Penelope P. Ziegler, M.D., Medical Director Janet S. Knisely, Ph.D., Program Evaluation Director Virginia Health Practitioners Monitoring Program

Transcription

1 Penelope P. Ziegler, M.D., Medical Director Janet S. Knisely, Ph.D., Program Evaluation Director Virginia Health Practitioners Monitoring Program Department of Psychiatry Division of Addiction Psychiatry Virginia Commonwealth University None 1

2 Inadequate oversight Lack of objective standards Lack of performance assessment Lack of quality measurement (auditing) and quality improvement activities Conflicts of interest Self-referral Preferred provider paybacks Kickbacks from drug monitoring and other fee-generating activities Managing your program s performance Measurement of current performance against standards Management of performance by identifying areas of difficulty System-wide Individual staff members Improving your program s quality on an ongoing basis System-wide Review/revise guidelines (policies and procedures) Develop plan to improve function Continue to measure and manage Individually Design improvement plan for individual staff members performance Continue to measure and manage 2

3 Improved continuity of services Improved ability to recognize patterns of non-adherent behavior and relapse warning signs Improved ability to respond to needs of stakeholders Participants Treatment providers Boards Employers Practice partners Insurance systems Improved participant retention and outcomes Operated by Division of Addiction Psychiatry, Department of Psychiatry, Virginia Commonwealth University Under Memorandum of Agreement with Virginia Department of Health Professions Provides services to health practitioners with impairing conditions who are licensed by 13 Health Care Boards Funding is via licensure fees 3

4 Seven members appointed by Director of Department of Health Professions Members are licensed professionals from various disciplines chosen for expertise in addiction or other impairing conditions Medicine Nursing Dentistry Pharmacy Behavioral Health Care DHP Program Manager serves as liaison between HPMP and Committee Committee meets with HPMP staff and Program Manager to review cases, discuss program operation, explore issues of treatment modalities and availability, review drug screen monitoring system, etc. External Audit by DHP Required via Memorandum of Agreement Randomly selected charts reviewed (10%) Chart component review More quantitative than qualitative HPMP External Audit Use of experienced outside clinician Randomly selected charts reviewed (5%) Equal number of charts from each case manager caseload Six month review period Qualitative and quantitative review Audit reports Recommendations for Administration Feedback for staff Report focus System-wide patterns Suggestions for quality improvement approaches and projects Individual case manager strengths/weaknesses 4

5 History of Internal Audit Activities Program evaluation team[ ] Paper chart content required monitoring and noncompliance reporting Electronic record content Report to medical director Senior Case Manager [ ] Paper chart content required monitoring and noncompliance reporting Monitoring follow-up Program guidelines adherence Feedback to case manager Program evaluation team [2010-current] Progress notes Formal group staffing Daily rounds with medical director Monthly Case Management Reports NPHS and supplemental intake form Relapse records Program guideline adherence Monthly report to case manager Quarterly report to medical director Case Presentations Written Case Reports Requests for Stay of Discipline Compliance reports for Board Hearings Noncompliance reports Requests for resignations Requests for dismissal of clients For noncompliance For ineligibility Requests for clients successful completion 5

6 Project Action Teams Peer review Group Clinical Supervision Individual Clinical Supervision In-Service Training Groups of 3-5 staff members appointed by medical director to focus on a specific problem area 1-2 case managers 1-2 assistants 1-2 senior management persons Team addresses an identified problem Creates clear description of problem Collects information and ideas from all staff Develops measurable goals Proposes specific actions for implementation Outcomes assessed via CQI 6

7 Case managers review randomly selected chart to present in monthly group meeting Case of another case manager Own case Review process Review intake, assessment, contracts, last 6 months of monitoring activities (progress notes, reports, toxicology reports, etc.) Identify monitoring strengths and weaknesses Is documentation consistent with monitoring history? Identify issues of focus for the next six months One page summary Case managers and supervisors receive all reviews in advance and come prepared with feedback, questions Case manager assistants also review each others charts for presence of required documents Case manager group supervision Once monthly One case manager presents a challenging case, focusing on the case manager-client interaction and communication Group discusses case with focus on using counter-transference issues to better understand client s behavior Similar to a Balint Group Developed to assist doctors to reflect on work-related stresses Increases group participants openness to self-awareness, new ideas for managing doctor-patient relationship Improves communication, job satisfaction 7

8 Each case manager meets individually monthly or more frequently with medical director Focus on quality improvement and professional development, utilizing results of internal audit process Assignments given between sessions Written assignments Reading assignments Trainings within university system Outside trainings, webinars Clinical topics New developments in drug monitoring Working with clients with Borderline Personality Disorder Chronic pain and addiction Pharmacotherapies for addiction Relapse prevention Boundaries DBT Virginia Prescription Monitoring Program PMQI topics Improving your progress notes Managing the new referral Preparing for a formal board hearing 8

9 Referrals Three or more choices of approved providers for initial assessment when possible Three or more choices for treatment when possible No HPMP staff members see participants in any treatment setting Choices may be limited when participant lacks resources for private options Second Opinions HPMP will accept re-assessment by another approved provider HPMP will accept second assessment if evaluator has access to initial assessment, other information Participant signs consent for contact with HPMP Participant signs consent for contact with previous treatment providers, family, colleagues, etc. Identification of areas where program improvement needed Identification of staff professional development and training needs Adoption of new techniques to enhance ongoing quality improvement activities Maintenance of objective and evidence-based program guidelines Documentation of continuous performance assessment Maximization of participant retention and positive outcomes Summary: Benefits of PMQI 9