ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Amplifying the Patient’s Voice: Person-Centered vs. Measurement- Based Approaches in Mental Health Kim MacDonald-Wilson Tara Miller Principal Investigator, Senior Director DSC Coordinator 11/1/2017 #PCORI2017
ANNUAL MEETING | #PCORI2017 Kim MacDonald-Wilson | Tara Miller • Has nothing to disclose November 5, 2017 2
ANNUAL MEETING | #PCORI2017 Objectives • At the conclusion of this activity, the participant should be able to: • Compare two approaches to enhancing psychiatric care in community mental health centers • Identify challenges and solutions to successfully implement new practices November 5, 2017 3
ANNUAL MEETING | #PCORI2017 Rationale • 43.8 million people with mental illness in a year; less likely that people without MI to seek health care, adhere to treatments, or receive services they need • Frequently report that their concerns are not heard • Dissatisfied with the quality of services • Feel blamed for non-adherence • Want their treatment preferences and functional goals supported • People who are engaged and active in health care • Better health and functioning • Higher quality of life • More satisfied with care • Patient-centered health care and engagement in decision making is one approach to improving quality of care November 5, 2017 4
ANNUAL MEETING | #PCORI2017 Overview of Study • To compare the effectiveness of two approaches to shared decision making in community mental health settings on improving patient-centered outcomes for adults with mental illness • Approaches • Person-Centered Care • Measurement-Based Care • Primary Outcomes • Patient Experience of Care • Involvement in Decision Making • Secondary Outcomes • Patient Activation Functional Status Side Effects • Symptom Severity Quality of Life Engagement in Services • Experience with intervention and with implementation of the approach November 5, 2017 5
ANNUAL MEETING | #PCORI2017 Two Perspectives on Psychiatric Visits Service User: “It’s like going through a McDonald’s drive-thru. You drive through the window, they give you your prescriptions, and you’re on your way.” November 5, 2017 6
ANNUAL MEETING | #PCORI2017 Psychiatric Visit Workflow Typical Medication Visit Get Check See doctor Check in Wait Answer questions treatment out Measurement-Based Care Decide on Check Check in Log on Do report Log off See doctor Discuss results treatment out Person-Centered Care Review Review Get Do Collab- Share Check Log in to results/ Check in peer health See doctor health orate decision out DSC learn report report support more November 5, 2017 7
ANNUAL MEETING | #PCORI2017 Patient Experience of Care Patient Experience of Medication Management (PEMM) [Score Range: 0-4] November 5, 2017 8
ANNUAL MEETING | #PCORI2017 Involvement in Decision Making Shared Decision Making Questionnaire – 9 (SDMQ-9) [Score Range: 1-100] November 5, 2017 9
ANNUAL MEETING | #PCORI2017 More of What We Found • Secondary Outcomes • Patient Activation in Care – PAM • Both groups saw significant improvements over time • Symptom Severity – BASIS-32 • Both groups decreased severity over time for depression and psychosis, different patterns • Both groups saw steady decline in overall score, PCC scores decreased faster • Quality of Life – QLESQ • Both groups improved life satisfaction modestly over time, PCC scores improved more. November 5, 2017 10
ANNUAL MEETING | #PCORI2017 A Formula for Successful Implementation Active Redesign Reinforce Leadership Work Flow Implementation November 5, 2017 11
ANNUAL MEETING | #PCORI2017 What We Learned from Stakeholders • Individuals Using Services • Orient to the new approach • Support them to be active participants • Ensure that psychiatric staff review reports • Psychiatric Staff • Engage and solicit input • Teach approach • Provide resources • Leadership • Set expectations with team • Share data on progress • Recognize good work November 5, 2017 12
ANNUAL MEETING | #PCORI2017 One Stakeholder’s Experiences CMSU behavioral health services at the start • Challenges involving service users • Buy-in of staff • Operations of the clinic November 5, 2017 13
ANNUAL MEETING | #PCORI2017 How We’ve Made a Difference • Engaging individuals in care • Focus on shared decision making • Building effective teams November 5, 2017 14
ANNUAL MEETING | #PCORI2017 Today • 95% of clinic using CMSU CG Statistics 2017 CommonGround 102% 100% 98% • Psychiatric staff use 96% Shared Decisions 95-99% % of completed reports 94% PERCENT % w/ personal medicine 92% % w/ power statements % w/ shared decisions • Individuals use CG 90% % w/ meds regularly 88% 86% • Improved relationships with staff 84% • More active in recovery 82% 1 2 3 4 5 6 7 8 9 • Using tools and resources in the Library November 5, 2017 15
ANNUAL MEETING | #PCORI2017 What Service Users Say “Often in the past, I would … forget what questions I had, or certain medication situations I wanted to discuss…” “… it gives m me an opportunity to t think a about m my progress.” “… we review it together and make decisions based on the report.” “Never i in my life fe have I had t the k kind o of r rapport w with a doctor.” November 5, 2017 16
ANNUAL MEETING | #PCORI2017 Learn More • www.pcori.org • info@pcori.org • #PCORI2017 • www.ccbh.com November 5, 2017 17
ANNUAL MEETING | #PCORI2017 Questions ? November 5, 2017 18
ANNUAL MEETING | #PCORI2017 Thank You! Kim MacDonald-Wilson Tara Miller Principal Investigator, Senior Director DSC Coordinator UPMC CMSU November 5, 2017 19
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