accountability and data sharing: improving mental health … · 2007. 12. 7.  · fy05-1stqtr...

Accountability andData Sharing:

Improving Mental Health Services in Oklahoma

National Conference of State Legislatures Fall Forum 2007

Mental Health Treatment:Promoting Entry and Retention

November 28, 2007Phoenix, Arizona

Accountability and Data Sharing:Improving Mental Health Services in Oklahoma

ContextAssuring AccountabilitySharing Data

Context

National SceneState Agency OrganizationState Agency Infrastructure

National Scene

DHHS—ACF, CMS, SACWISSAMHSA—CMHS, CSAT, CSAP, OAS, BH EHRAHRQ—HCUP, NMESONCHIT—NHIN, RHIOs, HIE, CCHITAHIC—Consumer Empowerment, Chronic Care, Biosurveillance, EHR, Personal Health, Quality and CPS WorkgroupsNCVHSCDC—NCHS, BRFSS, MMWR

Guiding Documents

Government Performance and Results Act--GPRA (1993)

Mental Health: A Report of the Surgeon General (1999)

IOM Crossing the Quality Chasm (2001)

The President’s New Freedom Commission on Mental Health (2003)

CSAT Technical Assistance Publication (TAP) Series TAP 29 (2007)

SAMHSA Ten Fundamental Components of Recovery

Individualized and Person-CenteredEmpowermentHolisticNon-LinearStrengths-BasedPeer SupportRespectResponsibilityHope

Context

National SceneState Agency OrganizationState Agency Infrastructure

State Agency Organization

GovernorBoardCommissionerDeputies—COO, MH, SA, C&PDivisions—MH, SA, Finance, HRM/HRD, Legal, IDSSOther agencies: OSDH, OKDHS, OKHCA, DRS, OJA, SDE, DOC

Oklahoma Department of Mental Health and Substance Abuse Services

Mental Health and Substance Abuse Services (SMHA and SSA)Prevention and Treatment ServicesAdults and YouthState-operated and Contracted Facilities

Context

National SceneState Agency OrganizationState Agency Infrastructure

State Agency Infrastructure

3.5M state population77 counties19 CMHCs, 60 SATs, 3 specialty, 2 hospitals, 19 APRCs, 20 RCHs2100 staff65,000 MH and SA treatment clients

Information and Decision Support Services (IDSS)

Information ServicesNetwork and TelecommunicationsEvaluation and Data AnalysisGrants Management

Integrated Client Information System (ICIS)

Web-basedCDC and Service FormsOn-line and batch entryUnique statewide agency, staff and recipient identifiersDesign based on MHSIP and DASIS standardsHIPAA, 42CFR Part 2, and OK43A compliantDemographics, diagnoses, assessments, referrals, drug use

Examples of Grants, Contracts and Other Projects

Building Data Infrastructure MH Transformation Demonstrating Program Effectiveness--PACT, SOC, Meth Prev, Suicide Prev, TANF, Drug Court, MH CourtIntegrated Services InitiativeAccess To RecoveryAdult Recovery Collaborative and Partnership for Children’s Behavioral Health

Accountability and Data Sharing:Improving Mental Health Services in Oklahoma

ContextAssuring AccountabilitySharing Data

Assuring Accountability

Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information

Continuous Quality Improvement

Systems Process CoordinatorPI CoordinatorsBoard PI CommitteeNIATxAccreditation OrganizationsPerformance Management ReportsDIRT

Residential Treatment Followed by a Lower Level of Care Within 14 Days

Question: What percent of residential clients received a lower level of care within 14 days? (Lower level care includes community living and outpatient treatment.)

8

11

26

36

38

41

43

45

46

50

56

71

88

96

58

23

38

42

40

14

49

47

36

42

85

86

71

100

0 10 20 30 40 50 60 70 80 90 100

Bill Willis

MHSSO

DRI

Norman Alc & Drug

NE OK Cncl On Alc

Vinita Alc & Drug

The Oaks

Western State Psych Ctr

12 & 12

Alpha II

Opportunities

New Hope

MONARCH

Second Chance CDU

Percent of Residential Services Followed by a Lower Level of Care

FY02 FY01 Standard Standard=35%

DIR visit

Assuring Accountability

Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information

Program Management

Service UtilizationResource AllocationFidelity/Goal Attainment Guidance for TA, Training and Support

3 staff 52% of services

52% of time3 staff

Peer Support Spec.

Doc

Agency A

Agency B

-

4 clients admitted in the month

Assuring Accountability

Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information

Program Evaluation

Fidelity to Implementation PlanProcess/PerformanceOutcomes

Fidelity to Implementation Plan

PACT ExampleAverage 3 direct services per weekServices are available to clients 24 hours a day, 7 days a weekServe people with severe mental illness

Bill Carl Central Jim North OU Red Rock Red RockWillis Albert OK Taliaferro Care Tulsa OKC Tulsa

Current Residence Private Residence 28 37 39 34 93 5 12 115 363 77.9On The Street 1 1 21 1 15 39 8.4Residential Care Home 5 3 3 11 2.4Institutional Setting 1 1 9 2 2 15 3.2Nursing Home 1 1 0.2Community Shelter 1 1 8 1 6 17 3.6Supported Living 1 1 3 4 11 20 4.3

Living Situation Alone 14 19 23 24 61 7 13 99 260 55.8With Family/Relatives 17 18 18 7 45 3 39 147 31.5With Non-Related Persons 1 1 9 32 2 14 59 12.7

Current Employment Full-Time 1 1 1 3 0.6Part-Time 3 3 1 1 3 11 2.4Unemployed 7 5 23 5 107 2 4 12 165 35.4Not in the Labor Force 21 32 15 33 31 4 14 137 287 61.6

Education: Highest Level Completed No Education 1 1 2 0.41-6 1 1 2 5 9 1.97-9 4 4 3 5 17 1 9 43 9.210-12 19 26 29 26 76 5 14 85 280 60.113-16 7 8 10 8 44 2 1 52 132 28.3

Level of Functioning 00-10 1 1 0.211-20 1 6 7 1.521-30 2 2 1 48 61 114 24.531-40 9 4 21 4 68 2 7 55 170 36.541-50 16 28 19 22 20 4 9 24 142 30.551-60 6 4 13 1 2 5 31 6.761 - 70 1 1 0.2

Diagnosis - Axis I Primary Mood Disorders 8 9 3 3 39 1 1 28 92 19.8Other 1 1 1 3 3 9 1.9Other Non-Psychotic 1 1 1 3 0.6Other Psychotic 16 11 27 16 44 4 9 53 180 38.7Schizophrenia 7 16 11 19 54 1 5 68 181 38.9

Diagnosis - Axis II Primary Developmental Disorders 1 1 1 1 1 5 1.1Personality Disorders 6 2 4 2 1 17 32 6.9Unknown/Other/No Diagnosis 31 32 39 35 135 7 16 134 429 92.1

In Need of Alc/Drug Abuse Treatment1 No 10 8 12 54 140 14 18 190 446 60.3Yes 14 4 26 136 12 102 294 39.7

1ASI Alcohol/Drug Use >=5

Demographics, Continued

Process/Performance

Access to CareContinuity of CareWashington Circle Indicators

IdentificationInitiationEngagement

Regional Performance Management Report

Figure 1: Percent of Adults Discharged from Inpatient Care in the Quarterwith Follow-up Outpatient Care within 7 Days (referred/transferred)

0

10

20

30

40

50

60

70

80

90

100

CN EC NE NW OK SE SW TU State

Region

Perc

ent

FY03-4thQtrFY04-1stQtrFY04-2ndQtrFY04-3rdQtrFY04-4thQtrFY05-1stQtrFY05-2ndQtrFY05-3rdQtr

Regional Performance Management Report

Figure 4: Initiation of Substance Abuse TreatmentFollowing a First Detoxification Service

0

10

20

30

40

50

60

70

CN EC NE NW OK SE SW TU State

Region

Perc

ent

FY03-4thQtrFY04-1stQtrFY04-2ndQtrFY04-3rdQtrFY04-4thQtrFY05-1stQtrFY05-2ndQtrFY05-3rdQtrGoal (1/2 SD)

NIATx MeasuresReduced Wait Times

First Contact to AssessmentAssessment to AdmissionFirst Contract to AdmissionAssessment to First Treatment Service

Reduced No ShowsPercent of Contacts which become Assessments

Increased AdmissionsPercent of Assessments which become Admissions

Increased ContinuationPercent w/ 1st Treatment which continue to 4th Treatment

Outcomes

Was it worth the investment?

Increased Quality of LifeReduction in hospital daysReduction in jails daysIncreased employment

PREYear 1Count Count %Change Count %Change Count %Change Count %Change

Days 4220 832 -80.3 939 -77.7 1218 -71.1 558 -86.8Distinct Clients 66 27 -59.1 25 -62.1 26 -60.6 20 -69.7

Episodes 93 37 -60.2 63 -32.3 68 -26.9 50 -46.2Average Days per Episode 45.4 22.5 14.9 17.9 11.2

POST Year 1 Year 2 Year 3 Year 4

Long-term inpatient hospitalization outcomes among 66clients who admitted to PACT prior to 7/1/02 and did not

discharge for at least four years

73 clients met the criteria for inclusion in the study but 7 had no reported pre PACT inpatient hospitalization so were not included in the cohort.

46 clients had at least one post-admission inpatient episode. Of these, eight clients had an inpatient episode in each of the four post-admission years. These eight clients accounted for 42% of all post-admission days.

Notes:

Assuring Accountability

Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information

Drug Court

Drug Court

Criminal Justice Collaboratives

Drug CourtsMental Health CourtsRe-entry Intensive Care Coordination Teams(Re) Establishing Medicaid after Release

Demonstrating the Physical Health-Behavioral Health Link

Oklahoma State Department of Mental Health and Substance Abuse Services (ODMHSAS)Integrated Client Information System (ICIS)

Clients Admitted and Served in 2000-2004Age 10 or olderRemoved dependent children or family members of substance abuse clients to include clients with mental or addictive disorders only212,767 admissions for 124,796 people

Physical Health Data

Oklahoma State Department of Health (OSDH) Center for Health StatisticsHospital Inpatient Discharge Data Set (HIDDS)

Discharges in 2002 & 2003Age 10 and olderNo principle diagnoses of mental disorders

ICD-9 290-319

956,492 discharges for 570,590 people

Data Matching - ConfidentialityThinking outside the box

How to match the data without violating regulations

Matching data in the darkCould not view the data during the matching process

Unique person identifiersRandomly assigned number

Data Matching - ResultsNo personal identifiers49,260 hospital discharges for 18,820 people found in both datasets

ODMHSAS-clients924,624 hospital discharges for 551,770 people not found in ODMHSAS

Non-clients

Results - Length of StayAverage Length of Stay in Hosptial

Days during Two Years

4.05.0

02468

10

ODMHSAS Clients Non-clients

Ave

rage

Num

ber o

f D

ays

Average Length of Stay in Hospital Days during Two Years by Cohort

4.2 3.8 3.75.0

02468

10

MH Only SA Only MH & SA Non-BH

Ave

rage

Num

ber o

f D

ays

Average Number of Discharges in Two Years

Average Number of Discharges During Two Years by Cohort

3.7 2.7

8.2

2

02468

10

MH Only SA Only MH & SA Non-clients

Ave

rage

Num

ber o

f D

isch

arge

s

Average Number of Discharges During Two Years

4.8

2.0

02468

10

ODMHSAS Clients Non-clients

Ave

rage

Num

ber o

f D

isch

arge

s

DemographicsRate of Hospitalization by Age

Rate of Hospitalizations in 2002-2003 by Age Group

5.9

24.5 27.6

13.3

4.8

1.64.2

10.8

8.6 10.3 12.7 15.2

19.2 19.0

0.9

21.4

05

101520253035

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Perc

ent

ODMHSAS Clients Non-clients Rate of Hospitalizations in 2002-2003 by Age Group and Cohort

6.2

20.7

27.1

17.5

7.2

3.0

9.6

31.6

24.8

23.2

7.8

2.7

0.4

0.13.

2

23.6

31.3

31.3

9.0

1.7

0.0

0.04.

2

10.8

8.6 10

.3 12.7 15

.2 19.2

19.0

1.6

16.7

05

101520253035

10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

Perc

ent

MH Only SA Only MH & SA Non-clients

Assuring Accountability

Continuous Quality ImprovementProgram ManagementProgram EvaluationFunding JustificationPublic Information

Public Information

Consumer choiceAdvocacy promotionProvider incentiveData quality

Accountability and Data Sharing:Improving Mental Health Services in Oklahoma

ContextAssuring AccountabilitySharing Data

Reasons for Data Sharing

Promote Cross-System Collaboration by Identifying Common ClientsAssess Long-Term OutcomesAssess Costs More CompletelyEvaluate Process MeasuresReduce Data Burden for Providers and RecipientsImprove Continuity of Care

Following Service Recipients Long-term through Administrative Databases

Incarceration, probation and parole (DOC)Arrests (OSBI)Employment, unemployment benefits (OESC)DUIs (DPS)Mortality (OSDH)Hospital discharges (OSDH)Medicaid—including SDE, DRS and OJA (OKHCA/OKDHS)

Examples of Data Sharing

Joint Oklahoma Information NetworkTreatment Outcomes and Performance Pilot StudiesOther State Agency projectBrandeis Washington Circle studyAdult Recovery CollaborativeElectronic Health Information Exchange

What has Data Done for Us Lately?

Pinpointed areas for improvement Helped explain why outcomes were achieved Provided evidence of program success Helped establish a more complete picture of program costsProvided feedback to programs about the results of their hard workDemonstrated effectiveness to the legislature to justify their funding and support for

More programsMore staff

Contact Information

Steven Davis, PhDChief Information OfficerOklahoma Department of Mental Health and Substance Abuse ServicesPO Box 53277Oklahoma City, OK 73152405-522-3813sdavis@odmhsas.orgwww.odmhsas.org/eda/statisticsother.htm