Section II.
Measures to Improve Quality
Chapter 6
Promoting Self-Assessment and Accountability: Introduction to Quality Improvement
Measures
Ronald W. Manderscheid, Ph.D.
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
Quality mental health services cannot exist without accurate measures of quality
that provide reference points for action. Hence, as the mental health community
undertakes the very important transformational task of developing recovery-oriented
care that is consumer and family driven, good measures will be a critical aspect
of the enterprise. Considerable work has already been undertaken to develop
appropriate measures. This chapter serves as an introduction to these measures.
Some may ask why quality improvement measures are necessary. Without common
measures for benchmarking and assessing performance, there can be no common,
independent unit of value, such as octane for gasoline. When there are no common
measures, cost is used as a surrogate (a process frequently called commodification),
and the price typically falls, as it has in the mental health field. Independent
performance measures are necessary to document quality.
In 1996, SAMHSA’s Center for Mental Health Services (CMHS) and the Mental
Health Statistics Improvement Program (MHSIP) introduced the Consumer-Oriented
Report Card. In subsequent years, most States adopted the Consumer Survey included
as a key component of this report card. Like the report card itself, the Consumer
Survey assesses care access, care quality, and care outcome from the consumer’s
point of view. Subsequently, versions of the Consumer Survey were developed
for adolescents and for their parents. CMHS has adopted these consumer surveys,
and they are available at www.ds2kplus.org.
The Forum on Common Performance Measures, a joint endeavor spanning SAMHSA’s
CMHS, the Center for Substance Abuse and Treatment (CSAT), and the Center for
Substance Abuse Prevention (CSAP) has also adopted the access-quality-outcome
framework. The principal goal of the forum is to develop and implement a small
set of common performance measures for the mental health and substance abuse
fields that can be used jointly by both fields for benchmarking to improve
quality of care. Like the earlier work on the Consumer-Oriented Report Card,
this work includes both administrative measures and a consumer survey. The
consumer survey is called a Modular Consumer Survey because it contains a small
set of items to be shared across fields and age groups, across fields within
age groups, and within fields and age groups. Field-testing was underway at
the end of 2004, with hoped-for initial implementation in 2005.
The work on report cards and common performance measures has focused on actual
care delivery. Parallel work has also been underway to develop performance measures
for systems of care. In CMHS, this work has taken the form of a Uniform Reporting
System (URS), developed collaboratively with the States, for self-assessing
and reporting the performance of the State mental health agency systems. Initial
Basic Tables have been collected for fiscal years 2002 and 2003, and Developmental
Tables have been added to the Basic Tables for fiscal year 2004. Data for 2002
and 2003 can be accessed at www.samhsa.gov,
and data for 2004 will be added shortly.
In FY 2004, the Substance Abuse and Mental Health Services Administration (SAMHSA)
administrator defined 10 National Outcome Measures (NOMs) for the mental health
and substance abuse service systems (see table 6.1).
Eight of these measures were already part of the URS. The remaining two, functioning/symptoms
and social connectedness, are being added in FY 2005.
The work on the URS and the NOMs has been facilitated greatly through the
State Data Infrastructure Grant program operated by CMHS. A first cycle of
these grants was completed in FY 2004; the second cycle will be completed in
FY 2007. By the end of FY 2007, all States are expected to report all URS and
NOM performance measures.
New work is also underway to facilitate transformation. A recovery measure
that will reflect the positive and negative features of mental health services
is being developed. A parallel recovery measure that will reflect self-agency
is also being developed. Finally, a second-generation MHSIP Quality Report
Card is due to be released shortly.
|
