Using State Administrative and Pharmacy Data Bases to Develop a Clinical Decision Support Tool for Schizophrenia Guidelines

Finnerty, Molly; Altmansberger, Richard; Bopp, James; Carpinello, Sharon E.; Docherty, John P.; Fisher, William A.; Jensen, Peter S.; Krishnan, Parukutty; Mittleman, Michael R.; Olfson, Mark; Tricarico, Joel; White, Tom; Felton, Chip J.

doi:10.1093/oxfordjournals.schbul.a006929

Cited by 15 publications

(20 citation statements)

References 25 publications

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“…The Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) is a Web-based decision support system that gives providers access to state administrative databases from 1989 onward and supports the implementation of clinical practice guidelines in NYSOMH hospitals (4). PSYCKES was developed by an inhouse team from NYSOMH in partnership with clinical supervisors, clinicians, and information technology staff.…”

Section: Project Setting and Backgroundmentioning

confidence: 99%

Best Practices: Long-Term Impact of Web-Based Tools, Leadership Feedback, and Policies on Inpatient Antipsychotic Polypharmacy

Finnerty¹,

Kealey²,

Leckman‐Westin³

et al. 2011

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This column describes a series of interventions to decrease antipsychotic polypharmacy in the New York State Office of Mental Health (NYSOMH) network of psychiatric hospitals. Phase 1 consisted of implementation of the Psychiatric Services Clinical Knowledge Enhancement System (PSYCKES), a Web-based application supporting clinical decision making and quality improvement, and a policy requiring approval by NYSOMH's medical director to prescribe more than two antipsychotics per patient. In phase 2 hospital leaders received feedback from the office of the medical director identifying specific patients on polypharmacy. In phase 3, access to PSYCKES continued, but the prior-approval policy and feedback were discontinued. Polypharmacy decreased significantly during phase 1, from 16.9 to 9.7 inpatients per 1,000, and decreased further in phase 2, to 3.9 inpatients per 1,000. In phase 3 the prevalence of antipsychotic polypharmacy remained low at six-month follow-up (3.1 inpatients per 1,000), despite the ending of state-level oversight. On long-term follow-up, polypharmacy increased, eventually rising to 9.2 inpatients per 1,000 after 36 months, but remained well below baseline levels.

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Section: Project Setting and Backgroundmentioning

confidence: 99%

Best Practices: Long-Term Impact of Web-Based Tools, Leadership Feedback, and Policies on Inpatient Antipsychotic Polypharmacy

Finnerty¹,

Kealey²,

Leckman‐Westin³

et al. 2011

View full text Add to dashboard Cite

show abstract

“…That said, quality measurement and management should focus on treatment outcomes. It is here that the gap between theory and practice is bridged: quality is ultimately improved through measurement (4) and subsequent comparison with established guidelines and standards of care (52)(53)(54)(55). If one treatment costs 5 to 10 times more than another treatment, we must be able to demonstrate that the outcome varies significantly (42).…”

Section: Shifting Attention From Process To Outcomementioning

confidence: 99%

Implementing Quality Management in Psychiatry: From Theory to Practice—Shifting Focus from Process to Outcome

McGrath

Tempier

2003

Can J Psychiatry

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With the increasing emphasis on the satisfaction of patient-clients balanced by the need for cost-efficient treatment, quality management is an ever-increasing concern for mental health care providers. It is now apparent that psychiatrists must follow treatment progress and outcome to assess and improve the quality of the care they provide. Most quality measurement and management programs to date have been carried out in research settings using process measures; however, it is clear that the focus must shift from research to practice and from process to outcome measurements. We discuss the notion of quality and outcome management and propose a model for selecting outcome measures. This model suggests 5 dimensions that are commonly assessed in outcome management. We successfully implemented a computerized documentation and quality measurement system in a psychiatric outpatient setting.

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“…Of the six UK studies, four used data from EP systems [11,[25][26][27], one from a EHP system [28], and one did not specify which [29]. Of the three US studies, one used data from an EP system [30], one from an EHP system, [31] and one from both [32]. Of the nine interventional studies, six were quantitative evaluations of interventions based on SUD, of which one was in a large acute hospital using a retrospective time series analysis design [25], one in a tertiary hospital using a controlled before-and-after design [32], one in a general district hospital using an uncontrolled before-and-after design [28].…”

Section: Overview Of Included Literaturementioning

confidence: 99%

The Secondary Use of Data to Support Medication Safety in the Hospital Setting: A Systematic Review and Narrative Synthesis

et al. 2021

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Objectives: To conduct a systematic review and narrative synthesis of interventions based on secondary use of data (SUD) from electronic prescribing (EP) and electronic hospital pharmacy (EHP) systems and their effectiveness in secondary care, and to identify factors influencing SUD. Method: The search strategy had four facets: 1. Electronic databases, 2. Medication safety, 3. Hospitals and quality/safety, and 4. SUD. Searches were conducted within EMBASE, Medline, CINAHL, and International Pharmaceutical Abstracts. Empirical SUD intervention studies that aimed to improve medication safety and/or quality, and any studies providing insight into factors affecting SUD were included. Results: We identified nine quantitative studies of SUD interventions and five qualitative studies. SUD interventions were complex and fell into four categories, with ‘provision of feedback’ the most common. While heterogeneous, the majority of quantitative studies reported positive findings in improving medication safety but little detail was provided on the interventions implemented. The five qualitative studies collectively provide an overview of the SUD process, which typically comprised nine steps from data identification to analysis. Factors influencing the SUD process were electronic systems implementation and level of functionality, knowledge and skills of SUD users, organisational context, and policies around data reuse and security. Discussion and Conclusion: The majority of the SUD interventions were successful in improving medication safety, however, what contributes to this success needs further exploration. From synthesis of research evidence in this review, an integrative framework was developed to describe the processes, mechanisms, and barriers for effective SUD.

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Using State Administrative and Pharmacy Data Bases to Develop a Clinical Decision Support Tool for Schizophrenia Guidelines

Cited by 15 publications

References 25 publications

Best Practices: Long-Term Impact of Web-Based Tools, Leadership Feedback, and Policies on Inpatient Antipsychotic Polypharmacy

Best Practices: Long-Term Impact of Web-Based Tools, Leadership Feedback, and Policies on Inpatient Antipsychotic Polypharmacy

Implementing Quality Management in Psychiatry: From Theory to Practice—Shifting Focus from Process to Outcome

The Secondary Use of Data to Support Medication Safety in the Hospital Setting: A Systematic Review and Narrative Synthesis

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