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8.4.1
Introduction
ADHS/DBHS is committed to establishing high quality behavioral health
services. One method for achieving this is through adherence to
the standards and guidelines set by the Centers for Medicare and
Medicaid Services (CMS). Conducting Performance Improvement Projects
consists of utilizing a comprehensive protocol endorsed by CMS.
For Medicaid, the standards and guidelines used in the protocol
for conducting Medicaid External Quality Review Activities ensure
that Medicaid managed care organizations meet the quality assurance
requirements set forth in the Balanced Budget Act (BBA) of 1997.
One way that ADHS/DBHS adheres to CMS standards and guidelines and,
in turn, promotes improvement in the quality of the behavioral health
care provided to behavioral health recipients, is through the development
and implementation of Performance Improvement Projects (PIPs).
What are
performance improvement projects (PIPs)?
A PIP is an initiative to:
- Implement
system interventions to improve quality;
- Evaluate
the effectiveness of system interventions; and
- Measure
performance.
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PIPs are designed
to:
- Demonstrate
achievement and sustainment of improvement for significant aspects
of clinical care and non-clinical services; and
- Correct
significant systemic issues that come to the attention of ADHS/DBHS
in part through:
- Internal
surveillance and service delivery monitoring,
- Tracking
and trending of complaints/allegations of abuse
- Provider
credentialing and profiling
- Utilization
management reviews, and
- Member
and/or provider satisfaction surveys.
What PIPs
are currently in progress?
Currently there are four ongoing PIPs; three projects address clinical
topics and one project addresses a non-clinical topic. Specific
information concerning current PIPs can be found in Section IIIA
of the ADHS/DBHS Quality Management/Utilization Management Annual
Plan.
The three clinical
Projects are:
- Medication
Management: Informed Consent for Psychotropic Medication Prescription
The purpose of this project is to affect positive clinical outcomes
through increased consumer understanding, compliance and empowerment
by improving the practice of obtaining and documenting informed
consent from consumers/parents/legal guardians for all prescribed
psychotropic medications.
- 0-5 Assessment
The
purpose of this project is to develop and implement a comprehensive
assessment for children from birth to age five in order to improve
the quality of care provided to this age group.
- Psychotropic
Medication
The
purpose of this project is to improve psychiatric services provided
to behavioral health recipients by increasing the quality of documentation
used to justify the use of multiple medications.
The non-clinical
project is:
- Access
to Care: Appointment Availability for Routine Assessment
The purpose of this project is to improve access to care for persons
receiving behavioral health services by assuring that appointments
are available for routine assessments within 7 days from the date
of referral.
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8.4.2
References
The following citations can serve as additional resources for this
content area:
8.4.3
Scope
To Whom Does this Apply?
T/RBHA and
behavioral health providers.
8.4.4
Did you know…?
The Performance Improvement Project (PIP) protocol includes
activities that public and private sector tools have in common.
The PIP protocol
is based on a guidebook produced by the National Committee for Quality
Assurance (NCQA) under a contract with CMS. The guidebook is entitled
"Health Care Quality Improvement Studies Managed Care Settings:
A guide for State Medicaid Agencies."
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8.4.5
Objective
To make sure that T/RBHAs and behavioral health providers understand
and actively participate in the implementation of the Performance
Improvement Projects (PIPs).
The
purpose of health care quality Performance Improvement Projects
is to assess and improve processes, and thereby outcomes, of care.
In order for such projects to achieve real improvements in care,
and for interested parties to have confidence in the reported improvements,
PIPs must be designed, conducted and reported in a methodologically
sound manner.
8.4.6
Procedures
T/RBHA subcontracted providers play an integral role in
the implementation of the ADHS/DBHS Performance Improvement Projects
(PIPs). Behavioral health providers may be asked to participate
with any or all aspects of the PIP implementation process.
There are ten
(10) steps to be undertaken when conducting PIPs:
- Select the
study topic(s). In general, a clinical or non-clinical issue selected
for study should affect a significant number of behavioral health
recipients and have a potentially significant impact on health,
functional status or satisfaction.
- Define the
study question(s). It is important to clearly state, in writing,
the question(s) the study is designed to answer. Stating the question(s)
helps maintain the focus of the PIP and sets the framework for
data collection, analysis, and interpretation.
- Select the
study indicator(s). A study indicator is a quantitative or qualitative
characteristic reflecting a discrete event (e.g., an older adult
has/has not received a flu shot in the last 12 months), or a status
(e.g., a person’s blood pressure is/is not below a specified
level) that is to be measured. Each project should have one or
more quality indicators for use in tracking performance and improvement
over time.
- Use a representative
and generalizable study population. Once a topic has been selected,
measurement and improvement efforts must be system-wide. A decision
needs to be made as to whether to review data for the entire population
or use a sample of the population.
- Use sound
sampling techniques (if sampling is used). If a sample is to be
used to select members of the study, proper sampling techniques
are necessary to provide valid and reliable information on the
quality of care provided. When conducting a study designed to
estimate the rates at which certain events occur, the sample size
has a large impact on the level of statistical confidence in the
study estimates.
- Reliably
collect data. Procedures used to collect data for a given PIP
must ensure that the data collected on the PIP indicators are
valid and reliable. Validity is an indication of the accuracy
of the information obtained. Reliability is an indication of the
repeatability or reproducibility of a measurement. Potential sources
of data include administrative data (e.g., enrollment, claims,
encounters), medical records, tracking logs, results of any provider
interviews and results of any recipient interviews and surveys.
Data can be collected from either automated data systems or by
a manual review of records.
- Implement
intervention and improvement strategies. Real, sustained improvements
in care result from a continuous cycle of measuring and analyzing
performance, and developing and implementing system-wide improvements
in care. Actual improvements in care depend on thorough analysis
and implementation of appropriate solutions.
- Analyze
data and interpret study results. Data analysis begins with examining
the performance on the selected clinical or non-clinical indicators.
The analysis of the study data should include an interpretation
of the extent to which the PIP was successful and what follow-up
activities are planned as a result.
- Plan for
“real” improvement. When a change in performance is
found, it is important to know whether the change represents “real”
change or random chance. This can be assessed in several ways,
but is most confidently done by calculating the degree to which
an intervention is statistically significant; and
- Achieve
sustained improvement. Real change results from changes in the
fundamental processes of health care delivery. Such changes should
result in sustained improvements. In contrast, a one-time improvement
can result from unplanned accidental occurrences or random chance.
If real change has occurred, the project should be able to achieve
sustained improvement.
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8.4
Performance Improvement Project
Last Revised: 06/30/06
Effective Date: 06/01/2006 |
