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THE QUALITY STAR – AN ALGORITHM FOR THE EVALUATION OF MENTAL HEALTH SERVICES

THE QUALITY STAR – AN ALGORITHM FOR THE EVALUATION OF MENTAL HEALTH SERVICES Bo Ivarsson, Lars Erdner and Ulf Malm. THE PRESENTATION : Background, history Instruments and Procedure Results, examples Development. THE PRESENTATION : Background, history

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THE QUALITY STAR – AN ALGORITHM FOR THE EVALUATION OF MENTAL HEALTH SERVICES

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  1. THE QUALITY STAR – AN ALGORITHM FOR THE EVALUATION OF MENTAL HEALTH SERVICES Bo Ivarsson, Lars Erdner and Ulf Malm

  2. THE PRESENTATION: • Background, history • Instruments and Procedure • Results, examples • Development

  3. THE PRESENTATION: • Background, history • Instruments and Procedure • Results, examples • Development

  4. 1994: Situation?? 1) PATIENT PARTICIPATON ? Too little and in vague forms 2) QUALITY FOLLOW-UP ? Only production statistics. No broadly accepted outcome measures

  5. 1994: Optimal Treatment Project ! 1) PATIENT PARTICIPATON ! ”Shared decision making, Empowerment… 2) OUTCOME QUALITY CONTROL BY YEARLY FOLLOW-UP! …systematic use of simple effectiveness measures yearly

  6. 1995:Presentation of concept; Donabedian logic Quality technology as an engine to organize better care and serivice for schizophenia – the most expensive desease in the world Kvalitetsteknologi som motorför att organisera bättre vård och service vid schizofreni - världens dyraste sjukdom Bo Ivarsson R&D officer, Psych services Borås hospital Ulf Malm Ass. professor, Sahlgrenska university hospital Gothenburg Karl-Otto Svärd Swedish Psychiatric Association, Head Psych dept. Karlstad 1997-99:Tests in routine services 1999:Decision on Routine Implementation Starting 2000 in Western region and part of Stockholm. Global measures obligatory for comparability, local additions wellcome Included in routine clinical programme. 2001:Presentation of established algorithm ”Kvalitetsstjärna – metod för regelbunden patientuppföljning som motor.”Bo Ivarsson and Ove Sonesson. Socialmedicinsk tidskrift nr 4/2002 “The Quality Star – A Tool for Regular Outcome Monitoring” Lars Erdner and Bo Ivarsson. In: ENTER conference monograph London 2000 Paris 2001, Ed.: Mervyn London, Cambridge UK 2002

  7. Recommened Quality Dimensions for Regular monitoring & Dialogue with Users Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  8. THE PRESENTATION: • Background, history • Instruments and Procedure • Results, examples • Development

  9. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  10. Question domains

  11. Very poor Poor Fairly poor Neither good nor bad (can't tell) Fairly good Good Very good Example: If you think you have had rather poor opportunities to get help when needed, circle in the following manner: 1. How did you find the availability of assistance when in need of help?

  12. Very poor Poor Fairly poor Neither good nor bad (can't tell) Fairly good Good Very good Example: If you think you have had rather poor opportunities to get help when needed, circle in the following manner: 1. How did you find the availability of assistance when in need of help? -3 -2-10 +1 +2 +3

  13. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  14. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  15. VAS-scale Visual Analogue Scale

  16. VAS-scale Visual Analogue Scale

  17. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  18. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  19. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  20. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  21. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  22. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage)

  23. ”Split-GAF” derived from DSM IV-TR is used to indicate Symptom severity and Psycho-social functioning respectively GAF-S GAF-F

  24. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning GAF-S GAF-F Syndome Specific Axis Family Burden (Resource usage)

  25. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage) For schizophrenia: Symptom screening for Adverse Effects of Medication

  26. Consumer Satisfaction with Services Patient's Perceived Distress Subjective Quality of Life Symptom Global Social Functioning Syndome Specific Axis Family Burden (Resource usage) Material forDIALOGUEwith user

  27. Software supporting over-time development for user – staff dialogue

  28. Regular export to common data-base for comparisons between services

  29. THE PRESENTATION: • Background, history • Instruments and Procedure • Results, examples • Development

  30. Material from someof the participating Centres - 1610 ratings

  31. Schizophrenia spectrum group – 5 years follow up Kungälv service

  32. Schizophrenia spectrum group – 5 years follow up Ljungby service

  33. Analysing differences: User subjective dimensions Ljungby versus Other services (examples SÄS and Ryhov) ns

  34. Quality of Life related to Years in contact with Service <3 months 3-18 m 1,5-3 y 3< years 3 year figures differ significantly from shorter duration

  35. Independent variables explaining Quality Star Out-come measures

  36. Schizophrenia

  37. Personality disorders Median 20 percentile 80 percentile

  38. Depression Differences Between two services Median 20 percentile 80 percentile

  39. THE PRESENTATION: • Background, history • Instruments and Procedure • Results, examples • Development

  40. 1. Adding background data into the method /parallell with National Quality Registers/ 2. Negociating common webb-based system together with National Quality Registers 3. Deciding resource usage axis content. Measure? Days-in-care is one option. Any suggestions are welcome!

  41. Thanks for Your Attention ! Powerpoint presentation available on webb-site: bo.ivarsson@vgregion.se lars.erdner@sll.se ulf.malm@neuro.gu.se http://forum.carelink.se/pages/newsbillNews.asp?DeptID=15&ProjID=21&Pages=159

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