Amplifying the Patients Voice: Person-Centered vs. Measurement- - - PowerPoint PPT Presentation

ANNUAL MEETING

• OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

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

ANNUAL MEETING | #PCORI2017

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Kim MacDonald-Wilson | Tara Miller

• Has nothing to disclose

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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

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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

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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

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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.”

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Psychiatric Visit Workflow

Check in Wait See doctor Answer questions Get treatment Check

• ut

Check in Log on Do report Log off See doctor Discuss results Decide on treatment Check

• ut

Check in Log in to DSC Do health report Review results/ learn more Get peer support See doctor Review health report Collab-

• rate

Share decision Check

• ut

Typical Medication Visit Measurement-Based Care Person-Centered Care

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Patient Experience of Care

Patient Experience of Medication Management (PEMM) [Score Range: 0-4]

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Involvement in Decision Making

Shared Decision Making Questionnaire – 9 (SDMQ-9) [Score Range: 1-100]

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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.

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A Formula for Successful Implementation

Active Leadership Redesign Work Flow Reinforce Implementation

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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

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One Stakeholder’s Experiences

CMSU behavioral health services at the start

• Challenges involving service users
• Buy-in of staff
• Operations of the clinic

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How We’ve Made a Difference

• Engaging individuals in

care

• Focus on shared

decision making

• Building effective teams

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Today

• 95% of clinic using

CommonGround

• Psychiatric staff use

Shared Decisions 95-99%

• Individuals use CG

regularly

• Improved relationships with

staff

• More active in recovery
• Using tools and resources in

the Library

82% 84% 86% 88% 90% 92% 94% 96% 98% 100% 102% 1 2 3 4 5 6 7 8 9 PERCENT

CMSU CG Statistics 2017

% of completed reports % w/ personal medicine % w/ power statements % w/ shared decisions % w/ meds

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What Service Users Say

“Often in the past, I would … forget what questions I had,

• r 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

• f r

rapport w with a doctor.”

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2017
• www.ccbh.com

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Questions

?

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Thank You!

Kim MacDonald-Wilson Tara Miller

Principal Investigator, Senior Director DSC Coordinator UPMC CMSU