Hospital Based Inpatient Psychiatric Services (HBIPS) - Institute of ...

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Hospital Based Inpatient Psychiatric Services (HBIPS) - Institute of ...

Hospital Based Inpatient

Psychiatric Services (HBIPS)

Core Measurement Set

Frank A. Ghinassi, Ph.D.

Vice President, Quality and Performance Improvement

Western Psychiatric Institute and Clinic

Assistant Professor in Psychiatry

University of Pittsburgh School of Medicine


Ghinassi / WPIC / University of

Pittsburgh / 2006


HBIPS

Partnership of organizations approached

Joint commission:

– National Association of Psychiatric Health

Systems (NAPHS)

– American Psychological Association (APA)

– National Association of State Mental Health

Program Directors (NASMHPD)

– National Research Institute (NRI)

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

Partnership of organizations approached

Joint commission:

– Concerned about move from 6 to 9 non-core

ORYX measures for inpatient services without

a consensus set of key quality indicators

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Joint Commission: The Model for Core

Performance Measurement Identification, Testing

and Specification

Establish Expert

Advisory Panel

Months 1-4

Measure

Identification

Months 5-8

Public//Stakeholder

Comment

Months 9 - 11

Expert Advisory

Panel Conf. Call

Month 11

Expert Advisory

Panel Conf. Call

Finalize Measures

Month 24

24 mo.

Conduct

Literature/

Evidence

Review

Months 1-2

Expert Advisory

Panel

In-Person

Meeting

Month 4

Ghinassi / WPIC /

University of Pittsburgh /

Milton / Joint Commission

/ 2010

Expert Advisory

Panel In-Person

Month 8

Measure

Specifications

Development

Months 12-16

Conduct

Pilot Test

Months 18-

24

Prepare for

National

Implementation

Months 24-27


HBIPS Advisory Panel

Frank A. Ghinassi, PhD (Chair)

Richard Bosworth, RN

Western Psychiatric Institute & Clinic

Colorado Mental health Institute at

University of Pittsburgh School of

Fort Logan, Denver, CO

Medicine, Pittsburgh, PA

Ann

Jean Campbell, PhD

Doucette, PhD

University of Missouri- Columbia

George Washington University

School of Medicine, St. Louis, MO

Medical Center, Washington, DC

Sue Eisen, PhD

Pam Galbraith, RN, MBA

Edith Nourse Rogers Memorial

ValueOptions, Santa Fe, NM

Veterans Hospital, Bedford, MA

Richard Hermann, MD, MS

Douglas Hancock, MA

Tufts- New England Medical Center

Texas Department of State Health

Boston, MA

Services, Austin, TX

Pablo Hernandez, MD

Karen Johnson, MSW

Wyoming State Hospital

Universal Health Services

Evanston, WY

Chicago, IL

Kathy Jordan- Sedgeman, MS, APRN

Michael Lambert, PhD

University of Michigan Health Systems

Brigham Young University

Ann Arbor, MI

Provo, UT

John Oldham, MD

Steven Onken, PhD

Medical University of South Carolina

Columbia University School of

Charleston, SC

Social Work, New York, NY

Joseph Parks, MD

Johan Smith, MBA

State of Missouri Dept. of Mental

Horizon Health Corporation

Ghinassi Health

/ WPIC /

Lewisville, TX

University Jefferson of Pittsburgh City, MO

/

Milton / Joint Commission

All information was / 2010

current at the time the individual served on the Advisory Panel. This information has not been updated


HBIPS

Pilot included over 200 hospitals

Began in late 2007

Go live date was October, 2008

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

24 vendors supporting HBIPS

311 hospitals participating in

HBIPS

238/311 (76%) free-standing

psychiatric hospitals

73/311 (24%) acute-care

care

hospitals with psychiatric units

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

HBIPS 4,5,6 & 7 endorsed August

2009

HBIPS 2 & 3 endorsed February

2010

HBIPS 1 not endorsed

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

Free-Standing Psychiatric Hospitals

Surveyed under Comprehensive

Accreditation Manual for Hospitals

(CAMH)

HBIPS measure set will be mandatory

beginning with January 1, 2011 discharges

and events

Acute-Care Hospitals with Psychiatric

Units

– One of four sets of core measures

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

HBIPS 2-72

7 will be publicly reported on

QualityCheck.org

HBIPS 2-72

7 will be included in Priority Focus

Process (PFP) or Strategic Surveillance System

(S3)

HBIPS-1 1 will not be publicly reported or included

in PFP and S3

All measures included in ORYX Performance

Measure Report used during survey

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

HBIPS-1: Admission Screening

HBIPS-2: Physical Restraint

HBIPS-3: Seclusion

HBIPS-4: Multiple Antipsychotic Medications at

Discharge

HBIPS-5: Multiple Antipsychotic Medications at

Discharge with Appropriate Justification

HBIPS-6: Post Discharge Continuing Care Plan

HBIPS-7: Post Discharge Continuing Care Plan

Transmitted

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS

Inpatient Psychiatric Patients

Psychiatric Inpatient Discharges- HBIPS-1,4

5, 6 & 7

Psychiatric Inpatient Days- HBIPS-2 2 & 3

Includes all ages stratified by four age groups

– Children (1-12 12 years old)

– Adolescents (13-17 17 years old)

– Adults (18-64 years old)

– Older Adults (>(

65 years old)

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 1

Admission Screening for Violence Risk,

Substance Use, Psychological Trauma

History and Patient Strengths Completed

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Rationale

High prevalence of co-occurring occurring substance

use disorders & history of trauma in acute

psychiatric settings

Risk assessment an important aspect of

patient safety

Assessment of patient strengths help

guide individualized treatment plans that

are culturally appropriate

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

Psychiatric inpatients with admission screening

within the first three days of admission for all of

the following: risk of violence to self or others;

substance use; psychological trauma history;

and patient strengths

_____________________________________

Psychiatric inpatient discharges

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 2

Hours of Physical Restraint Use

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Rationale

Need to respect the patient’s

independence, autonomy and safety

Avoid the use of dangerous or restrictive

interventions at all times

Restraint use should be closely monitored

and analyzed to reduce further use

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

The total number of hours that all

psychiatric inpatients were maintained in

physical restraint

________________________________

Number of psychiatric inpatient days

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 3

Hours of Seclusion Use

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

The total number of hours that all

psychiatric inpatients were held in

seclusion

_________________________________

Number of psychiatric inpatient days

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 4

Patients Discharged on Multiple

Antipsychotic Medications

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Rationale

Use of multiple antipsychotics associated

with severe side effects

50% of current inpatients on 2 or more

antipsychotics

Practice guidelines in place

– Previous failed trials of monotherapy

– Tapering down to one antipsychotic after

discharge

– Augmentation of Clozapine

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

Psychiatric inpatients discharged on two or

more routinely scheduled antipsychotic

medications

_______________________________

Psychiatric inpatient discharges

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 5

Patients Discharged on Multiple

Antipsychotic Medications with

Appropriate Justification

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

Psychiatric inpatients discharged on two or more

routinely scheduled antipsychotic medications

with appropriate justification

_________________________________

Psychiatric inpatients discharged on two or more

routinely scheduled antipsychotic medications

(Derived from HBIPS-4)

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Appropriate Justifications

Three previous failed trials of

monotherapy by history

Recommended plan to taper to

monotherapy

Augmentation of Clozapine

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 6

Post Discharge Continuing Care Plan

Created

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Rationale

Patients may not be able to report details

of hospitalization and follow-up required

Aftercare recommendations given to the

patient not always available

Information necessary to provide optimum

care

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

Psychiatric inpatients for whom the post

discharge continuing care plan is created and

contains all of the following: the reason for

hospitalization, principal discharge diagnosis,

discharge medications and next level of care

recommendations

_____________________________________

Psychiatric inpatient discharges

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


HBIPS Measure # 7

Continuing Care Plan Transmitted to the

Next Level of Care Provider upon

Discharge

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


Numerator and Denominator

Psychiatric inpatients for whom the post

discharge continuing care plan was

transmitted to the next level of care

_______________________________

Psychiatric inpatient discharges

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010


To view the HBIPS Measure

Specifications Manual and to

submit questions

http://manual.jointcommission.org


Questions?

Ghinassi / WPIC / University of

Pittsburgh / Milton / Joint

Commission / 2010