The Volume-Quality Relationship of Mental Health Care: Does Practice Make Perfect?

Druss, Benjamin G.; Miller, Carolyn Levinson; Pincus, Harold Alan; Shih, Sarah C.

doi:10.1176/appi.ajp.161.12.2282

Cited by 22 publications

(23 citation statements)

References 21 publications

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“…The measures were utilized to assess the relationship of mental health care quality with general health care quality and mental health care volume in health plans that included programs funded by state and federal governments (i.e. Medicaid) [48,64]. …”

Section: Resultsmentioning

confidence: 99%

“…PI for the appropriateness of depression care, and their relation to mental health care outcomes and structures were assessed in three studies [62,64,70]. The PI assess appropriateness expressed as the ratio of clients receiving outpatient depression care, which receive guideline-conformant medication dosage, medication duration, and follow-up visits.…”

Section: Resultsmentioning

confidence: 99%

“…Druss et al used HEDIS measures of medication management and follow-up to assess the volume-quality relationship and found significant associations between both follow-up and medication management measures, and volume of mental health services [64]. A study by Beaulieu et al assessed the criterion validity of the performance measurement instrument for local public health systems, developed by the CDC [50].…”

Section: Resultsmentioning

confidence: 99%

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Performance indicators for public mental healthcare: a systematic international inventory

et al. 2012

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BackgroundThe development and use of performance indicators (PI) in the field of public mental health care (PMHC) has increased rapidly in the last decade. To gain insight in the current state of PI for PMHC in nations and regions around the world, we conducted a structured review of publications in scientific peer-reviewed journals supplemented by a systematic inventory of PI published in policy documents by (non-) governmental organizations.MethodsPublications on PI for PMHC were identified through database- and internet searches. Final selection was based on review of the full content of the publications. Publications were ordered by nation or region and chronologically. Individual PI were classified by development method, assessment level, care domain, performance dimension, diagnostic focus, and data source. Finally, the evidence on feasibility, data reliability, and content-, criterion-, and construct validity of the PI was evaluated.ResultsA total of 106 publications were included in the sample. The majority of the publications (n = 65) were peer-reviewed journal articles and 66 publications specifically dealt with performance of PMHC in the United States. The objectives of performance measurement vary widely from internal quality improvement to increasing transparency and accountability. The characteristics of 1480 unique PI were assessed. The majority of PI is based on stakeholder opinion, assesses care processes, is not specific to any diagnostic group, and utilizes administrative data sources. The targeted quality dimensions varied widely across and within nations depending on local professional or political definitions and interests. For all PI some evidence for the content validity and feasibility has been established. Data reliability, criterion- and construct validity have rarely been assessed. Only 18 publications on criterion validity were included. These show significant associations in the expected direction on the majority of PI, but mixed results on a noteworthy number of others.ConclusionsPI have been developed for a broad range of care levels, domains, and quality dimensions of PMHC. To ensure their usefulness for the measurement of PMHC performance and advancement of transparency, accountability and quality improvement in PMHC, future research should focus on assessment of the psychometric properties of PI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Performance indicators for public mental healthcare: a systematic international inventory

et al. 2012

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“…1,3,4 Most previous studies on the volume-outcome relationship have been hospital-based. Yet most patients with long-term diseases, including diabetes, are managed in primary care.…”

Section: Introductionmentioning

confidence: 99%

Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care

Millett¹,

Car

Eldred³

et al. 2007

Journal of the Royal Society of Medicine

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SUMMARYObjective To examine the association between practice list size, deprivation and the quality of care of patients with diabetes.Design Population-based cross-sectional study using Quality and Outcomes Framework data.Setting England and Scotland.Participants 55 522 778 patients and 8970 general practices with 1 852 762 people with diabetes.Interventions None.Main outcome measures Seventeen process and surrogate outcome measures of diabetes care.Results The prevalence of diabetes was 3.3%. Prevalence differed with practice list size and deprivation: smaller and more deprived practices had a higher mean prevalence than larger and more affluent practices (3.8% versus 2.8%). Practices with large patient list sizes had the highest quality of care scores, even after stratifying for deprivation. However, with the exception of retinal screening, peripheral pulses and neuropathy testing, differences in achievement between small and large practices were modest (55%). Small practices performed nearly as well as the largest practices in achievement of intermediate outcome targets for HbA1c, blood pressure and cholesterol (smallest versus largest practices: 57.4% versus 58.7%; 70.7% versus 70.7%; and 69.5% versus 72.7%, respectively). Deprivation had a negative effect on the achieved scores and this was more pronounced for smaller practices.Conclusion Our study provides some evidence of a volumeoutcome association in the management of diabetes in primary care; this appears most pronounced in deprived areas.

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“…Using a standard suggested by the Health Plan Employer Data and Information Set (HEDIS, Corrigan and Nielsen 1993), 30 days (5 weeks) was selected as the maximum acceptable time between treatment contacts for a patient to be considered continuously engaged in care. HEDIS guidelines have been previously utilized in studies of post-discharge follow-up of psychiatric inpatients (Druss et al 2004) and in evaluations of VA mental health care quality (Harris et al 2009). Based on these guidelines, each veteran was rated as either remaining in treatment or leaving care during the 2 year follow-up period.…”

Section: Long-term Treatment Participationmentioning

confidence: 99%

Post-inpatient Attrition from Care “As Usual” in Veterans with Multiple Psychiatric Admissions

Bowersox¹,

Saunders

Berger

2012

Community Ment Health J

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Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed.

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The Volume-Quality Relationship of Mental Health Care: Does Practice Make Perfect?

Cited by 22 publications

References 21 publications

Performance indicators for public mental healthcare: a systematic international inventory

Performance indicators for public mental healthcare: a systematic international inventory

Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care

Post-inpatient Attrition from Care “As Usual” in Veterans with Multiple Psychiatric Admissions

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