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Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee

Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee. QIO Data Report. December 9, 2009. December 2009 Report. Are the recommended services and supports that were identified at discharge different from current recommendations?

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Mayview Regional Service Area Plan Quality Improvement/Outcomes (QIO) Committee

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  1. Mayview Regional Service Area PlanQuality Improvement/Outcomes (QIO) Committee QIO Data Report December 9, 2009 Allegheny HealthChoices, Inc.

  2. December 2009 Report • Are the recommended services and supports that were identified at discharge different from current recommendations? • What services are people actually accessing? • What types of early warning signs and critical incidents are occurring for individuals? • Are people maintaining their housing? Have there been changes to the level of restrictiveness since their discharge? Allegheny HealthChoices, Inc.

  3. Data Sources • Baseline Community Support Plans (CSPs) • Updated CSPs • Monthly CSP tracking reports • Data on the actual services delivered based on provider claims • AHCI CTT application • The Mayview residential tracking system • The early warning/critical incident tracking system Allegheny HealthChoices, Inc.

  4. Baseline and Updated CSPs:Distribution among the Mayview Counties • Most of the report focuses on the 244 people who have both plans. Allegheny HealthChoices, Inc.

  5. Q1: Are the recommended services and supports that were identified at discharge different from current recommendations? • Overview • Recommendations generally remain consistent from discharge • Some changes in the recommended use of CTT and CM/SC in Allegheny and the suburban counties • Shifts in recommended frequency of contact represent a better understanding of needed and desired support • All individuals have a crisis plan • Other services and supports indicate small changes Allegheny HealthChoices, Inc.

  6. Allegheny: 6% shift to CTT • Suburban: 19% shift to CM/SC Allegheny HealthChoices, Inc.

  7. CTT: Shift from Daily to 4-6 and 2-3/wk • CM/SC: Shift from Weekly to 2-3/wk, semi-monthly, and monthly Allegheny HealthChoices, Inc.

  8. Other Supports and Services • Benefits, income, and representative payees • Few changes in areas related to employment and education • Interest in hobbies and leisure activities remains high, with an increase in people who want to pursue activities on their own • Social supports – families and peers • Transportation – mostly providers Allegheny HealthChoices, Inc.

  9. Q2: What services are people actually accessing? • Other than a slight reduction when “Daily” is recommended, actual CTT contacts are consistent with recommendations • Actual CM/SC contacts often occurred more frequently than recommended • Most people received CTT services, with others receiving CM/SC • CTTs provide a wide array of services, including psychiatric services and supports, crisis services, drug and alcohol therapy, peer support, med management, and vocational rehabilitation • 97% of people had at least one visit with a medical doctor. Allegheny HealthChoices, Inc.

  10. Comparison of Recommended and Actual CTT Contact Frequencies from January 1, 2009 through June 30, 2009 by Residential Staffing Level Allegheny HealthChoices, Inc.

  11. Comparison of Recommended and Actual CM/SC Contact Frequencies from January 1, 2009 through June 30, 2009 by Residential Staffing Level Allegheny HealthChoices, Inc.

  12. Number of People Who Received Other Behavioral Health Services from January 1, 2009 through June 30, 2009, not Including CTT & CM/SC * Includes Partial, Mobile MH, Adult Outpatient, Psychiatric Rehabilitation, Lab, Consults, Community Vocational Rehab, Facility Based Vocational Rehab, Inpatient DA Detoxification, MH Justice-Related Services. Totals for each of these services were small so they were combined into one category. ** Crisis services include walk-in crisis, mobile crisis, and telephone crisis services. Allegheny HealthChoices, Inc.

  13. Summary of Crisis Services from January 1, 2009 through June 30, 2009 for People Receiving CTT and CM/SC • CTTs provide crisis services • 64 people totaling 662 events • Individuals receiving CM/SC had lower utilization of crisis services • 7 people totaling 48 events. • CTTs • Work with individuals who may need more support • Provide on-call coverage 24/7 – including when a person goes to hospital • Similar contacts may not be “crisis” contacts for CM/SC Allegheny HealthChoices, Inc.

  14. Allegheny HealthChoices, Inc.

  15. Q3: What types of early warning signs and critical incidents are occurring for individuals? From January 1, 2009 through September 30, 2009 • Most common early warning signs • Refusal to Take Medications-Posing Risk: 21.6 avg/month • Atypical Behavior–Change from Baseline: 16.9 avg/month • E/R Visit-Behavioral/Physical Health: 16.3 avg/month • Most common critical incidents • Medical Hospitalization: 11.2 avg/month • Community Hosp–Involuntary: 8.0 avg/month • Other Incident-Serious Nature: 7.4 avg/month Allegheny HealthChoices, Inc.

  16. Other Critical Incidents • Psychiatric hospitalizations • 69 (22%) people, 195 hospitalizations • ALOS 28 days (3 outliers excluded) • Incarcerations • 24 (8%) people, 42 events • ALSO 35.9 days (1 outlier excluded) • Deaths • 10 (3%) people: 6 from natural causes, 2 accidental, and 2 suicides Allegheny HealthChoices, Inc.

  17. Q4: Are people maintaining their housing? Have there been changes to the level of restrictiveness since their discharge? • 62 of 244 people (25%) changed their type of housing between their discharge date and August 31, 2009 • No one became homeless Allegheny HealthChoices, Inc.

  18. Summary of Changes in Housing Type by Level of Restrictiveness: Housing at Discharge and as of August 31, 2009 • 29 people (47%) moved to a less restrictive setting • 20 people (32%) moved to a more restrictive setting • 13 people (21%) moved to a setting with the same level of restrictiveness Allegheny HealthChoices, Inc.

  19. Housing: At Discharge, Recommended in the Updated CSP, and as of August 31, 2009 Allegheny HealthChoices, Inc.

  20. Summary, Discussion, and Recommendations • CM/SC in suburban counties – although there are often multiple contacts per week • Level of interest in employment and education • Social and community integration beyond residential programs • Families and peers continue to provide support • Mobility within community beyond using providers for primary transportation • Crisis utilization for those receiving CM/SC • Ongoing emphasis on physical health needs • Assessment of quality of life and general satisfaction Allegheny HealthChoices, Inc.

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