Quality Improvement
Introduction
The Fellowship Education Committee and the Quality and Safety Special Interest Group (SIG) have started this page to aid Academy members interested in quality and safety topics. We hope to enhance understanding and provide shared resources to those interested in engaging in assessment of individual and systems practice.
Consultation-Liaison psychiatry is uniquely poised to contribute to the meaningful advancement of measured and thoughtful application of quality and safety indicators. Inpatient and outpatient consulting psychiatrists have impact not only on psychiatric outcomes, but also influence outcomes of many current Centers for Medicare and Medicaid Services (MS) and Joint Commission dashboard measures. Collaborative and integrated care settings naturally embody the concepts of quality and safety fundamentals, including the guiding principles outlined by the ACA: better health, better care, and better value (http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx). The resources here are meant to engage the ACLP membership in meaningful reflection on clinical practice, in any setting.
Topics on Quality and Safety are taking high priority in healthcare systems around the world, though may be less developed within psychiatry. Regulators, payors, funders, as well as patients and families are increasingly interested in measurement and reporting of quality outcomes. The APA has outlined some specific topics within psychiatric settings. In addition, the ACGME states that “All physicians share responsibility for promoting patient safety and enhancing quality of patient care. Graduate medical education must prepare fellows to provide the highest level of clinical care with continuous focus on the safety, individual needs, and humanity of their patients….” (https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/409_ConsultationLiaisonPsychiatry_2019_TCC.pdf?ver=2019-03-27-090719-270). Within Consultation-Liaison psychiatry, there are great opportunities to help develop and define quality measures and goals of care.
Lisa J. Rosenthal, MD, FACLP
Chair, Fellowship Education Subcommittee
David Kroll, MD
Chair, Quality and Safety SIG
Quality Didactic with Dr. Kroll
Key concepts
Several recent items in the ACLP Newsletter from Dave Kroll, MD, Chair of the Quality and Safety SIG, offer an introduction to the field of quality studies.
Why measure quality in C-L Psychiatry?
Where do Quality Measures come from?
Annual Meeting
Quality and Safety project abstracts are presented at the Annual Meeting each year. We would like to call your attention to a study from this last year:
Each year the Fellowship Education Subcommittee will be peer reviewing abstracts of successful Quality and Safety projects, and posting them!
Demonstration project
A national Consultation-Liaison Quality and Safety project for Fellowship Programs and other interested members!
We have begun an initiative to create and share a Quality and Safety project that could be completed by CL psychiatrists and trainees in many settings. Currently the project is being piloted at 3 sites, testing a variety of outcome measures.
A workshop about the project was presented at the 2019 ACLP Annual Meeting on November 14: SIG02 – Teaching Quality Improvement to the Next Generation of C-L Psychiatrists, with Lisa Rosenthal, MD, FACLP – Northwestern University, Feinberg School of Medicine; Sejal Shah, MD, FACLP, Dave Kroll MD, and Brady Lonergan MD, all at Brigham and Women’s Hospital. A slide deck modified from this workshop covers ACGME requirements for teaching about QI, describes the growth of a national program to help support C-L fellows and faculty on their QI projects, and reviews several QI projects with trainee involvement. Please click here to access.
Upcoming
An online video by Dave Kroll MD explaining the basics of Quality Improvement will be filmed at the Annual Meeting in 2019. This should be posted in early 2020.
A brief didactic online “course” with content aimed at guiding quality and safety projects is in development.
Additional Links and resources
American Psychiatric Association webpage for Quality Improvement resources:
https://www.psychiatry.org/psychiatrists/practice/quality-improvement
A defining curriculum for psychiatry residents by Melissa Arbuckle MD, PhD and Deborah Cabaniss MD, with detailed instructions for the QI process for trainees:
Arbuckle, M.R., Weinberg, M., Cabaniss, D.L. et al. Acad Psychiatry (2013) 37: 42.
https://doi.org/10.1176/appi.ap.11120214
IHI, the Institute for Healthcare Improvement, has many resources and educational opportunities:
http://www.ihi.org/resources/Pages/default.aspx
And, IHI has a worksheet for the “Plan, Do, Study, Act” cycle:
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
CMS – The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS):
https://www.cms.gov
US Department of Human Services, Agency for Healthcare Research and Quality:
https://www.ahrq.gov/
A great review of Quality principles and their relationship with Collaborative Care by Mark Newman, MD:
Newman, M. Integrated and Collaborative Care: Quality Improvement in Action. Psychiatric Annals. 2017;47(7):374-377 https://doi.org/10.3928/00485713-20170525-01