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Quality Improvement

Delivering high-quality care and achieving the best outcomes for patients are key goals for the practice of medicine and psychiatry. However, there remain significant variations in outcomes and in adherence to evidence-based practices across different practitioners, care settings, and geographical areas.1 Moreover, despite their wide prevalence in the United States,2 mental and substance use disorders remain undertreated, imparting a significant economic burden and drain on health care resources.3 Persistent disparities in outcomes and access to care along ethnic and racial lines also demand a robust response from the health care system. Quality improvement, from a clinical and policy perspective, is becoming increasingly important in mental and behavioral health care.

In both the public and private health care sectors, there has been a movement toward “value-based” care, which aims to achieve improved quality and reduced costs through payment design and other incentives. In a value-based health care system, physicians, hospitals, and other health care providers receive compensation based on their ability to deliver efficient and high-quality care, rather than the volume of visits, procedures, services, or treatments provided. Most payers are moving to reimbursement models that hold systems and physicians accountable for improvements in the health and functional status of their patients through performance on quality measures.

Quality measures assess aspects of care such as patient outcomes (e.g., symptom reduction, improvement in function) or clinical processes (e.g, adherence to evidence-based guidelines for specific activities such as diagnosis, assessment, and treatment). Increasingly, payers such as the Centers for Medicare & Medicaid Services (CMS) are also seeking to measure costs and resource use associated with care delivery. Health care providers collect data on these measures and report their performance to federal and commercial payers who in turn use them to determine reimbursement rates for services. In addition, performance on these measures may be used to provide public information (e.g., rankings, star ratings, etc.) on the quality of care delivered by a particular health system, hospital, or clinician.

Given the current emphasis on performance measures, it is important that APA members are knowledgeable and actively involved to ensure that measures reflect the values of psychiatry. APA entities such as the Council on Quality Care, the Committee on Quality and Performance Measures, the Council on Research, and the Council on Healthcare Systems and Financing will continue to collaboratively monitor and participate in national performance measure initiatives; explore performance measure development and implementation support within the APA; and work with experts such as those involved with Practice Guideline development to ensure that performance measures developed by outside groups are valid, reliable, evidence-based, and practical.

View the official platform and strategy on performance measurement of the American Psychiatric Association here.

References

  1. Institute of Medicine. Washington D.C: National Academy Press; 2006. Improving Quality of Health Care for Mental and Substance Use Conditions
  2. Ahrnsbrak R., Bose J., Hedden S.L., Park-Lee, E. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA).
  3. Agency for Healthcare Research and Quality (AHRQ), 2015; Retrieved from http://www.hcupus.ahrq.gov/faststats/NationalDiagnosesServlet

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