Quality in Mental Health

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Quality in Mental Health

• Tom Callaly
• Dec. 2008

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Quality in Mental Health

• Safety and Quality movement
• 1991 Harvard Medical Practice Study -30,000
  records 3.7 adverse event rate, 28 considered
  negligent. 13.6 of adverse events resulted in
  death.
• 1995 Quality in Australian Healthcare Study
  14,000 admissions. 16.6 adverse event rate. 51
  adverse events considered preventable. 4.9 of
  patients who suffered an adverse event died
• 2000 Utah Colorado -15,000 records 2.9
  adverse event rate
• Marked discrepancy in adverse event rates
  -variation of reviewer interpretation and quality
  of medical notes
• Last 25 years era of Brownian motion in Health
  Care.
• Crossing the Quality Chasm, IOM, 2001

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Quality in Mental Health

• Quality judged differently be different people
• Patient/Consumer
• Clinician
• Team
• Organisation
• State
• Commonwealth

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Quality in Mental Health

• What is quality?
• In mental health care, quality is a measure of
  whether services increase the likelihood of
  desired mental health outcomes and are consistent
  with current evidence-based practice.
• This definition incorporates two components.
• For people with mental disorders,their families
  and the population as a whole, it emphasizes that
  services should produce positive outcomes.
• For practitioners, service planners and policy
  makers, it emphasizes the best use of current
  knowledge and technology.
• World Health Organisation, 2003. Quality
  Improvement for Mental Health.

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Quality in Mental Health

• Individual clinicians
• More than 50 of patients with bipolar disorder
  are on a medication regime which adheres to
  international guidelines.
• Lambert T, Berk M, Callaly T. ANZCP Jn. 2003

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Quality in Mental Health

• Organisations
• Must establish quality review and improvement
  framework
• E.g. Barwon
• Board
  (Quality Sub-committee)
• 
  CEO
• 
  
• Clinical Risk
  Management Committee
• (Chair - Executive
  Medical Director)
• Community and
  Mental Health
• Quality and Risk
  Management Committee

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Quality in Mental Health
MHNOCC website Dec. 2008
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Quality in Mental Health

• Organisational level
• Audit counting
• Quality assurance (QA) includes monitoring and
  evaluation. But retrospective, static
• Continuous quality improvement (CQI) - more
  dynamic, engaging all staff, prospective and
  aimed at continuous improvement.
• ACHS
• Clinical Indicator program QA
• EQuiP program designed around CQI

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Quality in Mental Health

• National perspective
• Establishment of the Commission on Safety and
  Quality

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Quality in Mental Health

• National perspective
• Establishment of the Commission on Safety and
  Quality
• National Mental Health Plans quality
  improvement a major objective
• National Standards for Mental Health Services
• A National Health Performance Framework - 2001

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National Health Performance Framework Page 7
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Tier 3 of the Australias framework(its all
about Quality)
Care, intervention or action achieves desired
outcome
Care/intervention/action provided is relevant to
the clients needs and based on established
standards
Achieving desired results with most cost
effective use of resources
Service provides respect for persons and is
client orientated
Ability of people to obtain health care at the
right place and right time irrespective of income
etc.
Avoidance or reduction to acceptable limits of
actual or potential harm from health care
management
Ability to provide uninterrupted, coordinated
care or service across programs,
An individual or services capacity to provide a
health service based on skills and knowledge
System or organisations capacity to provide
infrastructure such as workforce, facilities and
equipment,
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Quality in Mental Health

• National perspective
• Establishment of the Commission on Safety and
  Quality
• National Mental Health Plans quality
  improvement a major objective
• National Standards for Mental Health Services
• A National Health Performance Framework - 2001
• 13 Key Performance Indicators (KPIs) recent
  pilot exercise

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Performance indicators for Australian MH services
2005 - NMHWG Information Strategy Committee
Performance Indicator Drafting Group (2005). Key
Performance Indicators for Australian Public
Mental Health Services. ISC Discussion Paper No.6
Australian Government Department of Health and
Ageing, Canberra. Available at
www.health.gov.au
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Quality in Mental Health

• National perspective
• Establishment of the Commission on Safety and
  Quality
• National Mental Health Plans quality
  improvement a major objective
• National Standards for Mental Health Services
• A National Health Performance Framework - 2001
• 13 Key Performance Indicators (KPIs) recent
  pilot exercise
• National mandatory Outcome Measures (HoNOS
  etc.)

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Quality in Mental Health

• National perspective
• National Mental Health Plans quality
  improvement a major objective
• National Standards for Mental Health Services
• A National Health Performance Framework - 2001
• 13 Key Performance Indicators (KPIs) recent
  pilot exercise
• National mandatory Outcome Measures (HoNOS
  etc.)
• All Australian AMHS are required to seek
  accreditation

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You can become a Fellow by examination!
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Quality in Mental Health

• Future challenges
• Integration.
• Use of Information and Communication technology
• Leadership

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Quality in Mental Health

• Denmark Leads the Way In IT and patient-centered
  Primary Care 2006
• Highest public satisfaction with health system
  among European countries
• Physicians staff phone banks nights and
  weekends with computerized access to patient
  information paid for telephone consultations
• Physicians staff evening and weekend clinics,
  and
• - off-hours service physicians do home visits
• Health information technology and information
  exchange
• - 98 of primary care physicians totally
  electronic health records and e-prescribing
• Paid for e-mail with patients
• All prescriptions, lab and imaging tests,
  specialist consult reports, hospital discharge
  letters flow through a single electronic portal
  accessible to patients, physicians, and home
  health nurses

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