Transcript Handout Measurement Based Practice

Behavioral Health Integration Complex Care Initiative
BHICCI MEDICAL AND BEHAVIORAL
HEALTH MEASURES DATA PLAN FOR
MBC:
http://bhintegration.com/about/bhicci-data-plan/
What is MBC
• A standardized, evidenced based measure such as a
rating scale, physical exam measure or lab value used to
diagnosis a health condition and track response to an
intervention.
• Does the health condition have:
• a measure that can be easily measured and tracked?
• a significant impact on quality of life or mortality?
• an effective treatment(s)?
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Examples of health conditions amenable
to MBC
Type 2 Diabetes
Mellitus:
Hypertension:
• Hemoglobin A1c (HgA1c)
• Blood Pressure
Major Depression:
• PHQ9
Generalized Anxiety
Disorder:
• GAD7
Substance Use
Disorders:
• Substance Use Assessment Tool
(SUA)
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What would care be like without MBC?
• A patient with Type 2 DM shows up for f/u meds on metformin.
He has noticed some increased urination and thirst and some
numbness in his feet. He doesn’t check his sugars and the clinic
lost its contract with laboratory services.
• How does the doctor decide whether to adjust medications?
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What would care be like without MBC?
• A 35 y/o man presents after starting fluoxetine for
depression six weeks ago, he continues to feel
depressed but “it’s a little better.” He is sleeping 5
hours per night but his energy is low and still not
socializing with friends or family.
• How does the doctor decide whether to adjust
medications?
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It’s like…
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Goals
• Discuss example measurements
• Justify time frames for measurements
• Give teams time to “test out” your measurements sense
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Diabetes: Hemoglobin A1c (HgA1c)
% saturation of red blood
cells with sugar
Home run = Glucose of 120
Strike out = Glucose of 400
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Best metric to know how good or bad a
player (diabetes) is?
• A single at bat
• Office Blood Glucose level
• Watching some of the home games
• Home Glucose Log
• Batting average over a 3 month period
• HgA1c
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HgA1c to Mean Blood Glucose
Conversion (batting average)
Goal being < 7% for most patients
it take a number of “at bats”
(time) to see if a change in
batting technique affects
batting average
So…
Medications and lifestyle
changes (diet) takes 3 months to
notice stable change in HgA1c
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Hypertension: Blood Pressure (BP)
The pressure exerted
by blood on the walls
arteries
Systolic (top #)
Maximum pressure
------------------------------Diastolic (bottom #)
baseline pressure
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Simplified BP Goals
Age: 18-59
Less than
140/90
Age: ≥ 60
Less than
150/90
BP Monitoring
• A BP reading is an “at bat”
• No “Batting Average” equivalent
but can attend some home
games!
• If there are discrepancies b/w
home and office readings, have
patients bring in cuffs and
compare
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BP interventions: onset of
action
• BP medications have onset of
action < 1 day, so… response to
BP changes can be detected as
early as the next day
• Lifestyle changes (e.g. lower salt intake, weight loss)
takes weeks to months to affect BP
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Major Depression Disorders
• Caused by a combination of biological, psychological,
and social factors.
• Depression can be complicated making treatment less
straightforward
• Lifestyle choices, relationships, and coping skills
matter just as much—if not more so—than genetics.
• While not straightforward, we have good evidence of
what works
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Anxiety Disorders
• Related conditions rather than a single disorder
• Share one major symptom: persistent or severe fear
or worry in situations where most people wouldn’t
feel threatened.
• Effective treatment include talk therapies, particularly
those with behavioral components which emphasize
client self-management/self -care strategies,
medication, or some combination of the two.
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Major Depression: PHQ9
Anxiety Disorders: GAD7
• Self report scale rather a lab draw or physical
measurement
• PHQ9 and GAD7 based on DSM criteria for Major
Depression and Generalized Anxiety Disorder
• Can be done in person or telephonically
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GAD-7 Screening Tool
10 + Somewhat Difficult is cutoff for further evaluation and management
Interventions: onset of action
• Antidepressants and Therapy do not work
“instantly” for depression and anxiety
• Recheck PHQ-9/GAD7 monthly until remission
• Goal is < 5 on the PHQ9 and GAD7
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BHICCI Medical and Behavioral Health
Measures Data Plan for MBC:
http://bhintegration.com/about/bhicci-data-plan/
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