It’s largely accepted that to deliver optimal mental healthcare services, organizations must pursue evidence-based practices, measure progress and outcomes, and adapt care plans as needed. But planning to do such activities is not enough to ensure a behavioral health organization will successfully execute in these areas and maintain a high level of performance over time.
But what can be done to help behavioral healthcare providers accomplish these crucial goals that contribute to better mental health outcomes for patients? Enter quality improvement.
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The Centers for Medicare & Medicaid Services (CMS) defines quality improvement as “the framework used to systemically improve care.” Quality improvement in healthcare aims to standardize processes and structure to:
The work that goes into developing systems that will decrease variation and strengthen outcomes naturally relies on measurement. Within behavioral health, clinicians must be able to measure initial symptom level, changes with treatment, and outcomes, among other areas, to inform best practices and identify opportunities for improvement.
Behavioral health measures greatly rely on the use of self-report assessments as behavioral health lacks the observable and quantifiable vital signs that are available to other medical specialties (e.g., measurement of cardiac health using heart rate and blood oxygenation level). Examples of widely accepted self-report data in behavioral health measurement may include information gathered through tools like screeners, diagnostic interviews and monitors that track behavioral experience or frequency of behaviors. Ideally, the collection of this self-report data, combined with consistent care practices that include clinical follow-up, should be useful to predict outcomes at the patient population level. In addition, data should better allow clinicians to identify and then take the most appropriate steps that will lead to better decisions and healthier minds. As such, data collection needs to be reliable, easy to interpret and easy to scale.
Measurement-based care (MBC) in behavioral health includes four components:
When measurement-based care is put into practice, the results can be powerful. MBC appears to affect the course of treatment through the monitoring of symptoms, which enhances clinical judgments and patient-provider communications.
Researchers have found significant quality improvement when measurement-based care is embedded in existing technologies and incorporated into the overall culture of the treatment setting. MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration and improves patient outcomes. MBC also serves as a framework to guide treatment decisions.
As behavioral healthcare providers adopt the same measures and systems for measurement, it becomes easier to develop evidence-based practices across patient populations and determine the systems for meaningful quality improvement.
Efforts to identify optimal quality measures in behavioral health and create a framework for improvement are being led by government organizations like the U.S. Department of Health & Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) and private companies like nView Health.
The Office of Management and Budget (OMB) has approved the use of technical specifications and data-reporting templates to collect the 32 quality measures listed in the certified community behavioral health clinics (CCBHCs) certification criteria. CCBHCs and their states are required to collect 21 of the measures for SAMHSA’s demonstration program. In addition to increasing consistent use of evidence-based practices and solutions like nView, the program is also designed to integrate behavioral health with physical healthcare and improve access to care.
Much of this work is still being shaped. Some organizations, such as the National Committee for Quality Assurance (NCQA), feel the measures continue to have significant shortcomings. In Behavioral Health Quality Framework: A Roadmap for Using Measurement to Promote Joint Accountability and Whole-Person Care, the NCQA notes:
While there is much work left to finalize quality improvement metrics, clinicians can and should begin taking steps toward launching and supporting quality improvement projects at their own organizations.
As the industry continues to identify the best metrics and framework to use for behavioral health quality improvement, clinicians can best prepare by taking the following steps.
These foundations will serve clinicians well as they make the transition to evidence-based practices, regardless of current participation in formal programs.
nView provides organizations with a behavioral health solution and supporting tools that power gold-standard measurement-based care. nView combines screeners, interviews, clinical follow-up functionality and scales that allow providers to make appropriate decisions that lead to better, reproducible mental health outcomes for patients. To learn about nView and how it can help your organization achieve its quality improvement goals, visit nview.com and schedule a demo.
