Outcomes monitoring and management, sometimes termed Performance Measurement are receiving increasing attention due to the heightened emphasis on health care accountability and cost containment. Behavioral health and addiction treatment providers have been heavily criticized at many levels including the federal level for the lack in many cases and in others, the slow pace in which we have adopted outcome monitoring as an operational habit.
Efficient, electronic outcome monitoring systems are crucial tools if behavioral health providers are to successfully expect to compete in this hostile healthcare environment. Given the day to day press of everything else that has to be accomplished for those in the trenches delivering care, the ACG Group has a longstanding practical, effective outcome evaluation system that has been termed by CARF surveyors as a “national model”.
Modern outcome evaluation systems must have the capability of successfully augmenting an organizations quality improvement process and program evaluation data by systematically collecting important data on patient characteristics and treatment outcomes. In addition, the ACG Group’s capabilities includes statistical Outcome Reports. Regular Quality Assurance reports measuring performance data measured against national standards, can be utilized for Ql committee recommendations, for management oversight, all while providing credible information that can serve to inform stakeholders as well.
Historically, when addiction treatment services have been delivered and evaluated, it has usually been under an acute-care format. Fixed amounts or duration’s of treatment in the past have been provided and their effects evaluated after completion of care. The measures or expectations for treatment have been generally enduring reductions in substance use, personal health and social improvement generally referred to as “recovery”. In contrast, treatments for chronic illnesses such as diabetes and hypertension and asthma have been provided for indeterminate amounts periods and their effects continuously evaluated during the course of those treatments.
The many similarities between addiction and mainstream chronic medical illnesses stand in contrast to the differences in the ways addiction is conceptualized, treated and evaluated. In the newly conceptualized “recovery oriented systems of care” addiction is viewed as a chronic relapse prone brain-based disease bringing parallels to other chronic diseases and suggesting concurrent recovery monitoring. Thus, we evaluate patient outcomes using our computer-based survey system, at the initiation of treatment and at predetermined points throughout treatment and post discharge.
This updated process brings the benefits of outcome evaluation to decision-making during the course of treatment as well as following treatment episodes. We call this ‘concurrent recovery monitoring’ and believe it has the potential for producing more timely, efficient, clinically relevant and accountable evaluations.
One example of ACG’s electronic Monitoring system is the assessment at admission of the level of trauma experienced by the patient as well as through the use of screening instruments embedded within the survey, clinicians can determine the need for trauma treatment services such as “Seeking Safety”, a CBT intervention developed expressly for addiction treatment settings. By putting patients into this level of service, their trauma symptoms can be reduced permitting them to better engage in the main treatment process and reducing instances of relapse due to traumatic memories.
The same screen re-administered at the follow-up intervals indicates the level of progress or lack thereof. Thus the opportunity to improve services for individual clients through the monitoring system exists as well.
1 MclellanAT, McKay JR, Forman R, Cacciola J, Kemp J Reconsidering the evaluation of addiction treatment: from retrospective follow up to concurrent recovery monitoring.