DOCSLIB.ORG

2013 QI/UM Annual Program Evaluation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2013 QI/UM Annual Program Evaluation HealthChoices Capital Area Bedford/Somerset Franklin/Fulton Quality Improvement/Utilization Management Program Evaluation Calendar Year 2013 Based on National Committee for Quality Assurance (NCQA) Managed Behavioral Healthcare Organizations (MBHO) Standards for Accreditation and Pa. Dept. of Public Welfare (DPW) Office of Mental Health and Substance Abuse Services (OMHSAS) Program Standards and Requirements. This document contains proprietary information and may not be copied, duplicated, or distributed without the written authority of PerformCare April 2014 QI/UM Annual Program Evaluation 2013 Page 1 of 205 Table of Contents Table of Contents .......................................................................................................................................... 2 Executive Summary........................................................................................................................................ 4 SECTION I ................................................................................................................................................... 8 Introduction .............................................................................................................................................. 8 SECTION II .................................................................................................................................................10 Components of the QI Program .............................................................................................................10 PerformCare Strategic CQI Initiatives .................................................................................................11 SECTION III ...............................................................................................................................................13 Overall Effectiveness of the QI Program ...............................................................................................13 SECTION IV................................................................................................................................................16 Activities of the QI/UM Program ...........................................................................................................16 Program Structure ..................................................................................................................................16 Program Operations ................................................................................................................................16 Inter-Rater Reliability ...........................................................................................................................16 CCM Documentation Audits and Live Call Monitoring of CCMs .........................................................21 High-Risk or Enhanced Care Management directed at a reduction of readmissions ...........................27 Access and Availability ...........................................................................................................................31 Emergent, Urgent Access ......................................................................................................................32 Routine Access .......................................................................................................................................32 Access to Initial Psychiatric Care .........................................................................................................34 Access to Best Practice (BHRS) Evaluations ........................................................................................35 Access to Psychological Testing ............................................................................................................36 Access to BHRS .....................................................................................................................................37 Geographic Access to Providers ...........................................................................................................44 New Service Development .....................................................................................................................46 Appropriateness .......................................................................................................................................55 Utilization of Identified High-Volume and High-Risk Services .............................................................55 Denials...................................................................................................................................................58 Grievance Monitoring and Analysis ......................................................................................................62 Competency ..............................................................................................................................................67 Credentialing Committee Actions and Recommendations .....................................................................67 Provider Profiling .................................................................................................................................68 Provider Performance ...........................................................................................................................84 Co-occurring Competency .....................................................................................................................91 Autism Competency for BHRS Providers ..............................................................................................92 Provider Education ...............................................................................................................................93 Treatment Record Review of High-Volume Providers...........................................................................95 Consumer and Family Involvement .......................................................................................................99 Member Satisfaction Surveys .................................................................................................................99 Consumer / Family Satisfaction Team .................................................................................................105 Continuity and Care Coordination ......................................................................................................106 30 Day Readmission Rates & SMI Only Readmission Rates in Mental Health Inpatient ...................106 Ambulatory Follow-Up Rates after Hospitalization for Mental Illness ...............................................109 Clinical Practice Guidelines ...............................................................................................................115 Clinical Practice Guideline Measures .................................................................................................118 DPW Physical Health-Behavioral Health (PH-BH) Joint QI Initiatives .............................................123 PH-BH Collaboration Efforts with Primary Care Physicians (PCPs) ................................................125 PH-MCO/BH-MCO Projects ...............................................................................................................126 Pharmacy Initiatives ............................................................................................................................128 Coordination Efforts with CYS, JPO, and Other Service Agencies .....................................................129 School Coordination/Participation Report from ISPT ........................................................................131 Diversity and Cultural Competency ....................................................................................................134 Demographics, Penetration Rates, Top Diagnoses, and Percentage of Foreign-Language Speaking Members ..............................................................................................................................................134 Disparities in Treatment ......................................................................................................................138 Network Capacity of Spanish-Speaking Providers ..............................................................................139 Cultural Competency Assessments of Provider Sites...........................................................................140 QI/UM Annual Program Evaluation 2013 Page 2 of 205 Outcomes and Efficacy ..........................................................................................................................142 PerformCare Outcomes Monitoring ....................................................................................................142 Performance Outcomes Management System ......................................................................................144 Community Outreach ...........................................................................................................................147 Member Education ..............................................................................................................................152 Prevention ...........................................................................................................................................156 Domestic Violence, Smoking Cessation and Childhood Obesity .........................................................160
Load more

Recommended publications
  • Drug-Facilitated Sexual Assault and Chemical Submission
    © Psychology, Society, & Education, 2017. Vol. 9(2), pp. 263-282 ISSN 2171-2085 (print) / ISSN 1989-709X (online) Doi 10.25115/psye.v9i2.701 Drug-Facilitated Sexual Assault and Chemical Submission Manuel Isorna Folgar1, Coromoto Souto Taboada1, Antonio Rial Boubeta2, Antonio Alías3 and Kieran McCartan4 1University of Vigo, Spain 2University of Santiago de Compostela, Spain 3University of Almería, Spain 4University of the West of England, United Kingdom (Received on March 2, 2017; Accepted on April 10, 2017) ABSTRACT: In recent years, the use of psychoactive substances for sexual assault has taken on a greater role. The practice of sexual crimes associated with drug use is called Drug-Facilitated Sexual Assault (DFSA), while ‘Chemical Submission’ (CS) is used to include all type of crimes related to this activity. This paper reviews the epidemiology of this type of offenses, the main characteristics of the chemical substances consumed and the profiles of victims and aggressors. There have been also addressed principal signs of clinical suspicion to detect possible victims and the keys to the toxicology screening in case the victim presents evidences of being subject to chemical submission. Key Words: Alcohol, drugs and sexuality, Chemical Submission, Drug-facilitated sexual assault, sexual offenses. Drogas facilitadoras del asalto sexual y Sumisión química RESUMEN: En los últimos años, el uso de sustancias psicoactivas relacionadas con las agresiones sexuales ha asumido un mayor protagonismo. La práctica de los delitos sexuales relacionados con el uso de drogas se denomina Drogas Facilitadoras del Asalto Sexual (DFSA por sus siglas en inglés), mientras que el término «Sumisión Química» (CS) se usa para incluir todo tipo de delitos relacionados con esta actividad.
    [Show full text]
  • Methamphetamine and Other Potentially Risky Sex-Enhancing Drugs
    METHAMPHETAMINE AND OTHER POTENTIALLY RISKY SEX-ENHANCING DRUGS A DISSERTATION SUBMITTED TO THE FACULTY OF THE AMERICAN ACADEMY OF CLINICAL SEXOLOGISTS AT MAIMONIDES UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY BY DAVID MICHAEL FAWCETT ALFREDO EUGENIO TAULE' NORTH MIAMI BEACH, FLORIDA DECEMBER, 2004 DISSERTATION APPROVAL This dissertation submitted by David Michael Fawcett and Alfredo Eugenio Taule' has been read and approved by three faculty members of the American Academy of Clinical Sexologists at Maimonides University. The final copies have been examined by the Dissertation Committee and the signatures which appear here verify the fact that any necessary changes have been incorporated and the dissertation is now given the final approval with reference to content, form and mechanical accuracy. The dissertation is therefore accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Signature Date ______________________________ ______________ William Granzig, Ph.D., FAACS Advisor and Committee Chair ______________________________ _______________ John Achinapura, Ph.D. Committee Member ______________________________ _______________ James Walker, Ph.D. Committee Member ii ACKNOWLEDGEMENTS I dedicate this dissertation to my first born son Timothy who at the age of thirty-four after the terrorist attack in New York and Washington became a part of our proud military forces. At present he is a proud Airborne Ranger protecting our nation in a dangerous forward zone in the Sunni Triangle in Iraq. Timothy's resolve and courage as well as all of his accomplishments in such a short period of time have become a great source of inspiration for our family. My son has become my hero and he has made me aware of noble feelings like honor, loyalty, patriotism and commitment.
    [Show full text]
  • 1 Social Norms Related to Combining Drugs and Sex (“Chemsex”) Among Gay Men in South London
    Social norms related to combining drugs and sex (“chemsex”) among gay men in South London Ahmed AK (BSc, MSc)1, Weatherburn P (BA, MSc)1, Reid D (BA MSc,)1, Hickson F (BSc, PhD, BA)1, Torres-Rueda S (MSc, BA)2, Steinberg P (BA, MA)3, Bourne A (BSc, PhD)1* 1. Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine. 2. Department of Global Health and Development, London School of Hygiene & Tropical Medicine. 3. Department of Public Health, London Borough of Lambeth * Corresponding author: Dr Adam Bourne Sigma Research London School of Hygiene & Tropical Medicine 15-17 Tavistock Place London WC1H 9SH Email: [email protected] Tel: 020 7927 2793 Word count (Introduction to Discussion): 5454 Word count (Abstract): 299 1 Social norms related to combining drugs and sex (“chemsex”) among gay men in South London Abstract Background ‘Chemsex’ refers to the combining of sex and illicit drugs, typically mephedrone, GHB/GBL, and crystal methamphetamine. While numerous studies have examined the role of illicit drugs in sexual risk taking, less attention has been paid to the broader social context and structures of their use among gay men. Given their established role in influencing health related behaviour, this study sought to examine the nature and operation of social norms relating to chemsex among gay men residing in South London. Methods In-depth interviews were conducted with thirty self-identifying gay men (age range 21-53) who lived in three South London boroughs, and who had used either crystal methamphetamine, mephedrone or GHB/GBL either immediately before or during sex with another man during the previous 12 months.
    [Show full text]
  • Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida David W
    Masthead Logo Florida Public Health Review Volume 13 Article 10 2016 Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida David W. Forrest Bryan Page Gabriel Cardenas Caitlin Marquardt Robin Morey See next page for additional authors Follow this and additional works at: https://digitalcommons.unf.edu/fphr Part of the Public Health Commons, and the Social and Behavioral Sciences Commons Recommended Citation Forrest, David W.; Page, Bryan; Cardenas, Gabriel; Marquardt, Caitlin; Morey, Robin; Metsch, Lisa R.; Feaster, Daniel J.; and LaLota, Marlene (2016) "Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida," Florida Public Health Review: Vol. 13 , Article 10. Available at: https://digitalcommons.unf.edu/fphr/vol13/iss1/10 This Research Article is brought to you for free and open access by the Footer Logo Brooks College of Health at UNF Digital Commons. It has been accepted for inclusion in Florida Public Health Review by an authorized administrator of UNF Digital Commons. For more information, please contact Digital Projects. © All Rights Reserved Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida Authors David W. Forrest, Bryan Page, Gabriel Cardenas, Caitlin Marquardt, Robin Morey, Lisa R. Metsch, Daniel J. Feaster, and Marlene LaLota This research article is available in Florida Public Health Review: https://digitalcommons.unf.edu/fphr/vol13/iss1/10 Forrest et al.: Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida David W. Forrest, PhD; J. Bryan Page, PhD; Gabriel Cardenas, MPH; Caitlin Marquardt, BA; Robin Morey, BA; Lisa R.
    [Show full text]
  • Sex, Drugs and Techno
    Dennermalm et al. BMC Public Health (2021) 21:863 https://doi.org/10.1186/s12889-021-10906-6 RESEARCH ARTICLE Open Access Sex, drugs and techno – a qualitative study on finding the balance between risk, safety and pleasure among men who have sex with men engaging in recreational and sexualised drug use Nicklas Dennermalm1,2* , Julia Scarlett1, Sarah Thomsen1, Kristina Ingemarsdotter Persson1 and Helle Mølsted Alvesson1 Abstract Background: Recreational and sexual drug use among men who have sex with men may result in increased risk of poor health. The aim of this study was to better understand drug use and harm reduction techniques among Swedish men who have sex with men traveling to Berlin in order to improve the health of this population and inform public health strategies. Methods: A qualitative study based on semi-structured interviews with 15 Swedish men aged 23–44 with experience of drug use were recruited through network sampling. Interviews were conducted in Stockholm and Berlin and analysed using content analysis. The interview guide included questions on drug use, context, health and safety. Results: The participants engaged in drug use in both settings and in various contexts. Participants saw themselves as capable of finding a balance between pleasure, safety and risk with the aim to maximize positive effects while minimizing negative ones. The different risks of drug use were known, and participants relied on knowledge, harm reduction strategies and self-defined rules of intake to stay safe and healthy in a broad sense, both short term (i.e. during each session) and long term. Choice of drug and, frequency of intake, multi-use, risk of overdose, risk of HIV, purpose and context of use, how often, etc.
    [Show full text]
  • ADHD-Guide.Pdf
    i ADHD: A GUIDE TO UNDERSTANDING SYMPTOMS, CAUSES, DIAGNOSIS, TREATMENT, AND CHANGES OVER TIME IN CHILDREN, ADOLESCENTS, AND ADULTS ii iii FIFTH✦ EDITION ADHD A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults PAUL H. WENDER, MD AND DAVID A. TOMB, MD 1 iv 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Paul H. Wender and David A. Tomb 2017 First Edition published in 1973 Second Edition published in 1978 Tird Edition published in 1986 Fourth Edition published in 2000 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging- in- Publication Data Names: Wender, Paul H., 1934– author. | Tomb, David A., author.
    [Show full text]
  • HIV Prevention, Treatment, Care and Support for People Who Use Stimulant Drugs: Technical Guide
    HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS TECHNICAL GUIDE UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna HIV Prevention, Treatment, Care and Support for People Who Use Stimulant Drugs TECHNICAL GUIDE UNITED NATIONS Vienna, 2019 Recommended citation United Nations Office on Drugs and Crime. HIV Prevention, Treatment, Care and Support for People Who Use Stimulant Drugs. Technical Guide UNODC; Vienna 2019. © United Nations Office on Drugs and Crime 2019 The content of this document does not necessarily reflect the views of the United Nations Office on Drugs and Crime (UNODC) as well as of the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), or their Member States. The description and classification of countries and territories in this publication and the arrangement of the material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries, or regarding its economic system or degree of development. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Contents Acknowledgements ..................................................................................1 Abbreviations and acronyms .........................................................................4 Definitions ..........................................................................................6
    [Show full text]
  • Hypersexuality Addiction and Withdrawal: Phenomenology, Neurogenetics and Epigenetics
    Open Access Review Article DOI: 10.7759/cureus.290 Hypersexuality Addiction and Withdrawal: Phenomenology, Neurogenetics and Epigenetics Kenneth Blum1, Rajendra D. Badgaiyan2, Mark S. Gold3 1. Department of Psychiatry, McKnight Brain Institute , University of Florida, 2. Department of Psychiatry, and Laboratory of Advanced Radiochemistry, University of Minnesota ,School of Medicine, Minneapolis , MN., USA 3. Departments of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA Corresponding author: Kenneth Blum, [email protected] Disclosures can be found in Additional Information at the end of the article Abstract Hypersexuality is now part of the DSM-V and has been defined as abnormally increased sexual activity. Epidemiological and clinical studies have shown that this non-paraphilic condition consists of "excessive" sexual behaviors and disorders accompanied by personal distress and social and medical morbidity. Hypersexual disorder is conceptualized as primarily a non- paraphilic sexual desire disorder with impulsivity. Pathophysiological perspectives include dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity. The nucleus accumbens, situated within the ventral striatum, mediates the reinforcing effects of drugs of abuse, such as cocaine, alcohol, nicotine, and food as well as music. Indeed, it is believed that this structure mandates behaviors elicited by incentive stimuli. These behaviors include natural rewards like feeding, drinking, sexual behavior, and exploratory locomotion. An essential rule of positive reinforcement is that motor responses will increase in magnitude and vigor if followed by a rewarding event. Here, we are hypothesizing that there is a common mechanism of action (MOA) for the powerful effects drugs, music, food, and sex have on human motivation.
    [Show full text]
  • The Child and Adolescent Psychiatrist
    No. 00 May 2008 The Child and Adolescent Psychiatrist The child and adolescent psychiatrist is a physician who specializes in the diagnosis and the treatment of disorders of thinking, feeling and/or behavior affecting children, adolescents, and their families. A child and adolescent psychiatrist offers families the advantages of a medical education, the medical traditions of professional ethics, and medical responsibility for providing comprehensive care. Practice The child and adolescent psychiatrist uses a knowledge of biological, psychological, and social factors in working with patients. Initially, a comprehensive diagnostic examination is performed to evaluate the current problem with attention to its physical, genetic, developmental, emotional, cognitive, educational, family, peer, and social components. The child and adolescent psychiatrist arrives at a diagnosis and diagnostic formulation which are shared with the patient and family. The child and adolescent psychiatrist then designs a treatment plan which considers all the components and discusses these recommendations with the child or adolescent and family. An integrated approach may involve individual, group or family psychotherapy; medication; and/or consultation with other physicians or professionals from schools, juvenile courts, social agencies or other community organizations. In addition, the child psychiatrist is prepared and expected to act as an advocate for the best interests of children and adolescents. Child and adolescent psychiatrists perform consultations in a variety of settings (schools, juvenile courts, social agencies). Training Child and adolescent psychiatric training requires four years of medical school, at least three years of approved residency training in medicine, neurology, and general psychiatry with adults, and two years of additional specialized training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry.
    [Show full text]
  • Substance Use and Sexual Risk Taking in Adolescence by Karen Schantz
    ACT for Youth Center of Excellence A collaboration of Cornell University, University of Rochester, and New York State Center for School Safety Substance Use and Sexual Risk Taking in Adolescence by Karen Schantz Sexual exploration is a normal and typically healthy part of adolescent development. However, certain behaviors increase the likelihood of unwanted outcomes such as pregnancy or sexually transmitted disease (STD). Researchers have long been interested in describing the relationship between substance use, also fairly common in adolescence, and sexual risk taking -- a relationship that appears to be complex and not always as we might expect. This article outlines what research has to say about connections between substance use and sexual risk taking among adolescents (primarily middle and high school aged youth), and describes how adults can promote healthier environments for growing up. Risk taking in adolescence Adolescence: A time for taking chances Risk taking is common and expected in adolescence. Across the lifespan, adolescence is the time of greatest risk taking (Chick & Reyna, 2012). While understanding or even over-estimating the likelihood that an action will result in harm, adolescents may place higher value on the benefits that might come from taking a particular risk. Adolescents are more responsive to the rewards of risk (such as peer approval), may be less sensitive to feeling the ill effects of substance use (such as hangovers), and are still developing the capacities for judgment and self-control (Institute of Medicine [IOM] & National Research Council [NRC], 2011). Context matters in decision making. A teen who drives recklessly with a group of joyriding friends may decide to be more careful when with friends who disapprove of unsafe driving, in part because youth are highly sensitive to their image among peers.
    [Show full text]
  • Substance-Linked Sex in Heterosexual, Homosexual and Bisexual Men and Women: an Online, Cross-Sectional ‘Global Drug Survey’ Report
    SUBSTANCE-LINKED SEX IN HETEROSEXUAL, HOMOSEXUAL AND BISEXUAL MEN AND WOMEN: AN ONLINE, CROSS-SECTIONAL ‘GLOBAL DRUG SURVEY’ REPORT ABSTRACT Introduction Substance use in sexual contexts has received recent attention, but it has mostly been restricted to men who have sex with men (MSM) and the so-called ‘chemsex’ phenomenon. Aim To explore the use of licit and illicit substances in combination with sex in heterosexual, homosexual and bisexual men and women; to explore substance-linked sex (SLS) differences across sexual orientation and gender. Methods An international online self-selecting cross-sectional drugs survey: the Global Drug Survey (GDS) 2013 (n=22,289). Respondents were asked about: which drugs (including alcohol) they had had sex on; how frequently they used drugs to enhance sex; and how different drugs changed different aspects of the sexual experience. We report descriptive statistics and test differences between men and women and between different sexual orientations. Main outcome variable (1) Percentage of each group reporting last-year use of each drug with sex, (2) Mean subjective rating (-10 to +10) from each group for each drug on each aspect of the sexual experience. Results SLS occurred across sexual orientations and in both men and women. All groups reported that alcohol, cannabis and 3,4-methylenedioxymethamphetamine (MDMA) were the most commonly used drugs with sex. Larger proportions of homosexual and bisexual men had sex on most drugs than heterosexual men (ps<0.001); and larger proportions of bisexual women had sex on most drugs than heterosexual women (ps<0.004). At least 20% of each group 1 reported having used drugs with the intention of enhancing a sexual experience; larger proportions of homosexual and bisexual men reported this behaviour than heterosexual men (ps<0.001).
    [Show full text]
  • Hip-Hop 2 Prevent Substance Abuse and HIV (H2P)
    Excellence in Prevention – descriptions of the prevention programs and strategies with the greatest evidence of success Name of Program/Strategy: Hip-Hop 2 Prevent Substance Abuse and HIV (H2P) Report Contents 1. Overview and description 2. Implementation considerations (if available) 3. Descriptive information 4. Outcomes 5. Cost effectiveness report (Washington State Institute of Public Policy – if available) 6. Washington State results (from Performance Based Prevention System (PBPS) – if available) 7. Who is using this program/strategy 8. Study populations 9. Quality of studies 10. Readiness for Dissemination 11. Costs (if available) 12. Contacts for more information ______________________________________________________________________ 1. Overview and description Hip-Hop 2 Prevent Substance Abuse and HIV (H2P) is designed to improve knowledge and skills related to drugs and HIV/AIDS among youth ages 12-16 with the aim of preventing or reducing their substance use and risky sexual activity. The program incorporates aspects of hip-hop culture--including language, arts, and history--as a social, cultural, and contextual framework for addressing substance use and HIV risk behaviors. H2P uses a curriculum consisting of 10 modules, called "ciphers," delivered in 10 2-hour sessions. Through the curriculum's use of hip-hop culture, an interactive, multimedia CD, and a mix of traditional teaching methods, students learn information about drugs, HIV/AIDS, and sexual behavior; resistance and refusal skills; effective communication and negotiation skills; information about healthy alternatives to sex and drugs; and prevention self-efficacy skills. School staff (e.g., teachers, counselors) deliver the first four modules in after-school or in-school sessions and the remaining modules at H2P camp, a 3-day retreat offering students structured learning and recreational activities, team-building experiences, mentoring, and opportunities for creative expression.
    [Show full text]