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Clinical Quality Improvement

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Clinical Quality Improvement (CQI), monitoring and outcomes management are receiving mounting attention because of increased emphasis on health care accountability and cost containment by government, consumers and 3rd Party payers. Efficient, practical outcomes monitoring systems (OMS’s) are crucial if health care system performance is to be determined and effective/cost-effective treatments are to be identified and improved, but in most cases effective monitoring systems generally are lacking.Historically, addiction treatment facilities have been delivered and evaluated under an acute-care format.

Fixed amounts or duration of treatment have been provided and their effects evaluated 6 – 12 months after completion of care. The explicit expectation of treatment has been enduring reductions in substance use, improved personal health and social function, generally referred to as ‘recovery’.

The many similarities between addiction and mainstream chronic illnesses stand in contrast to the differences in the ways addiction is conceptualized, treated and evaluated. Recent research has been built around the notion that during-treatment evaluations offer significant ongoing improvements for correcting patient services while the individual is still in treatment.

The suggested new system of evaluation retains traditional patient-level, behavioral outcome measures of recovery, but strongly urges that these outcomes should be collected and reported immediately and regularly by clinicians at the beginning of addiction treatment sessions, as a way of evaluating recovery progress and making decisions about continuing care. This paradigm shift to one of Continuous Quality Improvement as (CQI) and it provides maximum potential for producing more timely, efficient, clinically relevant and accountable evaluations.

Although monitoring of treatment response is standard practice for many medical conditions, practitioners in behavioral health care, specifically mental health and substance abuse treatment centers in particular, have been slow to adopt these practices. Continuous Quality Improvement monitoring (CQI), consisting of patient progress, measurement and feedback, has the potential to significantly improve treatment outcomes.

To address drug use, current patient monitoring in behavioral health treatment has typically relied on treatment attendance and urine screens as indicators of treatment progress. However, SAMHSA research has shown that other means of CQI can significantly improve behavioral health treatment effectiveness. Previous government based data analyses shows continuous quality improvement monitoring significantly improves outcomes in behavioral health services.

Although monitoring of treatment response is standard practice for many medical conditions, practitioners in mental health and substance abuse treatment in particular, have been slow to adopt these practices. Continuous Quality Improvement Monitoring has clearly shown the potential to significantly improve treatment outcomes. Past efforts in the Behavioral Health Field measurement based care has typically only relied on treatment attendance and urine screens as indicators of treatment progress.

Clinical quality measures, or CQMs, are tools that continuously measure and track the quality of health care services provided by professionals, facilities within the health care system. These measures use data associated with providers’ ability to deliver high-quality care or relate to long term goals for quality health care.

Clinical Quality Improvement (CQI) measures many elements of patient care:

  • health outcomes
  • clinical processes
  • patient safety
  • efficient use of health care resources
  • care coordination
  • patient treatment services
  • population and public health
  • adherence to clinical guidelines

Measuring and reporting CQMs helps to ensure an organizations health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care

The growing use of quality performance indicators has now become an increasingly important part of payment and cost control incentives for both health plans and providers. Some medical facilities are often reporting as many as 80 different quality indicators with most of this information directly available to consumers.

Unfortunately many behavioral health providers are still far behind in developing effective internal monitoring for quality Improvement and in developing performance measurement criteria. Persistent problems identified include poor patient retention due to early unplanned discharges, low treatment completion rates, high re-admission rates, as well as many other problems.

Many issues can only be corrected through the adoption of a comprehensive Quality Improvement System (Ql). These Ql processes can only work effectively if service providers are willing to adopt a new mindset regarding their need to measure service performance outcomes. Failures to upgrade legacy delivery systems will likely doom those service providers unwilling or incapable of meeting the demands of this new, more competitive environment. If as predicted, when provider performance report cards become readily available on the internet as standard practice, only those programs conducting ongoing, comprehensive quality monitoring will likely survive the revolutionary care now underway.