The quest for quality: the AED experience

1
The quest for quality the AED experience

• Dasha Nicholls
• AED Board of Directors

2
Origins

• Arose from Family Focus Groups at NEDA conference
  in 2003
• Family members had no way of knowing whether
  various residential treatment programs espoused
  and implemented evidence-based practices.
• NEDA approached AED
• AED Credentialing Task Force formed in 2004
• AED, NEDA, IAEDP partnership

3
Aims

• AED, IAEDP, and NEDA believed that standards of
  care and a site accreditation process could help
• safeguard patients and families
• ensure and elevate quality of care
• provide a quality of care benchmark for third
  party payers (insurers)

4
Scope

• Standards apply to eating disorder program sites
  that offer treatment to patients 24-hours per
  day, 7 days per week under the supervision of a
  licensed health care professional who has access
  to a licensed physician
• Standards initially developed for USA-based
  programs with the intent to adapt them for use in
  other countries. Expert consultation from
  colleagues in other countries was sought to
  maximize future applications to non-USA programs

5
AED Credentialing Task Force

• Mary Tantillo PhD RN CS (Chair)
• Ovidio Bermudez MD
• Doug Bunnell PhD
• Jillian Croll PhD MPH RD
• Julie Holland MHS, CEDS
• Craig Johnson PhD
• Jim Mitchell MD
• Pauline Powers MD
• Benita Quakenbush PhD
• Mae Sokol MD
• Janet Treasure FRCPsych
• Consultants Marsha Marcus PhD, Joel Yager MD

6
First steps (2005)

• Explore Credentialing and Accreditation Models
• e.g., Burn Center Verification, American Diabetes
  Association Education Recognition Program
  (National Standards for Diabetes Self-Management
  Education), JCAHO, CARF
• Published practice guidelines
• APA Practice Guidelines, NICE Guidelines,
  Australian Practice Guidelines, Quality Network
  for Inpatient CAMHS Service Standards 2004-2005
• Establish and Chair Work Groups
• I Assessment and Treatment Planning
• II Treatment Delivery
• III Quality Improvement
• IV Specialized Protocols
• V Outcome Measurement
• VI Certification Process

7
Work Groups

• 7-9 members each
• 1-2 chairs
• Representatives from AED, IAEDP, NEDA, leaders in
  the eating disorders field and related
  professions, residential/inpatient treatment
  program directors, insurers, recovered
  individuals and family members.
• Develop standards for inpatient/residential
  treatment

8
Standardized Format for Work Group Reporting

• Date/Work Group Focus Assessment and Treatment
  Planning/Work Group Co-Chairs/Work Group Members
• Background and Overview paragraph(s)
• Standards 1 An initial screening and/or
  assessment of each individuals physical,
  nutritional, psychological, and social
  functioning is conducted to determine the need
  for treatment, the type of treatment, and the
  need for any additional assessment
• Rationale (optional) An initial screening and/or
  assessment of each individuals biopsychosocial
  functioning ensures a more accurate understanding
  of predisposing, precipitating and perpetuating
  factors related to the eating disorder and allows
  for more accurate determination of level and type
  of treatment required.
• Elements of Performance 1 The physical health
  assessment (medical history and PE) is performed
  within one week of admission to the program. If a
  physical health assessment has been conducted 30
  days prior to admission, this may be used in the
  clinical record as the physical health assessment
  and any subsequent changes must be recorded at
  the time of admission.
• Process Measures The initial screening/assessment
  will be entered into the patient record within
  the first 48 hours of the patients admission.
• Outcome Measures Patient satisfaction survey
  shows that patient and family felt they received
  an adequate evaluation.
• Table that has concise overview of standards
• 
  (adapted from JCAHO Behavioral Health
  Standards)

9
Stakeholders Meeting (2006)

• 2 day meeting 25 participants
• Review of
• Initial draft of standards for inpatient/
  residential treatment
• Initial work plan for accreditation body that
  would use these standards in a formal program
  accreditation process
• Funders
• AED
• NEDA
• IAEDP
• Massachusetts Eating Disorders Association
• Eating Disorder Coalition of Tennessee
• The Elisa Project

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Stakeholders Meeting Values

• Accreditation is a process of elevating practice
  and helping others learn and shine
• Openness
• Transparency
• Embracing and building on differences

11
Invited stakeholders

• AED Credentialing Task Force Members/Work Group
  Chairs
• AED
• American Academy of Pediatrics
• American College of Sports Medicine Re Female
  Athlete Triad
• American Dietetic Association SIG (Sports,
  Cardiovascular, Wellness)
• American Diabetes Association special interest
  group for ED
• American Nurses Association
• ANAD
• APA Workgroup for Guidelines
• APA Eating Disorders Caucus
• Eating Disorder Coalition
• Eating Disorder Coalition (Include Family Action
  Council)
• Eating Disorders Coalition of Tennessee
• Eating Disorder Referral
• ECRI
• The Elisa Project

• Fredda Merzon Associates
• FREED
• IAEDP
• Insurance representatives
• Klarman Foundation
• Massachusetts Eating Disorders Association
• McLean Eating Disorders Program
• NEDA Parent Family Network
• NEDA
• NICE Guidelines Work Group
• Australian Guidelines Work Group
• NIMH
• American Psychiatric Nurses Association
• AED Nursing SIG
• NY State Senator Bruno /staff
• Society for Adolescent Medicine
• Board of Examiners of Social Work
• All work group members

12
Consumers views sought

• 1. What did you find helpful about the eating
  disorders inpatient/residential experience that
  should help inform development of credentialing
  standards for inpatient/residential treatment
  sites?
• 2. What did you NOT find helpful about the eating
  disorders inpatient/residential experience that
  should help inform development of credentialing
  standards for inpatient/residential treatment
  sites?
• 3. What did you feel contributed the most to your
  loved one's/your own healing during the
  inpatient/residential treatment experience? 

13
Champions of AED Quest

• ECRI INSTITUTE- ( www.ecri.org )
• 40-year history of applied research in healthcare
• Major role in technology planning, procurement
  and management, patient safety, quality and risk
  management, healthcare policy and research, and
  healthcare environmental management
• Produces comprehensive technology assessments and
  evidence reports on healthcare technologies for
  public benefit
• A WHO collaborating center for patient safety,
  risk management and healthcare technology 

14
2006-2008

• Final draft of general standards document
  (integrated adult and child/adolescent standards)
• Final draft of specialized programs standards and
  specialized protocols (men, athletes, mid-life
  pts, and medical co-morbidity pts).
• Put on hold till general standards implemented
• Vetting of general standards document
• Insurers
• Eating Disorders Coalition and Association for
  Behavioral Health and Wellness
• Conferences
• AED, IAEDP, NEDA members website survey
• AED Patient/Carer Task Force review
• Residential treatment sites invited to comment on
  the standards

15
The Accreditation body

• Independent non-profit
• Identify funding for development of
  accreditation body
• Applied for Grants in partnership with ECRI
• AED, IAEDP, NEDA continued funding AED Cred Task
  Force efforts
• With ECRI drafted work plan for development and
  implementation of Accreditation Body (Spring,
  2008)

16
Challenges

• Buy-in from stakeholders
• Choosing solid and open-minded stakeholders for
  the task force itself
• Core stakeholder group members were those who
  showed interest. Others were recommended.
• Important that all disciplines are represented
  and representatives from each of the main ED
  organizations in the USA plus a wise person
  outside the US...
• Maintaining the values, avoiding conflict of
  interest
• Establishing the accreditation body