Transcript Slide 1

TMAP
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NorthSTAR
IMPLEMENTATION
PLANNING TEAM
12-13-2002
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PLANNING MEETING GOALS
Define specific goals for successful
implementation
 Define activities to achieve goals
 Troubleshoot barriers to carrying out
activities
 Assign activities to achieve goals to team
members
 Identify timeline for completing activities

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CONSULTANTS TO PROCESS
Dr. Steve Shon, TDMHMR Medical
Director
 Dr. Ken Altshuler, TDMHMR Board of
Directors & UTSMC Professor
 Carole Matyas, ValueOptions V-P
 Dr. Lynelle Yingling, DANSA Board Chair

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Review of Basics
Dr. Shon
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Everyone “Just Doing Their
Best”
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TMAP: Aligning the Arrows
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Algorithm
“A step by step procedure for
solving a problem or
accomplishing some end.”
Webster’s Dictionary
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GOALS OF MEDICATION
GUIDELINES/ALGORITHMS
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Systematic Approach to Medication Management
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Quantifiable and Reliable Outcome Measures
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Documentation of Medications and Outcomes

Enhance Medication Adherence by Patients
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Clinical Reasons for Algorithms
Facilitate clinical decision-making
 Improve quality of care
 Make treatment plans consistent across
sites and physicians
 Tailor treatment to individuals
 Provide adequate clinical documentation
 Define where new medications fit for
optimal outcomes

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Administrative Reasons
for Algorithms
Accountability for scarce resources
 Uniform expectations for providers
 Improve cost efficiency
 Predictable costs
 Define where new medications are
cost- effective
 Define costs related to specific
treatments or outcomes

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Medication Algorithms
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Three disorder groups
Major depressive disorders
 Schizophrenia
 Bipolar disorders
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Strategies (identifying the
what)
 Tactics (identifying the how)
 Specific guidelines
 Planned revisions
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DOCUMENTATION
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PATIENT AND FAMILY
EDUCATION
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Educational Materials
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Patient objectives
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Teaching patients disease management
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Involving patients in treatment choices
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Optimizing treatment benefits
Provider objectives
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Optimizing treatment benefits
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Teaching optimal medication use
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Clarifying and documenting clinical
decision-making
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The Texas Medication
Algorithm Project (TMAP):
Outcomes for Persons with
Schizophrenia (SCZ)
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55
SCZ Adjusted Mean Symptoms
(BPRS18): All Subjects
TAUnonALO (n=144)
ALO+ED (n=165)
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41.8
BPRS18
45
40
35
30
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Baseline
1
2
Quarter
3
4
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SCZ: Sum of Cognition z Scores:
All Subjects
Sum of z Scores
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TAUnonALGO (n=122)
ALGO+ED (n=137)
1
0
0
Baseline
1st Quarter
3rd Quarter
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Cognitive Impairment Predicts
Functional Outcomes
Positive
Symptoms
Adaptive
Function
Cognitive
Impairment
Negative
Symptoms
Velligan et al. Schizophr Res 1997;25:21-31.
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HOSPITALIZATIONS FOR SCZ
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ALGO
Patients
165
% Admits 3.0%
# Admitted
5
Days/Pt.
1.48
# of Admits
6
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TAU
Patients
300
% Admits 8.7%
# Admitted
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Days/Pt.
3.84
# of Admits
36
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The Texas Medication
Algorithm Project (TMAP):
Outcomes for Persons
with Bipolar Disorder
(BPD)
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BPD Adjusted Mean
Manic/Hypomanic Symptoms (CARSM): All Subjects
14
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TAUnonALGO (n=124)
ALGO+ED (n=141)
11.0
CARS-M
10
8
6
4
2
0
Baseline
1
2 Quarter 3
4
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The Texas Medication
Algorithm Project (TMAP):
Outcomes for Persons with
Major Depressive Disorder
(MDD)
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IDS-C 30
MDD Adjusted Mean Symptoms
(IDS-C30): All Subjects
45
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37
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TAU (n=175)
ALGO+ED (n=175)
41.8
Baseline
1
2
3
Quarter
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Official
TMAP/TIMA/CMAP
Internet Sites
http://www.mhmr.state.tx.us/
centraloffice/medicaldirector
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Goals for NS TMAP
Implementation
Develop a clear implementation plan
 Begin changes with incorporating medical
records used with TMAP by summer
 Begin with computerized version
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Activities to Achieve Goals
Initial workgroup [VO, Dr. Shon, Dr.
Altshuler, DANSA ED + PAC] review
TDMHMR implementation guides for
appropriateness/adaptation
 VO meet with Dr. Altshuler to plan
electronic requirements
 VO pilot with 1 or 2 providers to refine the
process before full implementation
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Barriers & How To Overcome
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Startup cost
Ongoing cost of meds
Mental mindset
Training large number
of private providers [1
day of training initially]
Develop a uniform
plan with a large
number of providers
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Possible software grant
Long-term reduced meds
Careful planning
Possibly minimize time
required by using
teleconferencing
Pilot first & streamline
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Assignment of Specific Tasks
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Share implementation guides with
initial workgroup for review & possible
modification
Meet to plan electronic requirements
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David
[to Carole,
DANSA
PAC, Dr.
Altshuler]
David,
Carol, Dr.
Altshuler
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Timeline
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Spring
2003
Summer
2003
Fall
2003
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Plan for implementation defined
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Pilot project fully implemented and
evaluated
Plan for complete NS
implementation defined
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Next Step to Success
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Demonstration of Software
Resource
Dr. Altshuler
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