When Patient Care Issues Arise, QIPS Is on the Job

The mission of APA’s Department of Quality Improvement and Psychiatric Services (QIPS) is to facilitate the optimal provision of psychiatric and substance abuse services. In plain terms, that means the department helps psychiatrists acquire timely tools and information necessary to giving good care.

The department promotes evidence-based psychiatry and advances appropriate quality-care standards, guidelines, measures, and interventions. It collaborates with other organizations to improve psychiatric services and advocates for special populations, particularly children, adolescents, and their families; individuals with substance use disorders; and individuals with severe and persistent mental illness. In partnership with APA components, QIPS supports or executes many projects and relies extensively on APA members to bring their clinical expertise to the work at hand.

Under the direction of Claudia Hart, the department has a staff of 5.6 full-time employees with more than 67 years of combined service to the Association and its members and a combined annual budget of $650,000.

The President’s New Freedom Commission on Mental Health emphasized the essential need for the field to “advance evidence-based practices using dissemination and demonstration projects” and “improve and expand the workforce providing evidence-based mental health services and supports.” The following examples demonstrate QIPS’ contributions to advancing APA’s efforts in these areas.

• APA’s Practice Guideline Program, overseen by the Steering Committee on Practice Guidelines and implemented through QIPS, has developed 13 practice guidelines since 1991, including four revisions. Not intended to be construed as “standards” of care, the guidelines assist psychiatrists in clinical decision making, help improve care, and document and synthesize the evidence available to determine appropriate care.

The guideline-development process involves systematic, meticulous review and documentation of evidence by expert work groups and broad, iterative review by peers, allied organizations, and APA members and components. After approval by the APA Board and Assembly, practice guidelines are disseminated to all APA members as supplements to the American Journal of Psychiatry. Expect a revision of the schizophrenia guideline with your copy of the February issue.

The guidelines and the accompanying derivative quick reference guides may be found on APA’s Web site at www.psych.org/psych_pract/treatg/pg/prac_guide.cfm. CME courses based on the guidelines are posted at www.psych.org/edu/cme/cmeindex.cfm. A compendium of the guidelines and a quick reference guide can be ordered from APPI.

A new guideline on PTSD/ASD is in development, and the guidelines on substance use disorders and Alzheimer’s disease are being revised. Work is beginning on production of pocket cards for the guidelines on treatment of depression, schizophrenia, and bipolar disorders.

• APA participates in deliberations of several national accrediting organizations, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Utilization Review Accreditation Committee, National Committee on Quality Assurance, Council on Accreditation of Rehabilitation Facilities, and others. APA members who are representatives to these organizations serve as members of the APA Committee on Standards and Survey Procedures. Committee members and QIPS staff assure that the views of psychiatry are brought to the leadership of these accrediting organizations through ongoing participation on their boards or committees, as well as through formal review and comment on proposed standards.

Hospitals and physicians’ offices spend undue time and money to meet the administrative requirements of multiple accrediting and regulatory bodies, MCOs, MBHOs, and other plans. Much effort is devoted to reporting data relevant to performance measures. The administrative burden of these requirements needs to be minimized, and the results of data collection need to be meaningful and useful to clinicians and administrators. In concert with APA’s Council on Quality Care and Committee on Quality Indicators, QIPS staff is working with counterparts at the National Association of State Mental Health Program Directors (NASMHPD), the NASMHPD Research Institute, and the National Association of Psychiatric Health Systems to build a consortium of stakeholders and to identify “core measures” for use by psychiatric inpatient services. The JCAHO appears receptive to a preliminary proposal, and with a great deal of hard work, collaboration, and good fortune, national core measures for inpatient care will be proposed in 2005.

• Patient safety goes hand in glove with quality improvement. QIPS is working with the APA Committee on Patient Safety to help implement recommendations in a 2002 APA task force report. The report, which includes recommendations for APA leaders, individual psychiatrists, district branches, and training directors, is posted on APA’s Web site at www.psych.org/psych_pract/pract_mgmt/apa_patientsafety_toc21003.pdf. QIPS is collecting information on descriptions of patient safety programs and tools for psychiatric care and will make this information available to members. Members are encouraged to forward examples for individual office practice or institutional sites to [email protected].

• A special series of sessions, “Integrating the Science of Addiction Into Psychiatric Practice,” will be held at APA’s 2004 annual meeting. QIPS staff is working with the National Institute on Drug Abuse and APA’s Council on Addiction Psychiatry to organize the series, which will feature more than 40 sessions encompassing lectures, symposia, and workshops. Ten psychiatry residents interested in pursuing careers in drug abuse research will be selected to receive NIDA-funded travel scholarships to the meeting. They will have opportunities to meet with top researchers and participate in specially planned activities. Subsequent to the meeting, the American Journal of Psychiatry will feature many presentations in a supplement.

• A project focusing on office-based treatment of opiate addiction stems from changes authorized in the federal Drug Abuse Treatment Act. The act allows physicians who complete required training and receive a waiver to their DEA licenses to provide such treatment. The Food and Drug Administration approved buprenorphine for this indication in October 2002. APA is one of only four organizations legislatively authorized to provide the training. Since 2001, courses have been offered at APA’s annual meeting and Institute on Psychiatric Services. Staff is collaborating with district branches and state associations to present local training programs. A recent course offered by the Massachusetts Psychiatric Society was well attended. Training is also available through a course on APA’s CME Web page.

• The department supports APA’s Council on Children, Adolescents, and Their Families and its many activities, including development of guidelines for a curriculum to incorporate issues about mental health and illness in school courses about health. Staff works with the Division of Government Relations to monitor legislative activity and obtain member input. Postings about issues concerning children can be found in the “Advocacy” section of APA’s Web site at www.psych.org/advocacy_policy/.

Staff provides an APA presence at myriad meetings of other children’s health organizations in Washington, D.C., and has ongoing communication and coordination of activities with the staff of the American Academy of Child and Adolescent Psychiatry. In response to the recognized shortage of child and adolescent psychiatrists, the APA/Shire Fellowship in Child Psychiatry was established this year in an effort to increase interest in careers in child and adolescent psychiatry by providing special opportunities to general psychiatry residents. The two-year fellowship supports the travel to and participation of nine residents in APA’s annual meeting. The fellows have the opportunity to be mentored by leaders in the field, to become more knowledgeable about the field through a special track of programs, to network with peers, and to submit and present (if accepted) workshops at the annual meeting held during their second year of fellowship. Application materials for the fellowship are on the APA Web site.

• An APA initiative led by President Marcia Goin will promote change in the systemic and economic forces that have led to the growing number of mentally ill persons in jails and prisons. QIPS is collaborating with APA’s Office of Healthcare Systems and Financing and Corresponding Committee on Jails and Prisons to support the program. A small invitational meeting of experts and representatives of organizations active in this area is scheduled in mid-February, and a President’s Forum on the topic is scheduled for APA’s 2004 annual meeting.

Feel free to share your thoughts, comments and suggestions with me at [email protected]. ▪