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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
slide21
Cognitive Impairment Predicts

Functional Outcomes

Positive

Symptoms

Adaptive

Function

Cognitive

Impairment

Negative

Symptoms

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

hospitalizations for scz
ALGO

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)

slide27
Official TMAP/TIMA/CMAP Internet Sites

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

goals for ns tmap implementation
Goals for NS TMAP Implementation
  • 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
  • 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

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

Summer2003

Fall 2003

Plan for implementation defined

Pilot project fully implemented and evaluated

Plan for complete NS implementation defined

Timeline
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