Transcript Outcome-Informed Care is the practice and system of providing

APS Outcome-Informed Care
Clinician Training
Overview
• Importance & Benefits of Outcome-Informed Care
• APS Outcome-Informed Care Initiative
– Goal
– Process
– Clinician Tool Kit
• Question & Answer
• Appendix
– Resources
– Research
What is Outcome-Informed Care?
Outcome-Informed Care is the practice and
system of providing psychotherapy treatment
that is informed by patient-reported treatment
outcomes.
Importance of Outcome-Informed Care
• Routine patient feedback to clinicians improves
treatment outcomes 26-35
– Identifies patients who are most at risk for treatment failure
– Increases identification of clinical risks
• Suicide: Routine feedback improved detection by 15%
The Journal of Crisis Intervention and Suicide Prevention. Vol. 24, No. 2, 2003, pp.
49-55
• Substance abuse: Significant reduction in under-reporting with
introduction of feedback
Joint Commission Journal on Quality and Safety, Vol. 30 (8), August 2004, pp. 448454
– Early identification permits proactive work to keep patients
engaged in treatment
Importance of Outcome-Informed Care
• Recommended by APA & IOM
– APA 2005 EBPP standard:
“ongoing monitoring of patient progress and adjustment of treatment
as needed are essential to EBPP” (p. 3)
– IOM 2006 standard 4.2:
“Clinicians and organizations providing services should:
– Increase their use of valid and reliable patient questionnaires or
other patient-assessment instruments…to assess the progress and
outcomes of treatment systematically and reliably
– Use measures of processes and outcomes of care to continuously
improve the quality of care…” (p. 12)
Benefits of Outcome-Informed Care
• Improves patient outcomes
• Objective measurement system
– National normative database (1996 – present)
– Case mix adjustment
– Data demonstrates quality of care
• Provides data/trends not currently available
– Collects patient self-reported diagnostic and symptom
information
– Measures and tracks reported progress
– Real-time treatment outcome report
APS Outcome-Informed Care Initiative
• GOAL: Assist clinician in improving member health
• Tactics:
– Educate about outcome-informed care
– Provide tools to deliver outcome-informed care
• Initial Clinician assessment (baseline)
• Member survey (measures)
–
–
–
–
Global Distress
Substance abuse
Therapist alliance
Overall health status
• Online Clinician toolkit (view/track patient feedback/outcomes)
– Alert clinician of member elevated risk
– Encourage voluntary enrollment in initiative via incentives
APS Outcome-Informed Care: Process
• APS:
– Mail pre-printed Provider Assessment & Member Survey with
authorization packet
– Post patient/member feedback on secure website
– Contact clinician if member survey shows elevated risk
• Office staff:
– Administer member survey every session
– After clinician review, fax to 866-831-7962
• Clinician
– Complete initial provider assessment
– View outcome data on secure personal webpage (clinician
toolkit) within 24 hours view
– Discuss with patients; create a culture of feedback within each
treatment
Provider Assessment
Provider Assessment
• Demonstrates outcomes
– Baseline for member
survey
– Case mix variables
• Data-driven
– Tested
– Measured
• User friendly
– 1 page
– 8 questions
Member Name:
Provider:
Member ID:
Provider ID:
Member Date of Birth:
Client ID:
Total number of sessions authorized to date:
Authorization Number:
Start Date:
End Date:
Instructions to Provider:
Please complete the information below when you have finished your initial assessment of the above named member.
Fax this form, together with the completed initial member survey to 866-831-7962.
(Please fill in circles completely using black ink)
ICD-9 Diagnosis: (Example: XXX.xx)
Axis I (primary):
1
2
3
4
5
6
7
8
9
0
.
Axis III:
Axis I (secondary):
Axis II (primary):
Axis V (GAF)
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
.
.
.
Axis IV:
Symptoms (Please indicate all that apply)
Reduced Work Hours
Job Attendance/Tardiness
Decreased Job Performance
C onflict with C oworkers
Disability
Decrease in Social/Family Relations
Depressed Mood
Thoughts of Self-Harm:
Present
Hallucinations
Problems with concentration
Disruption of thought process/content
Delusions
Paranoia
Mood Swings
Elevated Mood
Not Present
Substance Abuse:
No history
Irritability
Hy peractivity
Anxiety
Impulsivity
Panic Attacks
Obsessions/C ompulsions
Dissociative States
Active
In recovery
Does the patient have a medical problem that is a source of significant concern to them?
Yes
No
Is the patient receiving treatment from another behavioral health care provider(s)?
If y es, do y ou intend to contact the other behavioral health care provider(s)?
Is the patient on any of the following Medications:
Antidepressants
Yes
No
Mood Stabilizers
Anti-Psy chotics
Yes
No
Anti-Anxiety
Yes
Yes
No
No
Yes
Yes
No
No
33659
Member Survey
• Measures
– Global Distress
• Anxiety and depression
• Interpersonal problems
• Impaired productivity
(work & other daily
activities
• Concerns about health
problems
• Feelings of hopelessness
& thoughts of suicide
– Substance abuse
– Therapist alliance
– Overall health status
ONGOING Member Survey
Member Name:
Provider:
Member ID:
Provider ID:
Member Date of Birth:
Client ID:
Total number of sessions authorized to date:
Authorization Number:
Start Date:
End Date:
Instructions to Member:
Please respond to this survey as honestly as possible because this will help your doctor or therapist know if the
treatment is working for you. The survey results will be used to help your therapist monitor your improvement. Your
personal information is kept strictly confidential. This survey is voluntary. If you do not complete the survey it will
not affect your treatment or insurance coverage in anyway.
Instructions to Provider:
Please fax this survey to 866-831-7962
Member to complete the following sections (please fill in circles completely using black ink)
In the past two weeks, how often did you
Never
Hardly-ever
Poor
Fair
Agree
Somewhat
agree
Sometimes
Often
Very often
…feel unhappy or sad?
…have a hard time getting along with family , friends or coworkers?
…worry about a lot of things?
…feel no interest in things?.
…feel that y ou were not able to complete y our work or other
important daily tasks in a timely manner?
…have someone express concerns about y our alcohol or drug use?
…feel tense or nervous?
…have problems with sleep (too much or too little)
…feel lonely ?
…feel hopeless about the future?
…feel that y our medical problems were a source of significant concern
to y ou?
…have a problem at work or home because of alcohol or drugs?
…feel that y our emotional problems interfered with taking care of
y our overall health?
…have thoughts of ending y our life?
Good
Excellent
Please rate y our overall health status.
If this is not your first session, please take a moment to give
feedback on your most recent session.
Not sure
Somewhat
disagree
I felt that we talked about the things that were important to me.
I felt that the therapist liked and understood me.
I felt confident that the therapist and I worked well together.
37653
Do not
agree
Clinician Toolkit
• Secure online access to outcome data
• Summary statistics and case level data
– Graph progress for individual cases
– Compare results to national benchmarks & metaanalyses of psychotherapy studies
• Outcome data updated multiples times per day
Improved Outcomes: Success! (baseline 2006)
2006
Baseline
2007
9% improvement
2008
22% improvement
Question & Answer
Appendix
Online Toolkit
Register or Login
here
Links to FAQ,
Forms & OIC
information
Online Toolkit: Registration
Online Toolkit: Access
Appendix: Resources
• Frequently Asked Questions
 www.psychoutcomes.org/APS
• Technical/Data/Web:
 [email protected]
 [email protected]
 801-541-9720
• General comments or questions:
 [email protected]
 1.800.305.3720, extension 3320
Appendix: Supporting Research
1. Wampold BE. 2001. The great psychotherapy debate: Models, Methods, and Findings. Mahwah NJ: Lawrence Erlbaum Associates. 272 pp.
2. Westen D, Morrison K. 2001. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An
empirical examination of the status of empirically supported therapies. J Consul Clin Psychol 69:875-99.
3. Sapyta J, Riemer M, Bickman L. 2005. Feedback to Clinician: theory, research, and practice. J Clin Psychol 61(2):145-53.
4. Hannan C, Lambert MJ, Harmon C et al. 2005. A lab test and algorithms for identifying clients at risk for treatment failure. J Clin Psychol
61(2):155-63.
5. Lambert MJ, Harmon C, Slade K et al. 2005. Providing feedback to psychoClinicians on their patients progress: Clinical results and practice
suggestions J Clin Psychol 61(2):165-74.
6. Harmon C, Hawkins, Lambert MJ et al. 2005. Improving outcomes for poorly responding clients: The use of clinical support tools and
feedback to clients. J Clin Psychol 61(2):175-85.
7. Brown GS, Jones ER. 2005. Implementation of a feedback system in a managed care environment: What are patients teaching us? J Clin
Psychol 61(2):187-98.
8. Miller SD, Duncan BL, Ryan S, et al. 2005. The Partners for Change Outcome Management System. J Clin Psychol 61(2):199-208.
9. Claiborn CD, Goodyear EK. 2005. Feedback in psychotherapy. J Clin Psychol 61(2):209-21.
10. Brown GS, Burlingame GM, Lambert MJ, et al. 2001. Pushing the quality envelope: A new outcomes management system. Psychiatr Serv
52(7):925-34.
11. Lueger RJ. 1998. Using feedback on patient progress to predict the outcome of psychotherapy. J Clin Psychol 54:383-93.
12. Lambert MJ, Whipple JL, Smart DW, et al. 2001. The effects of providing Clinicians with feedback on patient progress during
psychotherapy: Are outcomes enhanced? Psychother Res 11(1):49-68.
13. Lambert MJ, Whipple JL, Vermeersch DA, et al. 2002. Enhancing psychotherapy outcomes via providing feedback on client progress: A
replication. Clin Psychol Psychother 9:91-103.
14. Whipple JL, Lambert MJ, Vermeersch DA, et al. 2003. Improving the effects of psychotherapy: The use of early identification of treatment
failure and problem-solving strategies in routine practice. J Counsel Psychol 50(1):59-68.
15. Lambert MJ, Whipple JL, Hawkins EJ, et al. 2003. Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clin Psychol Sci
Prac 10:288-301.
16. Addis ME. 2002. Methods for disseminating research products and increasing evidence-based practice: Promises, obstacles, and future
directions. Clin Psychol Sci Prac 9:367-78.
17. Chorpita BF, Yim LM, Donkervoet JC, et al. 2002. Toward large-scale implementation of empirically supported treatments for children: A
review and observations by the Hawaii Empirical Basis to Services Task Force. Clin Psychol Sci Prac 9:165-90.
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11:267-88.
19. Manderscheid RW, Henderson MJ. 2004. Mental health, United States, 2002 executive summary. Admin Policy Mental Health 32:49-55.
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synthesis of dissemination theory. Clin Psychol Sci Prac 11:343-59.
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Appendix: Supporting Research
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psychotherapy. J Counsel Psychol 48:251-7.
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52:685-716.
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Orthopsychiatry 56:501-12.
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Res 1:81-91.
30. Crits-Christoph P, Mintz J. 1991. Implications of Clinician effects for the design and analysis of comparative studies of psychotherapies. J
Consul Clin Psychol 59:20-6.
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