Quality Management & Access Subcommittee

Meeting Summary: Oct. 21, 2005

(Next meeting: Friday November 18 at 9 AM)

BH Indicators

The intent of the Subcommittee’s review of the indicator list is to agree to the items conceptually. HSRI will work with the BHP in developing actual measures. The 50 indicators apply to the child (<19 years) and the family. Comparable HUSKY adult indicators will be generated by the State. These indicators are not associated with ASO financial rewards or sanctions as the critical performance measures recommended by the SC prior to July 2005.

The indicators and comment section were reviewed. Key discussion items were:

ü Access:

o “Intake” refers to the initial visit of a new person. The goal is to avoid the gap between intake and start of treatment.

o “Urgent” will be defined as part of the development of the measure.

o Suggest results be broken out by race/linguists. Dr. Schaefer will review the inclusion of race with VOI as this in the eligibility system and this file should be used for consistency (DCF also includes this in their database.

o How much time is allotted between the first visit and the 2^nd visit (i.e. family doesn’t come back after 1^st intake visit)? On the DCF forms completed for all Child Guidance clinics, discharge information is required. Clinics determine the time of discharge for clients that do not return after the intake. Per the last meeting, there is no intent to burden providers with additional discharge forms. This concern resulted in the SC recommendation that will be presented to the BHP Council that the two agencies review existing forms to identify comparable data and recommend streamlining forms where possible.

o Medical evaluation date would be identified when medication treatment indicated and the parent approves this for their child or the HUSKY adult person agrees to this.

o Adult substance abuse and detox indicators can be adapted from child/youth.

ü Connection to Care:

o F/U care after hospital would include substance abuse hospitalization, F/U care from sub acute and residential.

ü Delays: initial goal is to quantify delays (items 11-16).

ü ED discharge delay is for stays beyond the 23- hour observation stay. Billed as inpatient per diem rate, although this may not identify where in the hospital system the patient stays (i.e. in the ED or admitted to a medical floor awaiting psych services. The ASO will know through VOI Case management system.

ü Coordination of BH & Medical care:

o The BH registration form provides consent for ROI to PCP.

o #21: the goal is to encourage relationship between BH providers and Primary care medical system.

ü Client stability measures (#22-29):

o The SC agreed these are important measures in identifying over time, the growing impact of community-based (CB) services.

o #28-30 would allow identification of high utilizers, where they cluster by provider site. Need to consider OP Clinic case mix, frequency of use of emergency mobile psychiatric teams (EMPS). Goal is to support child/family before EMPS or ED service needed. May consider this similar to HEDIS test measure rather than actual initial performance measure.

o Caution in interpreting #27; while the goal is less hospital admissions and greater use of CB services, don’t want to create a perverse incentive. May see hospital use increase when beds are freed up through shorter hospital lengths of stay related to available CB BH services.

o “Community tenure” relates to uninterrupted stay in Community-based care. Conceptually the numbers could show access to higher levels of CB care, some level of reduction of “bump ups “ to these levels, residential stability (i.e. # of foster home changes).

ü Use of Natural support: agreement with this.

o Group consensus - that parent consent mandatory for teacher evaluation as part of the BH assessment of the child.

ü School (#56-60): these will need further work when State Dept of Education joins the Council.

ü Additional measures:

o No agreement to include SBHC measure at this time.

o BH/OBGYN communication for pregnant women screened for depression – hold. Look at # of teen births in HUSKY (about 22%/year for <19 years of total HUSKY A 10,000 births) versus state indicator for adult measure.

The BH registration form

This was distributed & discussed. The initial intake visit has to be a clinical intake in order to bill 90801. On the first visit it should be possible to identify DMSIV Axis 1-4. Complete clinical assessment may take more than one visit.