crisis metrics t atkinson
TRANSCRIPT
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Is It Working?Measuring the Effectiveness of Crisis Services2021 Wisconsin Crisis Intervention Conference
Living the Dream – Tonka Style
Today’s FacilitatorTravis Atkinson, MS, LPC
Director of Clinical & Crisis Services,TBD Solutions
President,Crisis Residential Association
Host,The Crisis Podcast
@TravisJAtkinson
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What is a Measure?
Types of Measurement
ProcessDid we do the things?
StructureWhat are the things?
OutcomeDid the things we did
make a difference?
Triple Aim ofHealthcare
Population Health
Satisfaction of Persons
Served
Reducing Cost
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POLL QUESTION #1
What is the most accurate description of how data is used in your crisis program?
Our funders require us to report data to them
We collect our own data and review it internally
We collect data and share it with community partners
We don’t really collect any data
Why do crisis metrics matter?
What Do YouCare About?
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POLL QUESTION #2
What is one thing that you measure in your life outside of work?
Why Metrics Portfolios are So Hard
Fenton et al: High patient satisfaction led to fewer Emergency Department visits but higher inpatient hospital odds, higher pharmacy costs, andhigher mortality rates 25%). (2012)
When Satisfaction and Health Outcomes Don’t Correlate
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More Barriers to
Metrics
Metrics LimitationsCrisis Residential metrics are often defined by other
previously established metrics.
Primary Care MetricsMedical processes with limited behavioral health implications (HEDIS Measures, for example)
Psychiatric Hospital Metrics7-day and 30-day Re-admission rates
History of Crisis Metrics• From anecdotes to
objective data
• From the WHAT to the HOW & WHY
• From risk factors toprotective factors
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Sources of InspirationVibrant Call Center Report CRISES Paper
Modern-Day Crisis MetricsCrisis
Reliability
Indicators
Supporting
Emergency
Services
A Metrics Framework
EXCELLENCE IN CRISIS SERVICES
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Example 1: Rural Midwest County• County Population: 135,000• One hospital system• Crisis services
• Mobile Crisis• Crisis Call Center• Psychiatric Urgent Care• Psychiatric Inpatient
• Service of Focus: Psychiatric Urgent Care• Data participants
• One organization• Clinical Director, Behavior Analyst
TA1
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TA1 [@Patrick O'Brien]--please list in the Notes section of this slide all of the Wisconsin Counties between 100,000 and 150,000 people.Travis Atkinson, 9/14/2021
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Example 2: Urban Midwest County
• Population: 630,000• Three hospital systems, two psychiatric hospitals• Crisis Services
• Mobile Crisis• Crisis Call Center• Psychiatric Urgent Care• 23-Hour Crisis Stabilization (EmPATH Unit)• Crisis Residential (Adult)• Psychiatric inpatient
TA2
Slide 21
TA2 [@Patrick O'Brien]--please list in the Notes section the Wisconsin counties with a population between 500k and 750k (and list the population next to the county name)Travis Atkinson, 9/14/2021
Example 2: Urban Midwest County
• 5 Measures Chosen• Time to Initial Evaluation
• Depression Screening and Follow-Up Plan
• Follow-Up after Hospitalization for Mental Illness
• 30-Day Readmission following Psychiatric Hospitalization
• Left Without Being Seen
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Example 3: Crisis Residential Providers in a Midwest State• Started in 2016• Provider-led & facilitated by TBD Solutions• Collaborative process
• Helpful/Relevant• Ease of Measure• Method of Collaboration
• Started small/simple
Excellence in Crisis Services
Timely
Safe
Least Restrictive
• Door to Diagnostic Evaluation• Left Without Being Seen• Median Time from ED Arrival to ED Departure for ED Patients: Discharged,
Admitted, Transferred• Admit Decision Time to ED Departure Time for ED Patients: Admitted, Transferred
• Rate of Self-directed Violence with Moderate or Severe Injury• Rate of Other-directed Violence with Moderate or Severe Injury• Incidence of Workplace Violence with Injury
Partnership
Effective
• Law Enforcement Drop-off Interval• Hours on Divert• Provisional: Median Time From ED Referral to Acceptance for Transfer• Post Discharge Continuing Care Plan Transmitted to Next Level of Care Provider
Upon Discharge• Provisional: Post Discharge Continuing Care Plan Transmitted to Primary Care
Provider Upon Discharge
• Denied Referrals Rate• Provisional: Call Quality
• Community Dispositions• Conversion to Voluntary Status• Hours of Physical Restraint Use• Hours of Seclusion Use• Rate of Restraint Use
• Unscheduled Return Visits – Admitted, Not Admitted
Accessible
Consumer and Family Centered
• Consumer Satisfaction• Family Involvement
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Defining Outcome Metrics for Facility-Based Crisis Services
80% 80%83%
79% 77%67% 73% 69% 71%
83%71%
63%
Annual Average, 75%
60%
50%
40%
30%
20%
10%
0%
70%
80%
90%
100%
January February March April July August September October November December
Perc
ent o
f Disc
harg
edPo
pula
tion
May June
Monthly Avg Annual Average
Planned Discharge Rates (CY2019)
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Annual Average, 78%
76% 77%84%
75% 77%68%
76% 77% 76%85% 83% 86%
30%
20%
10%
0%
40%
100%
90%
80%
70%
60%
50%
January February March April May June July August September October November December
Annual Average Monthly Average
Client Satisfaction (CY2019)
Lessons Learned
1 Buy-in, engagement, and application is needed from multiple levels of the organization
2 Relationship power is a better, purer motivator than role power…but it still doesn’t always last
POLL QUESTION #3
What gets in the way of your program using data?
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COMMON EXCUSES TO AVOID DATA
Common Excuses to Avoid Data1. “But I don’t know data!”Your understanding of data hasA direct impact on the long-term existence of your program.
2. “But I’m not good at this!”Data collection takes time anddiscipline to assimilate it intoyourwork culture, and others in your organization can help.
3. "But I’m not good at math!”Balance your needs & strengths with those of your colleagues atyour organization.
Steps to a Data-Rich Crisis Program
• Start Small• Client Satisfaction• % of discharges according to plan
• Data sharing is Data Caring• Staff at Crisis program• Within the organization• Community-level (funder, county, state)
• Advocate for access to your state’s Medicaid encounter data• Compare• Benchmark• Advocate
• Leverage your data with your TotalCost of Care• It starts with…determining your TCOC
And remember…the best time to collect data is when you
DON’T HAVE TO!
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Metrics Action Plan
I. Make a choice, make it simple a.1-question Likert scale b.Previously used toolc.Yes/No Question on “If it weren’t for
this service, I would have gone to the Emergency Department”
II.Small victoriesa.Reporting at 100%, 3 months of
collecting a measureIII.Include system users
Metrics Action Plan: Considerations forCounty- or Region-Level System Monitoring
• Collaborative with Operating Agreement• Data Sharing Agreements• Monthly meetings
CRISIS RESOURCES
1. Crisis Residential Best Practices Handbook
2. Alternatives to Hospitalization: Research Overview
3. BH Capacity in Emergency Departments
https://www.tbdsolutions.com/papers-presentations-2/
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https://www.crisisresidentialnetwork.com
Reaching Travis
Travis AtkinsonTBD [email protected] @TravisJAtkinson
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