understand your provider’s grid– 20 hours (502, 513 slots) for individual psychotherapy– Two 2 hour blocks (516, 550 slots) for group psychotherapy– 5 hours (502, 513 slots) for access (walk‐in, crisis management)

8:00 AM 9:00 AM 10:00 AM 11:00 AM12:00 noon 1:00 PM 2:00 PM 3:00 PM 4:00 PM

Monday Clinic Clinic access Clinic admin Clinic ClinicTuesday Clinic Clinic Clinic Clinic Dep Group access

Wednesday Dept & other meetings access Clinic PTSD Grp

EBP consult (admin)

Thursday admin Clinic Clinic Clinic Clinic Clinic access

Friday Clinic Clinic access Clinic admin Clinic Clinic


Know your Tools

Pay Period 19 20 21 22 23 24

MH Outpatient Encounters 59 37 49 48 52 42

Total Outpatient Encounters 59 37 49 48 52 42

MH Outpatient Clinical Hours 80.00 72.00 80.00 80.00 80.00 80.00

Total Hours Worked 80.00 72.00 80.00 80.00 80.00 80.00

MH Outpatient Clinical FTE 1.00 0.90 1.00 1.00 1.00 1.00

wRVU 102.81 73.47 79.89 89.53 84.66 76.67

Demand-Supply-Activity (Slots) 2/28/2015 Total Slot Demand 340

Adjusted Slot Demand 303

Slot Supply (Total Slots) 685

Calculated Slot Activity (CheckedOut Slots) 238

Clinic Slot Utilization 34.70% 238 685

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Access Level Measures

Access Glide Path

Facility, VISN, Peer Group, National

3rd Next Available, Missed Opportunities, Cancelled by Clinic.

http://reports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fMgmtReports%2fAccess%2fAccessGlidePath&rs:Command=Render

Access Clinic Index

National, VISN Facility, Provider Clinic

Octane Missed Opportunities, Cancelled by Clinic; clinic utilization, appointment length

http://bi.vssc.med.va.gov/sysredesign/Dashboards/Clinic%20Access%20Index/Clinic%20Access%20Index%20‐%20Mental%20Health.aspx

Access Clinic Index (v2)

National, VISN Facility, Provider Clinic

Octane Missed Opportunities, Cancelled by Clinic; clinic utilization, appointment length

http://bi.vssc.med.va.gov/sysredesign/Dashboards/Clinic%20Access%20Index%20V2/Clinic%20Access%20Index%20‐%20Mental%20Health.aspx

Specialty Care Compass (SCC)

VISN, Facility 500 series Section and Clinic Level ‐ 3rd

next available, New Patient Wait Time (days), Octane level

https://securereports2.vssc.med.va.gov/Reports/Pages/Report.aspx?ItemPath=%2fTeleHealth%2fSCC_Master

Top 50 Clinic Dashboard

National, VISN, Facility

502, 509, 510, 513, and 540 clinic access measures

http://bi.vssc.med.va.gov/ReportsLibrary/Top%2050%20Clinics/Top%2050%20Clinic%20Dashboard.aspx

Consult Dashboard

National, VISN, Facility

Open Consults by department

https://securereports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSystems+Redesign%2fConsults%2fConsult_Switchboard&rs:Command=Render

MH Consult SharePoint

Definitions https://vaww.portal.va.gov/sites/OMHS/implementation/default.aspx


Missed Opportunities – A critical opportunity

• Missed Opportunities can be thought of as true no-shows.– VHA defines missed opportunities as the sum of 3 individual data

elements: No Shows (appointments marked in the computer by the clerical associate as having no-showed); Cancelled by Clinic After the Appointment time (CCAA) or Cancelled by Patient After the Appointment time (PCAA).

– The Missed Opportunity Rate is calculated by counting the number of Missed Opportunities (numerator) and dividing by the number of Checked Out Appointments plus the number of missed opportunities (denominator). A lower percentage is the better. The current national Missed Opportunity Rate target is 10% or lower for the Top 50 clinics.

• Source: WaitTimeCancel cube.• Numerator: [No Show] + [CCAA] + [PCAA] • Denominator: [Checked Out Appointments] + [No Show] + [CCAA] + [PCAA]

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Missed Opportunity (Call List)

VAMC High probability no show

https://securereports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSystems+Redesign%2fMissed+Opportunity+Call+List&rs:Command=Render

Clinic Utilization Cube

National, VISN, Facility, CBOC

% Clinics Utilized, Encounters for Mental Health

Clinic Utilization Cube: http://fcdm.vssc.med.va.gov/Cube%20Library/Document%20Library/Clinic%20Utilization.bbk

Clinic Utilization (ProClarity web)

National, VISN, Facility, CBOC

% Clinics Utilized, Encounters for Mental Health

http://vaww.fcdm.med.va.gov/pas/en/src/proclarity.asp?uiConfig=&book={D1D16D2E‐B922‐4075‐A01C‐3C45EB6CAE84}&page={4481004C‐B1B3‐4717‐B4A4‐71FE595CB80C}&folder=root&LibID={4AEC1B7E‐468E‐4859‐A92C‐8E412E095D71}

Yearly Clinic Utilization

VISN, Facility

Yearly Clinic (Stop Code) Encounters

http://vaww.fcdm.med.va.gov/pas/en/src/proclarity.asp?uiConfig=&book=Favorites&page={DFFB0F62‐4429‐442F‐8DF6‐9B34FCAA3680}&folder={2A6A61E2‐A945‐487B‐B7DA‐FFF36FCA498E}&LibID=

ARC Data sites https://vaww2.arc.med.va.gov/secure/main.asp?cd=S585CS7&salias=vhairosmithc

CUSS Report VAMC Stop Code http://vssc.med.va.gov/webrm/cussrpt.aspx

Encounter Action Required Report (EARR)

VISN, VAMC, CBOC

Encounters with errors

https://securereports2.vssc.med.va.gov/Reportserver/Pages/ReportViewer.aspx?%2fWorkload%2fEARR%2fEARRSummary&rs:Command=Render&rs:ClearSession=TRUE

Encounter Closeout

Facility Encounter needing closed

https://securereports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fWorkload%2fOutpt%2fWorkload_Closeout&rs:command=Render


Encounters = Productivity

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(V12) (537) Jesse Brow n VAMC (Chicago), IL 1,137 39,257 246 4,292 21

(V12) (676) Tomah, WI 230 14,907 36 1,072 8

(V12) (578) Hines, IL 1,423 50,959 324 6,539 83

(V12) (556) Captain James A Lovell FHCC 530 25,447 148 1,712 14

(V12) (607) Madison, WI 1,172 27,917 106 1,955 33

(V12) (695) Milw aukee, WI 1,664 49,691 249 5,504 34

(V12) (585) Iron Mountain, MI 243 12,763 31 567 2

MAY-FY15 Inpatient

Encounters not closed

V12 6,399 220,941 1,140 21,641 195

Facility Encounters with Action Required

Status

MAY-FY15 Total

Outpatient Encounters

MAY-FY15 Outpatient Encounters not closed

MAY-FY15 Total

Inpatient Encounters


Mental Health Outcomes Oriented Quality Metrics

• Dashboard of metrics representing National Quality Forum domains of key outcomes

• Includes metrics that:– Characterize patient populations seen at a facility (e.g.

smoking and risky alcohol use rates)– Track clinical processes linked to important patient

outcomes in VA studies (e.g. loss to care for SMI patients)– Track rates of undesirable MH treatment utilization (e.g.

emergency or inpatient visits)• May be helpful for identifying special treatment needs of

local population, and clinical processes improve patient treatment outcomes

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MHTC1 patient detail report

• Helps to identify unassigned patients who require a Mental Health Treatment Coordinator

• May also help identify patient appropriate for BHIP team assignment

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Resource List• MH Management Dashboard available from VISN MH leads • SAIL available at:

http://reports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fMgmtReports%2fVATR%2fSAIL_Prod%2fSAIL&rs:Command=Render

• SAIL MH Domain Components Summary available at:https://spsites.dev.dwh.cdw.portal.va.gov/sites/OMHO_PEC/_layouts/ReportServer/RSViewerPage.aspx?rv:RelativeReportUrl=/sites/OMHO_PEC/AnalyticsReports/MHDomainCompositeSummary.rdl&Source=https%3A%2F%2Fspsites%2Edev%2Edwh%2Ecdw%2Eportal%2Eva%2Egov%2Fsites%2FOMHO%5FPEC%2FAnalyticsReports%2FForms%2FAllItems%2Easpx&DefaultItemOpen=1

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Resource List• Onboard Mental Health Clinical FTE and Productivity

– Version 1 available at: https://securereports2.vssc.med.va.gov/Reports/Pages/Report.aspx?ItemPath=%2fMentalHealth%2fMHOB%2fMHOB_Summary

• Mental Health Information System available at:http://reports2.vssc.med.va.gov/Reports/Pages/Report.aspx?ItemPath=%2fMentalHealth%2fMHInformationSystem%2fMHInformationSystem

• MH Referral Timeliness report available at:https://spsites.dwh.cdw.portal.va.gov/sites/OMHO_Consult/_layouts/ReportServer/RSViewerPage.aspx?rv:RelativeReportUrl=/sites/OMHO_Consult/AnalyticsReports/TimelinessMatrixReport.rdl&Source=https%3A%2F%2Fspsites%2Edwh%2Ecdw%2Eportal%2Eva%2Egov%2Fsites%2FOMHO%5FConsult%2FAnalyticsReports%2FForms%2FAllItems%2Easpx&DefaultItemOpen=1

• VHA Performance Measure Report (includes MH measures) available at:http://reports2.vssc.med.va.gov/reportserver?%2fPMR%2fPerformanceMeasures%2fPerformanceMeasureReport&rs:Command=Render

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Resource List:

• Mental Health Outcomes Oriented Quality Metrics available at:https://securereports3.vssc.med.va.gov/Reports/Pages/Report.aspx?ItemPath=%2fMentalHealth%2fMHOutcomes%2fOutcomes

• Consult Switchboard available at:https://securereports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fSystems+Redesign%2fConsults%2fConsult_Switchboard&rs:Command=Render

• Mental Health Treatment Coordinator Patient Detail available at:https://securereports2.vssc.med.va.gov/ReportServer/Pages/ReportViewer.aspx?%2fMentalHealth%2fMHSecureReports%2fmhtc_detail&rs:Command=Render

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