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The Readmissions Quality Collaborative
Edith Kealey, MSW Kate M. Sherman, LCSW New York State Office of Mental Health, 2013
Overview
Background and Scope of the Problem
The Readmissions Quality Collaborative Participants and Activities Strategies to Reduce Readmissions
Resources PSYCKES indicators PSYCKES public website and training webinars
Reducing Hospital Readmissions: A National Quality Focus
Hospital readmissions are common and costly 19.6% of Medicare beneficiaries discharged were re-hospitalized within 30
days; cost to Medicare of unplanned readmissions estimated at $17.4 billion (Jencks, 2009)
Medicaid enrollees aged 21-64 had 10.7% 30-day readmission rate (HCUP Statistical Brief #89, 2010)
National/multi-state initiatives to address preventable readmissions include Partnership for Patients Community-Based Care Transitions Program:
national initiative to reduce unnecessary hospital readmissions by 20% Project BOOST (Society of Hospital Medicine): 60 sites in 26 states IHI STAAR (State Action to Reduce Avoidable Readmissions) Initiative: 4-
state collaborative in 148 hospitals
While most attention nationally is on medical readmissions, behavioral health readmissions are an important component of the overall picture.
30-Day Readmission by Major Diagnostic Category at Initial Hospital Stay for Medicaid
Recipients Age 21-64, 2007
Among 15 states, behavioral health discharges ranked among the top 5 diagnostic categories for 30-day readmissions.
AHRQ Health Care Utilization Project Statistical Brief #89, 2010
30-day Behavioral Health Readmission Rates in the NYS Medicaid BH
Population, April 2011- April 2012
New York State Office of Mental Health, 2012
Characteristics of NYS Medicaid BH Recipients with 30-day BH Readmissions
NYS Office of Mental Health, 2012
The Readmissions Quality Collaborative
Goal: Reduce readmission rates among adults discharged from behavioral health inpatient services
Projected time frame: June 2012-December 2013
Sponsors: GNYHA, HANYS, OMH/PSYCKES
Steering Committee of peer institutions decides: Focus of project (i.e., readmissions) Strategies and activities Reporting requirements
Participating Hospitals and Service Types
47 Participating Hospitals Statewide NYC (23), LI (9), Hudson River (6), Central (5),
Western (3)
50 Inpatient Services 44 Psychiatry, 6 Detox / Rehab
16 Outpatient Services 12 Mental Health, 2 Chemical Dependency, 2 Dual
Diagnosis
3 Psychiatric Emergency Departments / CPEPs
Key Activities of the Collaborative
Conferences
Monthly Learning Collaborative Calls Interactive, report on progress
Strategies calls: Training on specific strategies
Data reporting Monthly self-report Quarterly Medicaid data
Site Visits (selected hospitals)
Core Project Activities Case finding: Implement admission protocol to identify
clients at risk of readmission, using Screening Tool and/or PSYCKES data.
Identify and address risk factors: Assess for risk factors and implement policy that identified risks for readmission are addressed explicitly on treatment plan and discharge plan.
Optimize discharge process: Implement a protocol or checklist to ensure best practices in discharge planning, including procedures for bridging time between discharge and first outpatient session. Coordinate discharge planning efforts with the BHO.
Priority Targets for Intervention
Improve medication practices
Improve engagement in outpatient care
Improve delivery of integrated treatment for co-occurring psychiatric and substance use disorders
Intervention: Improving Delivery of Integrated Treatment for
Co-Occurring MH and SUD
■ Using the evidence-based Integrated Dual Diagnosis Treatment (IDDT) model
■ **On-line training available via OMH “Focus on Integrated Treatment” Modules.**
Examples from Participating Hospitals
At several hospitals, if a potential readmission comes to ED, the inpatient treatment team who knows the client is called to ED for consultation.
Hospitals are attending more carefully to barriers such as insurance, e.g., checking which LAIs the client’s insurance will cover before initiating a regimen.
At Woodhull Hospital, clients at high risk of readmission receive two individual sessions focused on preventing readmission.
Examples from Participating Hospitals, cont’d
Several hospitals, including LIJ and Maimonides, are implementing “plan for discharge” workbooks and worksheets.
Lutheran Hospital “Warm Hands” initiative to improve transitions from inpatient detox to outpatient chemical dependency, e.g., before 1st appointment, clinician makes provides motivational interviewing on reminder call.
Next Steps
Midyear conference
Analysis of Medicaid and other data to review trends over time
Identify which strategies are most effective and result in best return on investment
Site visits to identify best practices and provide technical assistance
Brief Introduction to PSYCKES A HIPAA-compliant, web-based application that
provides access to Medicaid claims data for clinical decision-making and quality improvement Includes fee for service and managed Medicaid, but
not Medicare or private insurance
Includes data on NYS Medicaid behavioral health population
Up to 5 years of data across treatment settings
Quality measures calculated at state, region, county, and provider level
PSYCKES Quality Measures Acute Care Utilization
High Utilization (Inpatient/ER)
Behavioral Health Readmission
Preventable Hospitalization
Physical Health Outpatient Medical
Visits Lab monitoring
Psychotropic Medications Adherence Cardiometabolic Risk High Dose Polypharmacy
Psychotropic Prescribing for Youth Too much, too many,
too young
Clinical Summary Integrated view of all services Service Summary Tables by Category
Medications Outpatient Inpatient/ER And more …
Drill down to view linked claims/encounters Can be exported to Excel/PDF
Inpatient and ER Services Service type (ER or Inpt, BH or Medical), hospital name, date of admission/discharge, LOS, last diagnosis, procedures, “See all Data” > links to each invoice/claim
PSYCKES Home Page www.psyckes.org
Public website, PYSCKES access not needed Click on “Hospital Collaborative”
For Further Information PSYCKES website
www.psyckes.org
PSYCKES Help (PSYCKES support) 9:00AM – 5:00PM, Monday – Friday [email protected]
OMH Help Desk (PSYCKES access, SMS support) 7:00AM – 8:00PM, 7 days 800-HELP-NYS (800-435-7697) [email protected]