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TMAP. NorthSTAR IMPLEMENTATION PLANNING TEAM. 12-13-2002. PLANNING MEETING GOALS. Define specific goals for successful implementation Define activities to achieve goals Troubleshoot barriers to carrying out activities Assign activities to achieve goals to team members

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Planning meeting goals
PLANNING MEETING GOALS

  • Define specific goals for successful implementation

  • Define activities to achieve goals

  • Troubleshoot barriers to carrying out activities

  • Assign activities to achieve goals to team members

  • Identify timeline for completing activities


Consultants to process
CONSULTANTS TO PROCESS

  • Dr. Steve Shon, TDMHMR Medical Director

  • Dr. Ken Altshuler, TDMHMR Board of Directors & UTSMC Professor

  • Carole Matyas, ValueOptions V-P

  • Dr. Lynelle Yingling, DANSA Board Chair





Algorithm
Algorithm

“A step by step procedure for

solving a problem or

accomplishing some end.”

Webster’s Dictionary


Goals of medication guidelines algorithms
GOALS OF MEDICATION GUIDELINES/ALGORITHMS

  • Systematic Approach to Medication Management

  • Quantifiable and Reliable Outcome Measures

  • Documentation of Medications and Outcomes

  • Enhance Medication Adherence by Patients


Clinical reasons for algorithms
Clinical Reasons for Algorithms

  • Facilitate clinical decision-making

  • Improve quality of care

  • Make treatment plans consistent across sites and physicians

  • Tailor treatment to individuals

  • Provide adequate clinical documentation

  • Define where new medications fit for optimal outcomes


Administrative reasons for algorithms
Administrative Reasonsfor Algorithms

  • Accountability for scarce resources

  • Uniform expectations for providers

  • Improve cost efficiency

  • Predictable costs

  • Define where new medications are cost- effective

  • Define costs related to specific treatments or outcomes


Medication algorithms
Medication Algorithms

  • Three disorder groups

    • Major depressive disorders

    • Schizophrenia

    • Bipolar disorders

  • Strategies (identifying the what)

  • Tactics (identifying the how)

  • Specific guidelines

  • Planned revisions




Educational materials
Educational Materials

  • Patient objectives

    • Teaching patients disease management

    • Involving patients in treatment choices

    • Optimizing treatment benefits

  • Provider objectives

    • Optimizing treatment benefits

    • Teaching optimal medication use

    • Clarifying and documenting clinicaldecision-making



Scz adjusted mean symptoms bprs 18 all subjects
SCZ Adjusted Mean Symptoms (BPRS Persons with Schizophrenia (SCZ)18): All Subjects

BPRS18

Quarter


SCZ: Sum of Cognition z Scores: Persons with Schizophrenia (SCZ)

All Subjects


Cognitive Impairment Predicts Persons with Schizophrenia (SCZ)

Functional Outcomes

Positive

Symptoms

Adaptive

Function

Cognitive

Impairment

Negative

Symptoms

Velligan et al. Schizophr Res 1997;25:21-31.


Hospitalizations for scz

ALGO Persons with Schizophrenia (SCZ)

Patients 165

% Admits 3.0%

# Admitted 5

Days/Pt. 1.48

# of Admits 6

TAU

Patients 300

% Admits 8.7%

# Admitted 26

Days/Pt. 3.84

# of Admits 36

HOSPITALIZATIONS FOR SCZ




The texas medication algorithm project tmap outcomes for persons with major depressive disorder mdd

The Texas Medication Algorithm Project (TMAP): Outcomes for Persons with Major Depressive Disorder (MDD)


Mdd adjusted mean symptoms ids c 30 all subjects
MDD Adjusted Mean Symptoms Persons with Major Depressive Disorder (MDD)(IDS-C30): All Subjects


Official TMAP/TIMA/CMAP Internet Sites Persons with Major Depressive Disorder (MDD)

http://www.mhmr.state.tx.us/centraloffice/medicaldirector


Goals for ns tmap implementation
Goals for NS TMAP Implementation Persons with Major Depressive Disorder (MDD)

  • Develop a clear implementation plan

  • Begin changes with incorporating medical records used with TMAP by summer

  • Begin with computerized version


Activities to achieve goals
Activities to Achieve Goals Persons with Major Depressive Disorder (MDD)

  • Initial workgroup [VO, Dr. Shon, Dr. Altshuler, DANSA ED + PAC] review TDMHMR implementation guides for appropriateness/adaptation

  • VO meet with Dr. Altshuler to plan electronic requirements

  • VO pilot with 1 or 2 providers to refine the process before full implementation


Barriers how to overcome

Startup cost Persons with Major Depressive Disorder (MDD)

Ongoing cost of meds

Mental mindset

Training large number of private providers [1 day of training initially]

Develop a uniform plan with a large number of providers

Possible software grant

Long-term reduced meds

Careful planning

Possibly minimize time required by using teleconferencing

Pilot first & streamline

Barriers & How To Overcome


Assignment of specific tasks

Share implementation guides with initial workgroup for review & possible modification

Meet to plan electronic requirements

David

[to Carole, DANSA PAC, Dr. Altshuler]

David, Carol, Dr. Altshuler

Assignment of Specific Tasks


Timeline

Spring 2003 review & possible modification

Summer2003

Fall 2003

Plan for implementation defined

Pilot project fully implemented and evaluated

Plan for complete NS implementation defined

Timeline


Next step to success

Next Step to Success review & possible modification


Demonstration of software resource

Demonstration of Software Resource review & possible modification

Dr. Altshuler