DOCSLIB.ORG

2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry Overview Select Level of Care Partial Hospital Program (1, 2) Notes InterQual® criteria (IQ) is confidential and proprietary information and is being provided to you solely as it pertains to the information requested. IQ may contain advanced clinical knowledge which we recommend you discuss with your physician upon disclosure to you. Use permitted by and subject to license with Change Healthcare LLC and/or one of its subsidiaries. IQ reflects clinical interpretations and analyses and cannot alone either (a) resolve medical ambiguities of particular situations; or (b) provide the sole basis for definitive decisions. IQ is intended solely for use as screening guidelines with respect to medical appropriateness of healthcare services. All ultimate care decisions are strictly and solely the obligation and responsibility of your health care provider. © 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Overview Informational Notes The Adult and Geriatric Psychiatry Criteria are for the review of patients who are ages 18 and older. InterQual® content contains numerous references to gender. Depending on the context, these references may refer to either genotypic or phenotypic gender. At the individual patient level, a variety of factors, including, but not limited to, gender identity and gender reassignment via surgery or hormonal manipulation, may affect the applicability of some InterQual criteria. This is most often the case with genetic testing and procedures that assume the presence of gender−specific anatomy. With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. InterQual users should carefully consider issues related to patient genotype and anatomy, especially for transgender individuals, when appropriate. InterQual® criteria are derived from the systematic, continuous review and critical appraisal of the most current evidence−based literature and include input from our independent panel of clinical experts. To generate the most appropriate recommendations, a comprehensive literature review of the clinical evidence was conducted. Sources searched included the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program, American Psychiatric Association, American Academy of Child and Adolescent Psychiatry, American Psychological Association, American Society of Addiction Medicine, Centers for Medicare and Medicaid Services, Choosing Wisely, Cochrane Library, National Institute of Alcohol Abuse and Alcoholism, National Institute for Health and Care Excellence, National Institute on Drug Abuse, PubMed, Substance Abuse and Mental Health Services Administration, and other key medical societies. The Association of Ambulatory Behavioral Healthcare, Commission on Accreditation of Rehabilitation Facilities, and the Joint Commission were also searched. Other medical literature databases, medical content providers, data sources, regulatory body websites, and specialty society resources may also have been utilized. Relevant studies were assessed for risk of bias following principles described in the Cochrane Handbook. The resulting evidence was assessed for consistency, directness, precision, effect size, and publication bias. Observational trials were also evaluated for the presence of a dose−response gradient and the likely effect of plausible confounders. Licensed for use exclusively by Beacon Health Page 1 of 15 InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry PARTIAL HOSPITAL PROGRAM, One: (1, 2) Episode Day 1, All: Functional impairment, ≥ One: (3) Eating disorder and discharge from authorized Residential Treatment Center within last 24 hours, Two: − Inconsistent use of learned coping skills − Lack of daytime structure − Minimizing consequences of symptoms − Unable to independently make appropriate food choices Severe and change in baseline within last month, ≥ One: − Decision making or judgment poor − Does not recognize or acknowledge severe neglect of or dangerous living conditions − Frequent angry or irrational outbursts responsive to de−escalation or prn medication (4) Job or school performance impaired, ≥ One: − Self−employed and unable to maintain business − Suspended or terminated − Unsafe to care for dependent children or vulnerable adults due to impaired judgement − Medical or psychiatric treatments or medication nonadherence (5) − Not engaging in or abrupt withdrawal from social interactions or activities (6) − Rapid deterioration in functional ability − Repetitive impulsive behavior that places self or other in harm − Resists needed assistance to perform or complete self care tasks Unacceptable social behaviors, ≥ One: − Intrusiveness causing altercations with others − Restraining or protection order in place and continued stalking − Stable housing available − Support system able to provide required care and supervision during non−program hours (7, 8) Symptom within last week, ≥ One: Auditory hallucinations increasing and risk of dangerous behavior if continues, ≥ One: − History of physical harm to self or other attempted or completed within last 6 months (9) − Impaired judgement places patient at risk to harm self or others − Resistant to answering interview questions Co−occurring substance use disorder and psychiatric symptoms worsening, Both: − Not at risk for severe withdrawal − Unable to refrain from substance use Eating disorder, Both: (10) Requires monitoring to prevent further deterioration in condition, ≥ One: Need for external structure, ≥ One: (11) − Needs part−time external limits to prevent over−exercising (12) − Needs part−time external structure to prevent restricting behaviors and to gain weight − Needs part−time support from others to refrain from purging (13, 14) − Unable to break binge−purge cycle in outpatient or intensive outpatient treatment − Unable to stop use of substances to control or reduce weight while in outpatient or intensive outpatient treatment (15) − Preoccupied with intrusive or repetitive thoughts about eating or weight or body image greater than 3 hours per day (16) Symptom, ≥ One: − Laxative abuse and diarrhea reported with each bowel movement (17) − Pregnant with weight of fetus less than 10th percentile based on ultrasound evaluation (18) − Purging 3 to 4 times daily (14) − Recent and continuing weight loss and weight greater than 75%(0.75) but less than or equal 85%(0.85) ideal body weight (17, 19) − Recent and continuing weight loss and BMI at least 16 but less than 18 (20) − Restricting or refusing food intake at 2 or more meals daily − Status post acute medical treatment for life−threatening complication of eating disorder Hypomanic symptom increasing and risk of manic episode, ≥ One: − Decreased sleep and history of rapid cycling (21) − Pregnant Licensed for use exclusively by Beacon Health Page 2 of 15 InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry − Medication nonadherence and no history of rapid deterioration to mania (5, 22) − Obsessions about contamination or compulsive washing or cleaning behaviors (23) − Panic attacks multiple times daily or severe agoraphobia (24) − Persecutory delusions require clinical assessment and medication evaluation multiple times per week (25) − Placing self in unsafe situations during flashbacks or dissociative episodes − Psychomotor agitation (26) − Psychotic disorder and paranoia or suspiciousness worsening despite active engagement in intensive outpatient program and on medication (27) − Psychosis or hypomania requiring staff re−direction − Severe depressive symptoms (28) − Somatic delusions with repeated emergency department visits within last week Suicidal or homicidal ideation and denies plan or intent, ≥ One: − Discharge from acute psychiatric inpatient within last 24 hours and continued hopelessness (29) − Insomnia moderate or severe (30) − Moderate or severe major depressive disorder (28, 31) − Recurrent thoughts of death or wanting to die − Recurrent thoughts of killing another − Weight loss, involuntary and persistent within last month due to psychiatric condition − Transportation available (32) Treatment not expected to be successful in less intensive level of care, ≥ One: − Less intensive level of care attempted and unsuccessful − Requires intensive structured treatment and medical monitoring to prevent further deterioration in condition − Transfer from inpatient but remains unstable to function in community or has history of at least 3 inpatient admissions within last year (17) Episode Day 2−15, One: Symptom improved and discharge expected today, One: (33) − Patient or caregiver demonstrates ability to manage condition and condition does not require daily monitoring (see Outpatient criteria) High risk of hospitalization or rehospitalization (see Intensive Outpatient Program criteria), Both: − Impairment in daily functioning − Symptoms moderate in severity (28) Patient with severe and persistent mental illness or autism spectrum disorder or intellectual disability and lack of support (see Intensive Community−Based Treatment criteria), Both: (34) − Able to live in unsupervised residence within community − Unable to perform IADLs independently − In lieu of residential based care or patient homebound and requires skilled nursing care or assessment at least 1 time per week (see Home Care criteria) Patient with severe and
Load more

Recommended publications
  • Neuropsychiatric Symptoms in the Prodromal Stages of Dementia
    1 Neuropsychiatric Symptoms in the Prodromal Stages of Dementia Florindo Stella, Márcia Radanovic, Márcio L.F. Balthazar, Paulo R. Canineu, Leonardo C. de Souza, Orestes V. Forlenza Curr Opin Psychiatry. 2014;27(3):230-235. Abstract and Introduction Abstract Purpose of Review. To critically discuss the neuropsychiatric symptoms in the prodromal stages of dementia in order to improve the early clinical diagnosis of cognitive and functional deterioration. Recent Findings. Current criteria for cognitive syndrome, including Alzheimer's disease, comprise the neuropsychiatric symptoms in addition to cognitive and functional decline. Although there is growing evidence that neuropsychiatric symptoms may precede the prodromal stages of dementia, these manifestations have received less attention than traditional clinical hallmarks such as cognitive and functional deterioration. Depression, anxiety, apathy, irritability, agitation, sleep disorders, among other symptoms, have been hypothesized to represent a prodromal stage of dementia or, at least, they increase the risk for conversion from minor neurocognitive disorder to major neurocognitive disorder. Longitudinal investigations have provided increased evidence of progression to dementia in individuals with minor neurocognitive disorder when neuropsychiatric symptoms also were present. Summary. Although neuropsychiatric symptoms are strongly associated with a higher risk of cognitive and functional deterioration, frequently the clinician does not acknowledge these conditions as increasing the
    [Show full text]
  • 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry
    InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry Overview Select Level of Care Intensive Outpatient Program (1, 2) Notes InterQual® criteria (IQ) is confidential and proprietary information and is being provided to you solely as it pertains to the information requested. IQ may contain advanced clinical knowledge which we recommend you discuss with your physician upon disclosure to you. Use permitted by and subject to license with Change Healthcare LLC and/or one of its subsidiaries. IQ reflects clinical interpretations and analyses and cannot alone either (a) resolve medical ambiguities of particular situations; or (b) provide the sole basis for definitive decisions. IQ is intended solely for use as screening guidelines with respect to medical appropriateness of healthcare services. All ultimate care decisions are strictly and solely the obligation and responsibility of your health care provider. © 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Overview Informational Notes The Adult and Geriatric Psychiatry Criteria are for the review of patients who are ages 18 and older. InterQual® content contains numerous references to gender. Depending on the context, these references may refer to either genotypic or phenotypic gender. At the individual patient level, a variety of factors, including, but not limited to, gender identity and gender reassignment via surgery or hormonal manipulation, may affect the applicability of some InterQual criteria. This is most often the case with genetic testing and procedures that assume the presence of gender−specific anatomy. With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate.
    [Show full text]
  • Geriatric Psychopharmacology: Anti-Depressants Amber Mackey, D.O
    Geriatric Psychopharmacology: Anti-depressants Amber Mackey, D.O. University of Reno School of Medicine Department of Psychiatry Chief Resident, PGY-4 Pharmacologic issues in the elderly More likely to experience drug induced adverse events Cardiac effects: Prolonged QTc, arrhythmias, sudden death Peripheral/central anticholinergic effects: constipation, delirium, urinary retention, delirium, and cognitive dysfunction Antihistaminergic effects: sedation Antiadrenergic effects: postural hypotension Other effects: Hyponatremia, bleeding, altered bone metabolism Pharmacokinetic Organ system Change consequence Circulatory system Decreased concentration Increased or decreased of plasma albumin and free concentration of drugs increased α1-acid in plasma glycoprotein Gastrointestinal Table tract 20-1 Decreased intestinal and Decreased rate of drug splanchnic blood flow absorption Kidney Decreased glomerular Decreased renal filtration rate clearance of active metabolites Liver Decreased liver size; Decreased hepatic decreased hepatic blood clearance flow; variable effects on cytochrome P450 isozyme activity Muscle Decreased lean body mass Altered volume of and increased adipose distribution of lipid-soluble tissue drugs, leading to increased elimination half-life Table 20-1, Physiological changes in elderly persons associated with altered pharmacokinetics, American Psychiatric Publishing Textbook of Geriatric Psychiatry, Fifth Edition, Chapter 20: Psychopharmacology. Other issues Illnesses that effect the elderly also play a role in diminishing
    [Show full text]
  • Revealing a Blind Spot on the Global Mental Health Map: Scoping Review
    Revealing a blind spot on the global mental health map: scoping review of 25 years development of mental health care for people with severe mental illnesses in Central and Eastern Europe Authors PhDr. Petr Winkler* 1,3; Dzmitry Krupchanka* 1,3,4 PhD; Tessa Roberts2 MSc; Lucie Kondratova1 MSc; Vendula Machů1; Prof Cyril Höschl1 DrSc; Prof Norman Sartorius5 PhD; Prof Robert Van Voren6,7, 29, PhD; Oleg Aizberg8 PhD; Prof Istvan Bitter9 PhD; Arlinda Cerga-Pashoja2 PhD; Azra Deljkovic10 MD; Naim Fanaj11 PhD, ; Arunas Germanavicius12 PhD; Hristo Hinkov13 PhD; Aram Hovsepyan14 MD; Fuad N. Ismayilov1515, 30 DrSc; Prof Sladana Strkalj Ivezic1616,1717 DrSc; Marek Jarema1818 PhD; Vesna Jordanova1919 MD; Selma Kukić20; Nino Makhashvili2121 PhD; Brigita Novak Šarotar2222,2323 PhD; Oksana Plevachuk2424 PhD; Daria Smirnova2525 PhD; Bogdan Ioan Voinescu2626,2727 PhD; Jelena Vrublevska2828 MD; and Prof Graham Thornicroft PhD3 *Both authors contributed equally Institutions 1. Department of Social Psychiatry, National Institute of Mental Health, Prague, Czech Republic 2. Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK 3. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK 4. Institute of Global Health, University of Geneva, Geneva, Switzerland 5. Association for the Improvement of Mental Health Programmes, Geneva, Switzerland 6. Ilia State University, Tbilisi, Georgia 7. Vytautas Magnus University, Kaunas, Lithuania 8. Department of Psychiatry and Narcology, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus 9. Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary 10. Mental Health Center, Health Care Center Pljevlja, Plevlja, Montenegro 11. Mental Health Center, Prizren, Kosovo 12.
    [Show full text]
  • Evolutionism and Involutionism in the Ontogenesis of А Late
    S662 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S645–S709 EV0789 – Development of programs of psychological care to patients with Parkinson psychosis: A complex dementia and to caregivers; – Development of palliative care for patients with dementia; interaction of disease and medication – Cross-sectoral cooperation and multidisciplinary approach in related factors assistance to patients with dementia; 1,∗ 2 3 S. Petrykiv , L. de Jonge , M. Arts – Training in the field of geriatric psychiatry, denomination of the 1 University Medical Center Groningen, Department of Clinical specialty of geriatric psychiatrist; Pharmacy and Pharmacology, Groningen, The Netherlands – Fighting stigma of patients with dementia, protection of their 2 Leonardo Scientific Research Institute, Department of Geriatric rights, including in psychiatry and forensic psychiatry. Psychiatry, Department of Geriatric Psychiatry, Groningen, The The solution of these objectives requires foundation of the Rus- Netherlands sian observatory on dementia, the WHO cooperating center. The 3 University Medical Center Groningen, Department of Old Age tasks of such an Observatory will be: centralization and coordi- Psychiatry, Groningen, The Netherlands nation of actions concerning strategic planning, implementation of ∗ Corresponding author. mechanisms of a multispectral cooperation, assessment of services, Introduction Psychotic symptoms are the most important non- monitoring and providing reports on dementia issues in Russia. motoric symptoms of the Parkinson disease (PD). The quality of life Disclosure of interest The author has not supplied his/her decla- of those patients can be significantly improved with an appropri- ration of competing interest. ate therapy. In this article we provide evidence about the etiology, http://dx.doi.org/10.1016/j.eurpsy.2017.01.1120 differential diagnosis and therapeutic possibilities with a work-up for the clinics.
    [Show full text]
  • Clinical Manual of Geriatric Psychopharmacology This Page Intentionally Left Blank Clinical Manual of Geriatric Psychopharmacology
    Clinical Manual of Geriatric Psychopharmacology This page intentionally left blank Clinical Manual of Geriatric Psychopharmacology Sandra A. Jacobson, M.D. Assistant Professor, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island Ronald W. Pies, M.D. Clinical Professor of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts Ira R. Katz, M.D. Professor of Psychiatry and Director, Section of Geriatric Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2007 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 11 10 09 08 07 5 4 3 2 1 First Edition Typeset in Adobe’s Formata and AGaramond.
    [Show full text]
  • Table of Contents
    2018 AAGP Annual Meeting TABLE OF CONTENTS Notes.............................................................................................................................................................. S2 Session .Abstracts General .Session.Abstract.Book. A Path Forward: A Culturally Relevant Psychosocial Intervention for Depression in Cognitive Impaired Older Adults ............................................................................................................................................. S3 AAGP Training Programs: Stepping Stones to the Scholars Program: Implications for Recruitment Into the Field of Geriatric Psychiatry ............................................................................................................................................. S4 Ethical, Legal and Forensic Issues in Geriatric Psychiatry ................................................................................................ S4 Global Brain Health Research: Collaborative Partnerships to Advance Care and Build Research Capacity ..................... S5 Innovative Approaches to Training the Next Generation of Geriatric Psychiatrists .......................................................... S6 Introduction to Agile Implementation Science: How to Select, Implement, Scale Up, and Sustain Evidence Based Geriatric Psychiatry Health Solutions ...................................................................................................................... S6 Sexuality and Religion in Older Adults: The Devil is in the Details
    [Show full text]
  • Religious Versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results
    Hindawi Publishing Corporation Depression Research and Treatment Volume 2012, Article ID 460419, 11 pages doi:10.1155/2012/460419 Research Article Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results Harold G. Koenig1, 2 1 Departments of Psychiatry and Medicine, Duke University Medical Center, Box 3400 Medical Center, Durham, NC 27705, USA 2 Department of Medicine, King Abdulaziz University, Jeddah 21413, Saudi Arabia Correspondence should be addressed to Harold G. Koenig, [email protected] Received 2 January 2012; Accepted 6 March 2012 Academic Editor: Rachel E. Dew Copyright © 2012 Harold G. Koenig. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper (1) reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2) discusses research on the relationship between religion and depression-induced physiological changes, (3) describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a) overcome physical and religious barriers to CBT and (b) compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4) presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed.
    [Show full text]
  • Executive Summary
    Wing Memorial Hospital & Medical Centers A Member of UMass Memorial Health Care 2009 COMMUNITY BENEFITS REPORT to the Massachusetts State Attorney General Primary Contact: William J. Russo-Appel Director of Marketing and Public Relations Wing Memorial Hospital & Medical Centers 40 Wright Street Palmer, MA 01069 Telephone: 413-284-5238 Facsimile: 413-284-5212 E-mail: [email protected] Overview Wing Memorial Hospital and Medical Centers (WMHMC), a member hospital of UMass Memorial Health Care in Worcester, is a community-focused health care provider for residents living in the Quaboag Hills and Pioneer Valley region of Massachusetts. Wing Memorial, a 74- bed hospital, is situated between Worcester and Springfield in Palmer, MA. Wing Memorial provides acute and emergency care, and offers access to primary care physicians and specialty care through a network of local community medical centers, located in Belchertown, Ludlow, Monson, Palmer and Wilbraham. The Wing system also includes the Quaboag Valley VNA and Hospice in Palmer, and the Griswold Behavioral Health Center, located in Palmer and Ware. Wing Memorial provides 24-hour emergency services, inpatient care, surgical day care, an intensive care unit (ICU), a secure acute psychiatry unit approved by the Massachusetts Department of Mental Health, neuro-diagnostics (EEG, EMG, and sleep studies), and respiratory, physical, and occupational therapy. Wing Memorial is designated as a Primary Stroke Service Center and is approved to provide stroke-related services by the Massachusetts Department of Public Health. Also, the UMass Memorial Cancer Center at Wing Memorial offers various cancer services including chemotherapy, oncology, and hematology. The unit coordinates services with the UMass Memorial Cancer Center and has the ability to participate in oncology research conducted by the UMass Medical School.
    [Show full text]
  • List of Geriatric Psychiatry Fellowship Program Websites
    List of Geriatric Psychiatry Fellowship Program Websites ACGME Program Name Common Name Webpage link Alabama University of Alabama Medical Center University of Alabama at Birmingham http://www.psychiatry.uab.edu/education/geriatric-psychiatry/ Arkansas University of Arkansas for Medical Sciences http://www.uams.edu/psych/education/fellowship/geriatric.asp California Stanford University http://psychiatry.stanford.edu/ University of California San Francisco http://psych.ucsf.edu/residency-programs.aspx?id=862 UCLA Medical Center http://www.semel.ucla.edu/fellowship/geriatric University of California San Diego http://geropsych.ucsd.edu/residencytraining.html Connecticut http://www.psychiatry.yale.edu/education/clinfell/geriatric/geria Yale-New Haven Medical Center Yale University tric.aspx District of Columbia National Capital Consortium http://www.nccpsychiatry.info/Geratrics.htm Florida Jackson Memorial Hospital/Jackson Health University of Miami / Jackson System Memorial http://www.jhsmiami.org/body.cfm?id=8834 University of South Florida http://health.usf.edu/medicine/psychiatry/p_geriatric.htm Georgia Emory University http://www.psychiatry.emory.edu/Geriatric_Fellowship.cfm Hawaii University of Hawaii http://hawaiiresidency.org/psychiatry/geriatric.html Illinois McGaw Medical Center of Northwestern http://psychiatry.northwestern.edu/index.php/edu-geriatric- University Northwestern University psychiatry/ Indiana http://psychiatry.medicine.iu.edu/education-residency- Indiana University School of Medicine programs/fellowships1/geriatric-psychiatry-fellowship/
    [Show full text]
  • Health Share Pathways Regional Practice Guidelines
    Health Share of Oregon Pathways Regional Practice Guidelines Regional Behavioral Health Guidelines for Clackamas, Multnomah and Washington Counties A Manual for Utilization Review Staff and Health Share of Oregon Providers Revised: November 15, 2018 Effective January 1, 2019 Page 1 of 126 Table of Contents Section/Practice Guideline Page Introduction 4 Practice Guidelines – Values and Principles 5-6 Medical Necessity Criteria 7 List of Services Requiring Self-Authorized Service Notification 8 List of Services Requiring Prior Authorization 9 Mental Health and Substance Use Disorder Practice Guidelines Mental Health Practice Guidelines 10-85 Acute Inpatient 10-12 Community Based Intensive Treatment (CBIT) / Intercept- Youth 13-14 Enhanced Community Based Intensive Treatment (ECBIT) - Youth 15-17 Crisis Stabilization Services- Youth 18-20 Dialectical Behavior Therapy (DBT) 21-23 Eating Disorder Treatment 24-32 Partial Hospitalization (IOP) Services 24-26 Residential Treatment 26-28 Inpatient Hospitalization Services 29-32 Electroconvulsive Therapy 33-34 Mental Health Outpatient Services – Level A – D: Youth and Family 35-47 Mental Health Outpatient Services – Level A: Youth and Family 36-37 Mental Health Outpatient Services – Level B: Youth and Family 38-39 Mental Health Outpatient Services – Level C: Youth and Family 40-41 Mental Health Outpatient Services – Level D: Early Childhood (ages 0-5) 42-44 Mental Health Outpatient Services – Level D: Home Based Stabilization Youth and Family (ages 6-17) 45-47 Mental Health Outpatient Services
    [Show full text]
  • Connecticut Quality Council Measure Proposals to Fill Behavioral Health and Equity Gaps Measure Specifications
    Connecticut Quality Council Measure Proposals to Fill Behavioral Health and Equity Gaps Measure Specifications # Measure Name Page Number 1 Screening for Depression and Follow- Up Plan 2 2 Depression Utilization of the PHQ-9 Tool 7 3 Follow-Up After Hospitalization for Mental Illness 9 4 Follow-Up After Emergency Department Visit for 14 Mental Illness 5 Antidepressant Medication Management 19 6 Initiation and Engagement of Alcohol and Other 24 Drug (AOD) Abuse or Dependence Treatment 7 Follow-Up After Emergency Department Visit for 34 Alcohol and Other Drug (AOD) Abuse or Dependence 8 Alcohol and Drug Misuse: Screening, Brief 37 Intervention and Referral for Treatment (SBIRT) 9 Substance Use Assessment in Primary Care 44 10 Concurrent Use of Opioids and Benzodiazepines 46 11 Use of Pharmacotherapy for Opioid Use Disorder 50 12 Tobacco Use and Help with Quitting Among 53 Adolescents 13 ED Utilization among Members with Mental Illness 55 14 Lead Screening in Children 59 15 Meaningful Access to Health Care Services for 62 Persons with Limited English Proficiency 16 Health-related Social Needs Screening 97 17 SDOH Screening 99 Quality ID #134 (NQF 0418): Preventive Care and Screening: Screening for Depression and Follow- Up Plan – National Quality Strategy Domain: Community/Population Health – Meaningful Measure Area: Prevention, Treatment, and Management of Mental Health 2020COLLECTION TYPE: MEDICARE PART B CLAIMS MEASURE TYPE: Process DESCRIPTION: Percentage of patients aged 12 years and older screened for depression on the date of the encounter or 14 days prior to the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter INSTRUCTIONS: This measure is to be submitted a minimum of once per measurement period for patients seen during the measurement period.
    [Show full text]