Patient centered care improving outcomes that matter to patients in the real world
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Steven S. Sharfstein, M.D. AHRQ Conference September 27, 2010 PowerPoint PPT Presentation


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Patient-Centered Care: Improving Outcomes that Matter to Patients in the Real World. Steven S. Sharfstein, M.D. AHRQ Conference September 27, 2010.

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Steven S. Sharfstein, M.D. AHRQ Conference September 27, 2010

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Patient centered care improving outcomes that matter to patients in the real world

Patient-Centered Care: Improving Outcomesthat Matter to Patientsin the Real World

Steven S. Sharfstein, M.D.AHRQ ConferenceSeptember 27, 2010

revised


Sheppard pratt

Mission Statement:Sheppard Pratt, a not-for-profit behavioral health system, is dedicated to the improvement of quality of life in communities by serving the behavioral health and special education needs of individuals, families, and organizations.

Sheppard Pratt

  • Served more than 57,000 individuals in 2009, including children, adolescents, and adults

  • 37 locations in 12 Maryland counties, Baltimore City, and Northern Virginia

  • Comprehensive continuum, including hospitals, residential treatment centers, psychiatric rehabilitation programs, outpatient mental health and substance abuse treatment clinics, and special education schools.


Evidence based practices psychiatric rehabilitation programs

High Fidelity:

Supported employment

Assertive community treatment

Integrated dual disorders treatment

Family psycho-education

Multisystemic therapy

Seeking Fidelity: Illness Management and Recovery

Planning This Year: Permanent Supportive Housing

Evidence-supported Practice: Transition to Independence Process

Evidence-Based PracticesPsychiatric Rehabilitation Programs


Supported employment pilot components

Five-Year Pilot at 8 Sites in 7 Jurisdictions

Serving More than 600 Low-Income SMI/Year

Integrating Three Interventions:

EBP supported employment

Customized employment

Benefits counseling

Technical Assistance for Replication

Public-Private Partnership

Supported Employment Pilot –Components


Supported employment pilot research

Dartmouth College

Measuring

Impact of benefits counseling

Cost-benefit analysis of state funding

Eight non-Sheppard Pratt organizations in two comparison groups

Boston University

Measuring impact of adding a vocationally-focused illness management and recovery curriculum to EBP SE

Supported Employment Pilot - Research


Implementing ebp in real world challenges and recommendations

Challenge #1: EBPs More Expensive to Implement

Recommendations:

More research studies should include cost-benefit analyses relative to state funding

More states should employ Maryland strategy of implementation, focusing on incentives vs. mandates

Implementing EBP in Real World -Challenges and Recommendations


Implementing ebp in real world challenges and recommendations1

Challenge #2: Difficult for Front-Line Stakeholders to Let Go of Traditional Approaches and Beliefs

Zero exclusion and rapid job search for EBP SE

Discovery process for customized employment

Implementing EBP in Real World -Challenges and Recommendations


Implementing ebp in real world challenges and recommendations2

Recommendations

Use independent fidelity assessment process to reinforce and inspire provider staff

States develop fidelity assessment expertise

Providers do better job of articulating interventions for families and funders

Implementing EBP in Real World -Challenges and Recommendations


Implementing ebp in real world challenges and recommendations3

Challenge #3: Tension Between EBP Integration vs. Recovery Model Consumer Choice

EBPs require integration of services, which is most effectively implemented by one provider agency

Recovery model values consumer choice of providers, which can result in multiple agencies providing one EBP

Implementing EBP in Real World -Challenges and Recommendations


Implementing ebp in real world challenges and recommendations4

Recommendations

Reframe choice as:

between EBP providers

between EBP and non-EBP services

Compromise where possible for certain EPBs

Coordination vs. integration

States need flexible definition of coordination

Implementing EBP in Real World -Challenges and Recommendations


Final comment

There is no EBP for acute inpatient care

Need for comparative effectiveness studies

Ultra-acute care versus acute care

Hospital care versus residential diversion

A major public health issue

Final Comment


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